A toenail falling off can be an unsettling experience, especially if you're not sure why it's happening.
Your toenail may fall off after an injury or trauma to the toe or as a side effect of certain medications you may be taking. In other cases, it may be a sign of an infection, underlying skin condition, or autoimmune disorder.
Before a toenail falls off, you might initially notice the nail loosening from the nail bed, often starting at the tip and progressing toward the cuticle. As the nail lifts, it may appear as though the nail is "floating" above the nail bed. The area underneath the nail may look white, brown, or yellowish in color as a result of air, dirt, and debris collecting beneath the nail.
When a toenail is about to fall off, it may become discolored, cracked, brittle, misshapen, or thickened. The surrounding skin might be red, swollen, and tender, especially if an infection is causing the toenail to fall off. The skin around the nail may also feel sensitive or painful as the toenail separates from the nail bed. Losing a toenail isn't always painful, but you may notice that the skin beneath the nail is thicker than usual.
Types of Nail Separation
Onycholysis is the medical term for when a toenail separates and lifts away from the nail bed—the skin directly under the nail—causing the toenail to partially or completely detach from its nail bed. Onychomadesis is the medical term for when a toenail separates from the nail bed and nail matrix—the tissue where your nails form at the base of the nail—eventually falling off entirely.
Why Toenails Fall Off
A toenail can fall off for several reasons, ranging from a toe injury to underlying health conditions. Understanding the causes can help you identify the source of the problem and know when to seek medical care and treatment.
Trauma or Injury
Physical trauma is one of the most common causes of a toenail falling off. Injuries from stubbing your toe, dropping a heavy object on it, or persistent pressure from poorly fitting shoes or activities like running can cause the toenail to separate from the nail bed.
When trauma occurs, blood may pool under the nail, creating a dark purple or black discoloration (medically known as a subungual hematoma). This adds pressure and can eventually cause the nail to fall off.
Other symptoms of trauma-induced toenail loss include:
- Throbbing pain at the time of injury or with repeated pressure on the affected toe
- Increasing pain as blood collects under the nail
- Swelling around the toe
- Tenderness when walking or touching the toe
Fungal Infections
Fungal infections of the nail (known as onychomycosis) occur when fungi or yeasts grow in and around the nail. The infection often starts on the feet and spreads to the toenail(s), causing symptoms such as:
- Yellow or white streaks on the side of the nail
- Green or yellow nail discoloration
- Brittleness
- Flakiness of the outside edges of the nail
- Thick nails
- Pain, itching, or discomfort around the nail bed
- Distorted or irregular nail shape
- Toenail lifting away from the nailbed
Anyone can develop nail fungus, but the risk is higher in older adults and people with diabetes, poor circulation, weakened immune systems, and psoriasis.
Nail Psoriasis
Psoriasis is a chronic autoimmune condition that develops when an overactive immune system causes skin cells to grow too quickly, leading to itchy plaques of thick, burning, or irritated skin. Although psoriasis initially affects the skin, about 50% of people eventually develop nail psoriasis years after psoriasis symptoms begin.
When nail psoriasis affects the toenails, symptoms may include:
- Dents or pits on the nail surface
- Yellow or brown nail discoloration
- Thick, rough nail texture
- Separation of the nail from the nail bed
- Misshapen or crooked nails
- Pain and tenderness that may make walking or physical activity difficult
Medications
Certain medications can cause nail changes, including toenail loss. Usually, these changes resolve once you stop treatment or switch medications. Chemotherapy drugs, such as Cerubidine and Vyxeos (daunorubicin), Novantrone (mitoxantrone), and DTIC (dacarbazine), can cause nails to lift away from the nail bed. Blexonane (bleomycin), 5-FU, and Adruci (5-fluorouracil) can lead to nail loss.
Some medications, including antibiotics and anti-inflammatory drugs like Aleve (naproxen), can cause a toenail to detach or fall off after exposure to sunlight. Wearing footwear that exposes your toenails to the sun when taking any of these medications can cause a toenail to lift away from the nail bed or fall off.
