Why are my nails lifting? 10 reasons...

Nail problems are common in podiatry and a lot of patients who visit us, are concerned about changes to their toenails. Lifting of the toenails is not often discussed so in this piece we will look at the most common causes. Lifting nails is known medically as “onycholysis”. This is where the nail separates from the nail bed underneath creating an opaque colour to the nail. There are a host of reasons but let’s look at the most common.

The first question to ask is, how many and which nails are affected? This gives a strong clue to the likely cause and so the podiatrist will look at the digits affected as well as the “shape” of the lifted area as this can also help in making a diagnosis.

1.      Fungal nail infection. Probably the most common cause of nail lifting, this is when the fungus on the skin of the foot spreads under the nail, invading the nail bed. As it progresses, the fungus accumulates under the nail often producing debris and lifting the nail off the nail bed. Typically, the affected nails take on a yellow-brown discolouration, although a range of colours are possible. Usually, it’s the big toe, second and little toe that are affected. Treating athletes’ foot before it spreads to the nails can prevent it from occurring.

Toenail showing signs of lifting due to a fungal infection

2.      Trauma. The foot spends most of its day in the shoe and consequently a shoe which is too tight, or too loose, can mean damage to the tip of the toes and the nails causing the nail to lift. This normally affects the longest toes (the big toe and second toe). The nails generally won’t be discoloured but may thicken over time. Repeated stubbing the toe can have a similar effect.

3.      Reduced circulation. The nail is very sensitive to changes in blood flow. Consequently, patients who suffer with poor circulation in the finger and toes may suffer nail lifting as result. Patients with circulatory disorders such as Raynauds may suffer periodic “White finger” or “white toe” and repeated bouts over time can lead to nail changes including nail lifting. The condition can also cause nail thickening in the longer term.

4.      Nail varnishes and other chemicals. A range of cosmetic products are used on the nails these days and some of these have been known to cause onycholysis.

Damaged and lifting toenail

5.      Psoriasis. Psoriasis is a very common skin disease affecting up to 6% of the population. The condition causes dry scaly patches of skin which can be itchy and persistent. For a small proportion of patients, it can also affect the nails too resulting in accelerated nail growth, debris under the nails and most commonly - lifting of the nails. This can affect one or many nails, including the fingernails. Eczema is another skin disorder which occasionally can cause lifting of the nails. Treatment of the skin condition will gradually restore the nails to normal but it can take a while.

6.      Thyroid disease. Around 2% of the UK population have thyroid problems most commonly an underactive thyroid gland. This has many effects and one of the lesser-known effects is nail lifting in the digits. Treatment with thyroxine can usually prevent this from recurring. An overactive thyroid (hyperthyroidism) is less common but can lead to similar changes in the nails.

7.      Medications. Occasionally prescribed medicines can have the unusual side effect of nail shedding. These include some common antibiotics (including Doxycycline and Ciprofloxacin) and non-steroidal anti-inflammatory drugs (like Naproxen). Chemotherapy drugs used for cancer treatment also have the ability to cause nail shedding.

8.      Excessive Moisture. Feet which are regularly immersed in water or remain damp for extended periods of time can affect the skin but also lead to lifting of the nails. So leaky wellingtons or boots and damp shoes can be a cause!

Lifting toenails

9.      Alopecia. Hair loss is a common problem for adults. Certain types of alopecia which are auto-immune conditions leads to partial or total hair loss. A common accompanying feature is nail loss.

10.  Other causes. There are many other rarer causes of nail lifting and often these need specialist assessment to discover the underlying causes. There are number of infections which can lead to nail lifting or even shedding. For example, in children, hand foot and mouth disease is a very common, self-resolving infection. Strangely, the infection can lead to nail shedding sometime after the infection. In addition, nutritional deficiencies and iron deficiency anaemia can be a culprit.

What can be done to help?

Once a nail has begun to lift there is little you can do to reattach it. The main risk is snagging the loose nail on socks or bedclothes which can cause injury to the nail and nail bed. Applying adhesive tape over a loose nail to tape it onto the toe can prevent this from occurring. Keeping the nails short and well-trimmed can also limit the effect of onycholysis. 

What should I do if I am concerned about my nails?

If you think you may have onycholysis and are concerned, it’s important to see a podiatrist. As there are many causes it is key to get to the bottom of what’s causing it and see what the most effective treatment would be. Depending on the cause, this maybe treating an underlying nail infection, advice or a referral to a nail specialist.

If you require a podiatry appointment you can contact us via email info@mrpodiatrist.co.uk or call 0161 427 4937