Is it Toenail Fungus or a Damaged Nail Bed?
Nobody wants either toenail fungus or a damaged nail bed. Both conditions can be painful, embarrassing and difficult to get rid of. But the main reason they’re difficult to treat is that it’s so easy to confuse toenail fungus with other medical conditions. This means that your treatment might be ineffective for the real, underlying condition.
Fungal toenail infections almost always look the same. The same symptoms are applicable: yellow nails which crumble away and become thicker. Toenail trauma can come in several different forms, including lacerations, hematomas and dents and scrapes. However, after the initial trauma, the damaged toenail growing back thick can make you question whether you have toenail trauma or fungus.
In this guide, you’ll find out everything you need to know both about toenail fungus and damaged nail bed symptoms. We’ve also included a detailed guide on how to tell them apart so that you can self-diagnose your condition.
Table of Contents:
- 1 Is It Toenail Fungus or Damaged Nail Bed? Telling Them Apart
- 2 Toenail Fungus vs. Damaged Toenail Diagnosis
- 3 Other Toenail Conditions That Cause Confusion
- 4 Treatment for Damaged Toenail Matrix
- 5 Treatment for Fungal Toenail Infection
Is It Toenail Fungus or Damaged Nail Bed? Telling Them Apart
Many symptoms are classic signs of toenail fungus. However, you may not experience all of these symptoms at once, or at all. It also appears in regular stages, starting with the very first symptoms, and working its way to the last. As you’ll see, many of these symptoms are similar to those you may experience with a damaged toenail matrix. That’s why it’s so easy to confuse the two conditions.
One central difference between the two conditions is that they are caused by different things. Toenail fungus is typically caused by dermatophytes, or by a yeast called Candida. These same fungi also cause jock itch, athlete’s foot, and ringworm.
By contrast, a damaged nail bed is a more general condition. Fungal infection can cause a damaged nail bed, for example. You may also have a damaged nail bed because of blunt force trauma, or by repeat trauma over a period of time. However, if you aren’t sure what caused your condition, it can be difficult to tell them apart.
The section below is a symptom checker. In it, we detail the symptoms of each condition. Some are unique, some are shared, and others vary by degree. You can, therefore, use the symptom checker as a quick guide to determining which condition you have.
First of all, let’s take a look at the symptoms which are similar for each condition. You can’t necessarily use these symptoms to tell the two conditions apart. However, there are some slight differences in each symptom, which may give you a clue.
The odor is one of the most noticeable symptoms of toenail fungal infection. It is the same as normal foot odor, the only difference being that it is much stronger. However, if you already suffer from foot odor, then you may not notice that it gets worse once you have a fungal infection. It is also possible that your damaged nail bed becomes independently infected. This can produce a similar odor, even if it is not the same kind of fungal infection.
2) Some Nail Deformation
You may also notice slight deformation of the nail. This is where the nail grows small ridges from top to bottom. These ridges won’t cause any pain but are a sign of future changes. This can occur in both conditions, although you will only see this happen in the early stages of a fungal infection. It is also more common after toenail trauma than it is in a fungal infection.
3) Thicker Nails
Another common symptom is where the nail becomes much thicker than it used to be. In a fungal infection, this is accompanied by other changes to the nail: it becomes brittle, for instance. However, the nail becomes thicker in both conditions. After toenail trauma, the nail grows back thicker and harder than it used to be.
4) Toenail Peeling Away
With either condition, you may also notice that the toenail starts to come away from the nail bed. As the nail begins to grow out, a gap begins to form. This can be exacerbated if you ever catch your nail on something. An example might be when you take your socks off.
Last but not least, pain is a symptom that you may experience with either condition. When the fungal infection reaches its final stage, you will notice more heavy deformation. The nail can become twisted, and grow to the side, rather than straight out. This can cause pain where it cuts into the surrounding skin.
Toenail trauma can also cause pain. As the nail regrows, it may grow differently to its original shape. Again, this can cause pain if the nail cuts into the surrounding skin. However, you may also experience pain as a result of the initial trauma that caused your wound.
