Health

Why would my client’s toenails just fall off?

December 01, 2008 | Bookmark +

Why would my client’s toenails just fall off? She’s lost both big toes and says her father did too. And now she’s lost the nail on her second toe. She is a runner and I think that might be the problem, but she has no pain and no discoloration. They just become loose and fall off.

Answer

Trauma, especially repetitive trauma like running, will cause onycholysis, or the toenail falling off. This trauma may be completely painless. I find it commonly on the second toe in runners, and in the fourth toe in those wearing more pointy, fashionable shoes. Running shoes may be too big, and the sliding of the toe into the edge of the shoe can cause this. Shoes that are too small may cause this as well. The big toe can be affected. Also, trauma increases the likelihood of a fungal infection invading the toenail, which is a painless condition. A person with this condition would notice their nail thickening before it lifted off the nail bed.

The tendency to have fungal nails is definitely inherited, so this may also be a cause of the loss of your client’s toenail. A podiatry visit is recommended, so the nail can be helped to grow back cosmetically. Once a nail is damaged, the matrix can also be damaged. A timely visit to the podiatrist can help grow the nail back without incident.

— Johanna Youner, D.P.M., is attending podiatric physician and surgeon at New York Downtown Hospital and is also in private practice in New York City.

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What’s the cause of the pinkish-red oval area on the pad of my client’s toes?

I have a client who has a recurring problem with her fourth toes during the winter months. Both of her “ring finger” toes develop a pinkish-red oval area on the pad. Then a month later, when I see her again, the skin has become dry and hard like a callus, with the layers of skin peeling away to reveal a deeper, dark epicenter.  It’s extremely painful for her and, needless to say, we do not touch it. But it clears up in the summer when she’s wearing open-toed sandals, so I suspect it has to be due to the boots she wears in the winter. Plus she never puts lotion on her feet or uses a foot file in between visits. What do you think causes this?

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What are the big white spots on my natural-nail client’s nails?

I have a client who has been with me for about two years. She used to wear acrylic nails but has been a natural nail client for eight months or so. She has these white spots on her nails — big spots that are dry, but not flaky, right in the middle of the nail. I did try to buff them lightly but they do not come off or grow off. I had a new client come in last week who had the same on her toenails. She said it started after she had a pedicure done at another salon. Can you help?

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