What Causes Thick Toenails and How to Treat Them (2023)

Toenails are naturally thick to protect the tops of your toes. Sometimes, however, they become abnormally thick and can be a cosmetic issue for some people, especially if they become discolored.

It is natural for toenails to get thicker with age, but thick toenails may be caused by other factors, including fungal infections, autoimmune conditions, or mechanical stresses, such as from poorly fitting shoes.

This article discusses the appearance of thick toenails, common causes, and some treatment options.

Signs of Thick Toenails

For most adults, toenails are 1–2 millimeters thick. Men generally have slightly thicker toenails than women.

Toenail thickness can be measured using a tool called calipers, but this is mainly done for research. Most of the time, your healthcare provider will do a clinical assessment and look at your feet to see if your toenails are thicker than expected.

As toenails get thicker, you may see changes in the appearance, texture, and sensation of your toes and toenails.

Appearance

Toenails become thick when extra layers grow beneath the surface of the nail. If the thickening is too great, the nail may lift off from the nail bed. The medical term for this separation is onycholysis. This usually changes the color of the nail, giving it a white or slight yellow hue.

If the thickening of your toenails is caused by a fungus, they may take on a yellow or brown color. Often, toenail fungus will also cause the nails to become brittle and break off or flake easily.

Texture

Healthy toenails are typically smooth and strong. However, as nails thicken, they can crumble. Brittle toenails may break, crack, or split easily. The formerly smooth nail may be bumpy and irregular.

Sensation

Thickened toenails may cause discomfort or pain when wearing closed-toe shoes. Thicker toenails may not fit comfortably inside your shoe, causing rubbing, friction, or additional pain while walking. Paresthesia (numbness or tingling) of the toenail may also occur.

Healthy Toenail Growth

Toenails are an important part of your body’s natural outside barrier. They grow an average of 1 millimeter per month. Overall, nail growth tends to slow as you get older.

There are a few things you can do to promote healthy toenail growth:

• Keep nails trimmed.
• Wear well-fitting shoes.
• Minimize or prevent injury to your toenails, such as by being careful walking in the dark and when running or performing vigorous exercise.

What Causes Thick Toenails

Thick toenails come from a buildup of the cells that make up your toenails. Three possible causes are increased age, nail fungus, and nail psoriasis (an autoimmune disease).

Older Age

As we age, it is natural for your toenail thickness to change. Researchers have found that hip and shoulder flexibility begin to decrease in women over 63 and men over 71 years old. This loss of mobility and changes in hand strength (such as in using nail clippers) can make it harder to practice good foot hygiene and to keep nails trimmed.

Nail Fungus

Nail fungus is the most common nail disease in the world. It occurs in 10% of the U.S. population and is more common in people living with diabetes or human immunodeficiency virus (HIV).

There are some specific tests and several different treatment options available for nail fungus, though none is currently 100% effective. The most effective are two types of antifungal oral medications, usually taken while being monitored with blood work to ensure safety.

Nail Psoriasis

Psoriasis is a chronic autoimmune disease that can cause irritated and inflamed patches of skin. In some people, psoriasis also spreads to the nails, causing them to become thick and brittle.

Psoriasis can make your nails weak, and they may even fall off completely. There is a variety of treatments for psoriasis that affects the nails. Your healthcare team will work with you to determine what might help your condition.

Injured Nail

Runners and athletes can injure their toenails easily due to the repetitive microtrauma of the nail hitting against the shoe.

Foot Hygiene

Good foot care can help to reduce your risk of getting fungal infection and prevent it from returning once you have treated it. Some hygiene tips for your feet include:

• Keeping your toes clean and dry
• Keeping your nails short
• Not sharing nail hygiene tools (like nail clippers)
• Wearing shoes when in shared spaces like locker rooms or pools
• Avoiding shoes that are too tight or too loose.

Nail fungus often enters under the nail, so short nails help reduce the risk of fungus. Consider sanitizing (disinfecting with rubbing alcohol) your nail clippers each time you use them.

Washing and disinfecting your socks and treating your shoes are important parts of hygiene, especially if you have a nail fungus. This helps to prevent the fungus from reinfecting your toes.

When to Talk to Your Healthcare Provider

Let your healthcare provider know if you are seeing changes to your toenails. While you might be reluctant to show your toenails, rest assured that medical providers are comfortable looking at and evaluating all kinds of conditions.

If you have a difficult time keeping your toenails clean and trimmed, you may want to see a podiatrist (medical doctor specializing in conditions of the feet and lower legs) for foot care. In some circumstances, changes to your nails may be a sign of a more serious disease (including cancer), and you may need additional tests.

How to Get Rid of Thick Toenails

Repairing toenails often takes a long time because they grow slowly. Many of the available treatments require persistence over a long time. It may take up to a year to fix some toenail conditions.

Self-Care

Do all you can to focus on foot and nail hygiene to prevent toenail damage. If you notice a problem, follow your healthcare team's recommendations to keep the problem from getting worse. Make sure your shoes fit well and do not put pressure on your toes.

If you have had an injury to your toe and your nail is temporarily thick, it may get better over time. As a new, healthy nail grows out, you can see if it gets better. However, due to the slow growth of toenails, this can take many months.

Debridement

One treatment for thick toenails is called debridement. For this procedure, your healthcare provider will use tools to remove extra layers of your toenail and help reduce the thickness. The provider may also shorten (trim) the toenail. You may still require treatment for the cause of the nail thickening.

Medication

There are some medications that are available over the counter (OTC) from the store. These may be creams or liquids that get painted on the nail. Check with your healthcare team before trying any of these treatments. Topical OTC nail treatments may not be effective in curing nail fungus because it is difficult for the medication to pass through the nail to the fungus underneath.

If your nail fungus requires systemic medication (medication that works throughout your body), your provider may recommend oral pills.The pills for fungus treatment can have some serious side effects, so follow your provider’s instructions. Treatment for nail fungus may require months to a year to be effective.

Laser Therapy

Laser therapy has been used for nail fungal infections and nail psoriasis. Researchers are learning about different types of lasers that can be helpful in treating toenail fungus. Be sure to talk with your provider about how many treatments you may need and what kind of results to expect.

Summary

Thick toenails have a variety of causes (advanced age, nail fungus, psoriasis) and treatments. Your healthcare team can help you understand any changes to your toenails and recommend a plan of care. Focusing on properly fitting shoes and good foot hygiene will go a long way to prevent and fix thick toenails.

A Word From Verywell

Nail fungus is a very common cause of toenail changes. No matter what is causing your thickened toenails, your healthcare team can help you manage it. The good news is that thick toenails are rarely a major health problem, but they can be a source of social unease or body discomfort for some people. Your provider can help you manage this and may be able to help improve the appearance of your toes.