Moving on, these symptoms are the best way to tell the difference between fungal infection and damaged nail bed. If you have any one of these symptoms, then you should be able to identify which condition you have with ease.
If you still can’t tell, you may need to use our ‘strategy’ guide below on telling the conditions apart.
1) Nail Texture
The intermediate stage of toenail fungal infection is characterized by changes to the texture of the nail. You may notice that your nail becomes more brittle or crumbly, as opposed to flexible.
If you aren’t careful, the nail can become shorter and shorter until it becomes painful. This happens because the fungal infection is spreading through each layer of the nail. As it eats through, this destroys the natural, flexible structure of the nail.
By contrast, after nail trauma occurs, the nail grows back thicker and therefore harder. The toenail will be several times thicker, which makes it inflexible. This may also make the nail challenging to cut.
2) Nail Color
Toenail fungal infections turn yellow or brown. As the infection spreads and gets worse, this color becomes deeper and more noticeable. There are many conditions which also cause yellow toenails, but damaged nail bed is not one of them.
By contrast, a damaged nail bed turns a dark purple, even black in color. This is called a subungual hematoma and is basically where blood becomes trapped between the nail bed and the nail. However, your nail polish may make the problem more difficult to identify.
A damaged toenail from polish can look similar to toenail fungus. The iron in many polishes can leach through to the nail bed and color it yellow, and make it difficult to tell whether you have toenail trauma or fungus.
3) Nail Shape
Because fungal infection causes the nail to crumble, this changes the shape of the nail. The nail may, therefore, become much shorter than it used to be, while still being much thicker. It’s a similar appearance to the nail of a nail-biter, in that it’s far shorter than it should be.
By contrast, toenail trauma causes unique changes to the shape of the nail. It very much depends on the kind of trauma you suffered. If it was a specific incident, i.e., if you dropped something heavy on your nail, then this will create an indent. If the trauma is caused by shoes that are too tight, then the nails will point inwards.
Toenail Fungus vs. Damaged Toenail Diagnosis
If your condition is still in the early stages, it can be difficult to distinguish any symptoms clearly. This is a significant problem since effective treatment has to start as early as possible. If not, you may have to remove your toenail entirely. That’s why it’s so important that you figure out what’s wrong.
If you’ve been over the symptom checker above, and you’re still not sure, use the guide below. The following four strategies are your last resort if you’re unsure what the problem is. Let’s take a look.
What’s Causing The Damage?
Carefully consider the potential causes of your pain or swelling. As we mentioned above, toenail trauma can be the result of a sudden blunt force impact or the result of continual/ongoing trauma.
So, for example:
- Do you regularly go swimming? If so, you may have caught your infection there.
- Do you ever share a towel with anybody else? If so, you may have caught your infection there.
- In either the recent or distant past, did you drop something heavy on your foot?
- Do you regularly wear shoes that are too tight?
Any of these reasons could be the cause of your toe pain. If you regularly go swimming or share a towel that somebody else used, this can help fungus spread. The same goes if your feet are regularly warm and sweaty, for instance after exercise or in saunas.
Is It Spreading?
One of the most obvious ways to distinguish between the two conditions is to check whether it’s spreading. Toenail fungus doesn’t spread quickly like a rash, so don’t expect to notice it grow day by day. However, you will be able to discern the change over time.
Here’s a great way of telling if your infection is growing:
- Take a photo of the affected area on any given day. Even better is to take many photos from many angles.
- Leave your toenail alone for a day or two, without trying to treat it.
- Check your toenail against the photos you took a few days later. You may notice that the skin around your nail has become redder, or that the yellow hue of your nail has become deeper. You may also notice that the yellow area on your nail has become more prominent.
By contrast, toenail trauma does not ‘spread.’ You may notice the color change, but toenail trauma is a different color anyway. So, if you notice it spreading, then you must have a fungal infection.
An excellent way of identifying the problem is to begin treatment with a toenail fungus cream. This has the added benefit that, if you guessed correctly, you start to get rid of the problem. There are many ways to treat either condition, which are listed further below in this guide.
