Why Do Toenails Thicken In The Elderly?
Often, we associate toenail thickening only with fungal infections don’t we? Especially when it comes to the aging feet.
As a Podiatrist who practices in an area with a predominantly older population, I often wonder how many elders in the community are trying various treatments in an attempt to get rid of this “fungus” when in reality what they have may simply be naturally thickened toenails.
But why do they thicken?
There are a number of possible causes that may lead to thickening of toenails, e.g. injury or trauma, certain systemic diseases and of course, fungal infections. Today’s focus, however, is on one important predisposing factor: Aging!
Toenails turn to thicken with age because nail growth slows down. One contributing reason is reduced circulation to the feet, which is common in older individuals. This can impair the nail matrix (the part of the nail responsible for the production of new nail cells) and when it receives less oxygen and fewer nutrients due to reduced blood flow, there will be disruptions and irregularities in nail production; resulting in changes to the nail structure, shape or texture.
In simple terms, slower nail growth means that the old nail is not efficiently replaced and since nail shedding depends on new nail production from the matrix, reduced turnover leads to a build-up of older nail material, which can make the nail appear thickened, discoloured or brittle.
During a podiatry consultation, all toenails are carefully examined for cracks, splits, ridges, spikes, debris, and any mal-odour (which often develops beneath the nail plate where the debris often accumulates). The entire nail plate is also examined to determine whether it remains fully attached to the nail bed, as this attachment can sometimes become compromised.
Treatment often involves reduction of the thickness, trimming and filing of the nails using specialised tools and if a fungal infection is suspected and the patient wishes to treat it, a culture test can be performed to confirm the diagnosis before appropriate treatment is started.
In conclusion, thickened toenails can be quite uncomfortable as they may press against the top of the shoe, sometimes even leaving dents in the footwear. They can also affect the cosmetic appearance of the feet.
Simple podiatric care of these nails can greatly improve comfort, prevent other issues such as ingrown toe-nails and restore a much healthier appearance.