In addition to toenail loss, these drugs can cause other nail changes, such as:
- Thinning or fragile nails
- Discoloration, such as yellowed or darkened nails
- Changes in nail texture, including ridges, spots, or dents
- Painful or sensitive nailbeds or cuticles
- Slow or no nail growth
Eczema
Eczema is a group of inflammatory skin conditions that causes dry, itchy rashes or scaly patches of skin. It can also affect the fingernails and toenails, leading to nail changes and loss.
This condition can cause the skin around the nails to become dry, itchy, and inflamed, weakening the nails and making them brittle and prone to breakage. Eczema can also affect the nail matrix, the part of the nail responsible for forming the nails, causing painless nail shedding that causes the nails to fall off completely.
Other symptoms of eczema-related toenail issues include:
- Red, itchy, or scaly skin around the toenail
- Weak, brittle, or cracked nails
- Redness and tenderness around the affected area
Less Common Causes
Other conditions that can sometimes cause toenail loss include:
- Allergic reactions: Certain nail polishes and products containing irritant chemicals can cause an allergic reaction (known as contact dermatitis), causing inflammation and eventual detachment of the toenail.
- Viral infections: Some viral infections can cause a toenail to loosen from the nail bed or shed (fall off), usually several weeks after the infection resolves. Viral infections associated with toenail loss include COVID-19, hand-foot-and-mouth disease, and chickenpox.
It's a good idea to see a healthcare provider whenever you notice changes to your toenails, including:
- A toenail lifting away from the nail bed or falling off
- Nail discoloration
- Thickening nails
- Nail texture changes, such as deep grooves, pits, or dents
- Changes in nail shape
- Brittle, chalky, or flaking nails
It's also important to see a healthcare provider if the skin around your toenails is red, swollen, painful, or oozing pus or if you have difficulty walking or engaging in physical activities due to a sore toe.
Podiatrists and dermatologists are the specialists who can treat toenail conditions. A dermatologist is a doctor who specializes in diagnosing and treating conditions affecting the nails, skin, and hair. A podiatrist is a doctor with special training in diagnosing and treating conditions affecting the feet and ankles.
Your healthcare provider will review your medical history and examine your feet and toenails to determine what's causing the problem. They may clip off part of the affected toenail, collect debris under the nail, or scrape off some surrounding skin and send it to the lab for examination under a microscope to accurately diagnose the issue.
How To Treat a Toenail That Fell Off
Treatment for a toenail that's falling off or already fell off depends on the underlying cause of your symptoms. A detached toenail cannot reattach to the nail bed, so treatment focuses on ensuring the new nail growth remains attached. Toenails can take 12 to 18 months to grow, so it's important to be patient and follow your treatment plan while waiting for a new one to grow.
If sports, activities, or footwear are causing repetitive trauma to your toenails, wearing different or more supportive footwear to prevent putting excess pressure on the nails may be sufficient. When a medication is causing toenail problems, your healthcare provider may recommend switching your prescription to a different drug.
Topical or oral antifungal medicines can often treat fungal nail infections. Depending on the fungus type and the infection's severity, your healthcare provider may prescribe an antifungal cream you apply directly to the toenail or oral capsules and pills to clear the infection.
However, if skin or autoimmune conditions are causing your toenail symptoms, you'll need to receive treatment for the overall condition to see if your toenail health improves. Your healthcare provider can offer a range of lifestyle changes, medications, and therapies to improve your overall health if you have an underlying health condition.
Protecting your toenails from injury and addressing any underlying health issues can prevent a toenail from falling off. Proper foot hygiene and nail care are the best ways to care for your feet and prevent common causes of toenail loss. Here's what you can do:
- Clean your feet regularly with soap and water
- Wear well-fitting shoes made of mesh, canvas, or leather
- Use moisture-wicking socks that keep moisture away from your skin and nails
- Avoid wearing nail polish with irritating chemicals
- Keep your toenails trimmed straight across, shorter than the end of your toes
- Sanitize your nail clippers with soap, water, and rubbing alcohol
- Check your toenails at least once a month to check for changes in appearance or texture, and talk to your healthcare provider if you notice any changes
A Quick Review
Trauma or injuries, fungal infections, or underlying conditions like nail psoriasis or eczema can cause a toenail to fall off. If you notice your toenail is lifting away from the underlying skin or your toenail has fallen off, see a healthcare provider like a dermatologist or podiatrist. The sooner you seek professional treatment, the better your chance of improving your nail health and preventing future toenail problems.