If you suspect you have a fungal infection, you should purchase a basic antifungal product. Use it as directed for a week. As in the example above, take a photo before treatment, and then examine your toe afterward. If you’re still unsure, take more photos, and continue treatment. Do bear in mind that treatment for a fungal toenail takes a long time no matter how you treat it.
If you suspect you have toenail trauma, try wearing shoes that are less tight. If you know of some other reason why your toes might have a damaged nail bed, attempt to correct that. Again, take photos to compare and see whether the condition improves.
Talk To Your Podiatrist
Consulting a medical expert should always be on the table. However, you should know that doctors aren’t necessarily going to be able to diagnose you. They may need to send a sample of your nail away for tests. This is called a biopsy. The sample will be analyzed under a microscope, which can give a precise answer either way.
One fundamental problem is that you can have both conditions at once. This occurs when you suffer an initial toenail trauma. Because the toenail is under stress and may be bleeding, this allows for you to have both at once. This may be why you are still struggling to tell the two conditions apart: maybe you have them both.
Other Toenail Conditions That Cause Confusion
Aside from toenail trauma, many other conditions are often mistaken for toenail fungus. There are even some health conditions you may have that could, for example, turn your nails yellow. This may be the source of your confusion.
Psoriasis is a general skin condition that causes red, scaly skin in the affected area. It is caused by fungal infection, although the infection is caused by a different kind of spore. If you’re unlucky, your psoriasis could spread to your nails.
This causes many similar symptoms to toenail fungus:
- Your nails will change color to a yellow-red hue.
- Your nail may become loose and move away from the nail bed (onycholysis).
- Your nails will start to crumble and become thicker. This is because the mechanism of psoriasis- a fungal infection eating through the keratin in your nails- is the same as typical toenail fungus.
However, many differences make it evident that you have psoriasis:
- You may see small pits in the nail, almost like a thimble in appearance.
- You may also see ridges from side to side along the nail. The medical term for these ridges is ‘Beau’s lines.’
- Alternatively, you may see small black lines from top to bottom. These are called splinter hemorrhages and are caused by tiny capillaries bleeding underneath the nail.
Diabetes affects the feet more than many other parts of the body. Aside from swelling and pain in the feet, it can also cause yellow nails. This is not the result of an infection brought on by diabetes. Rather, it is a natural change because of the way the body processes sugar.
When diabetes turns your nails yellow, this isn’t anything to worry about. It doesn’t need to be separately treated. However, if you think you may be at risk of getting diabetes and your nails turn yellow, contact a medical professional. They will be able to give you further advice.
Having an overactive thyroid gland is a condition where your body produces too much of a certain hormone. This hormone, thyroxine, affects your body in many different ways. It alters your metabolism, causing sudden weight loss, sweating and mood changes.
Your overactive thyroid may be related to many other conditions, like Graves’ disease, Plummer’s disease or thyroiditis. Each of these conditions can be linked to yellow skin, yellow eyes and yellow nails. Having an underactive thyroid (hypothyroidism) may also cause similar problems.
Treatment for Damaged Toenail Matrix
Damaged nail bed repair is no simple task. The treatment depends on the exact cause of the damage, and the exact damage caused.
If the primary symptom of your damaged toenail matrix is a subungual hematoma, don’t worry. Nail bruises will fade from red/purple or black to blue over a few weeks. However, unless you choose a treatment method, the bruise will remain.
There are many courses for treatment, but each achieves the same thing. Ultimately, you have to drain the blood away from underneath the nail bed. The medical name for this treatment is ‘releasing the hematoma,’ draining, or trephination.
Here’s how it’s done:
- Before releasing the hematoma, make sure to numb your finger in some way. You could do this either with a numbing cream or with an ice cube. If you visit a doctor for this procedure, they may use lidocaine. Alternatively, commit to the treatment without pain relief.
- Use either cautery or a needle to open up a hole for the blood to drain through. If you would like to do this procedure at home, electrocautery tools are available online. If you would like to use a needle or paper clip, make sure to heat it up before you use it. This a) sterilizes the instrument, and b) makes it easier for you to create a hole in your nail.
- After treatment, stem the flow of blood with the tissue. Dress the wound as you would any other wound.
A subungual hematoma is a relatively minor damage when you consider what else can go wrong with your nail. You are perfectly fine to recover without recourse to a medical professional. However, you may not like the sight of blood or the idea of using needles/cautery. If so, talk to your doctor. The procedure is quite simple and can be performed quickly.
It is possible to cut the nail all the way down to the cuticle and damage the nail bed/matrix in the process. As you can imagine, this is incredibly painful, and the result of severe damage. Full laceration normally occurs after a severe blunt force injury and requires immediate medical treatment.
- Your medical professional will first enquire as to how you were injured. They may also perform an X-ray to identify any broken bones. They will also examine the nail physically, and if necessary, give you an anesthetic.
- They will clean the wound, release any blood from beneath the nail, and dress it.
- In severe cases, the nail will be removed.
If your nail has a relatively small tear, this is something that you can deal with at home. Wrap your nail in a bandage to protect it. As the nail grows out, the tear will be replaced by a healthy nail. However, deformities are possible if your nail bed was damaged. Also, bear in mind that it takes up to six months for a nail to grow from cuticle to tip.
A nail avulsion is where the nail has become separated from the nail bed. This leaves the damaged nail bed exposed and vulnerable, which is naturally very painful. In the event of nail avulsion, do not attempt to reattach the nail. Unlike other parts of the body, wrapping your nail up in a bandage and waiting for it to heal will not work.
Your body is unable to reattach a nail once it has come away from the nail bed. The only option is, therefore, to remove any remaining nail, and wait for more to grow in its place. This will take three to six months, depending on the length of your nail. See a medical professional if your nail comes away from the nail bed.
Treatment for Fungal Toenail Infection
There are plenty of home remedies that you can use to fix it. Some of these use products that you may have at home already. Others are relatively cheap, some are natural, and some are pharmaceutical. Whatever your preference, there will be a method for you below.
Tea Tree Oil
If you prefer to deal with your fungal infection naturally, tea tree oil for toenail fungus is probably the best choice. Tea tree oil is a proven antiseptic and antifungal solution.
Here’s how to use it:
- Purchase a high-grade tea tree oil online.
- Clip your nails as much as possible and clean the affected area. This limits the work that the oil will have to do.
- Apply just a few drops to the affected area. Alternatively, use a Q-tip or cotton bud to apply it.
- Scrub the area to encourage it to soak in, and then let it air dry.
- Repeat the process at least twice a day. If you notice the skin around your nail drying up, you may be using it too much.
If tea tree oil isn’t for you, you also have your choice of OTC pharmaceutical creams. You could also choose homeopathic ointments, although further testing is needed to prove their effectiveness. Bear in mind that whichever cream you choose, it may take many months to work, and may not work at all.
Home Laser Treatment
Alternatively, you could choose a home laser treatment. You can buy a handheld battery- or mains-operated laser device online to treat your fungal toenail. These devices use very small but powerful lasers to heat up the individual spores of the fungus. This burns them and prevents them from spreading.
Here’s how it works:
- Hold the device and point it at your nail. If the device is a clip-on model, clip it over the affected toe.
- ‘Fire’ the laser at the affected area. Hold it in one place until you feel a slight tingling/pricking sensation. Laser treatment may hurt, although not too much.
- Repeat the process until you have covered your entire nail. You may need to pause if your toe becomes too hot. Use the product three times a day for quicker results.
Home laser treatment works for some people, but not for others. It is more expensive than an OTC cream, but you can use the device as much as you like. You can also get laser treatment for toenail fungus performed by a doctor.
If all of the above isn’t enough to identify or treat your condition, there are only two options available. Either seek medical attention or leave your nail be. Since fungal infections can continue to spread, by far, the better option is to talk to a doctor. You can either talk to your family doctor or visit a podiatrist.
Podiatrists are professional ‘foot doctors,’ and will have seen problems like yours a thousand times before. That means that no matter what’s wrong, they should be able to help. With luck, whether you need a podiatrist or not, you can finally get rid of your fungal toenail infection.