Toenail Fungus Questions

Is it Toenail Fungus or a Damaged Nail Bed?

Nobody wants a yellow toenail fungus or damaged nail bed, but it is still crucial to be able to tell these two medical issues apart. Both conditions can be excruciatingly painful, ugly, and take time to heal. But the main reason they’re so difficult to treat is that toenail fungus is regularly confused with the visible symptoms of other toenail problems, which results in the wrong treatment being used.

Types of toenail trauma include lacerations, hematomas, dents, and scrapes. After the initial trauma, the damaged toenail can grow back thick and discolored (due to trauma and bruising). This can make you question whether you have toenail trauma or toenail fungus. That’s because the most obvious signs of toenail fungus are nail discoloration (yellowing) and thickening.

We’ll cover everything you need to know both about toenail fungus and injured nail bed (damaged toenail matrix) symptoms. You’ll know how to tell them apart and self-diagnose what’s wrong.

Is It Toenail Fungus or Damaged Nail Bed?

Many symptoms of nail injury are also classic signs of toenail fungus. However, you may not experience all of these symptoms at once, or at all.

One central difference between the two conditions is that they are caused by entirely 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.

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.

Similar Symptoms

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.

1) Odor

The unpleasant 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 have 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 a 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 starts to form.

This can be exacerbated if you ever catch your nail on something. An example might be when you take your socks off.

5) Pain

When the fungal infection reaches its final stage, you will notice more heavy deformation and swelling to the skin around the nail.

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.

damaged toenail bed

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.

Different Symptoms

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. Many conditions cause yellow toenails, but a 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. It is 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 also 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 depends on the kind of trauma. 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 tight shoes, 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.

What’s Causing The Damage?

Carefully consider the potential causes of your pain or swelling. Toenail trauma can be the result of a sudden blunt force impact or the result of continual/ongoing trauma.

  • Do you regularly go swimming?
  • Do you share a towel?
  • 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 cause fungus to spread. The same applies if your feet are regularly warm and sweaty, perhaps following exercise or a sauna.

Is It Spreading?

One of the most obvious ways to distinguish between the two conditions is to check whether toenail fungus is spreading. Nail 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 how to tell if a fungal infection of the toenails is growing:

  1. Take a photo of the affected area.
  2. Leave your toenail alone and don’t treat the condition.
  3. Check your toenail(s) against the photos you took a week 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. So, if you notice it spreading, then you likely have a fungal infection.

Attempt Treatment

One way of identifying the problem is to begin treatment with a toenail fungus cream. This has the added benefit that, if you got it right, you start to clear up the problem.

If you suspect you have a fungal infection, you should purchase an antifungal product. Use it as directed for a week. 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 to heal no matter how you treat it.

If you suspect you have toenail trauma, try wearing less tight shoes. If you know of some other reason why your toes might have a damaged nail bed, attempt to correct that. Take photos to compare and assess whether the condition has improved.

How to recover from toenail trauma

Talk To Your Podiatrist

Doctors 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 will provide a scientific answer.

One problem is that you can have both conditions at once. This occurs when you have 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 as you have them both.

Conditions Mistaken for Toenail Fungus

Aside from toenail trauma, many other conditions are often misdiagnosed for toenail fungus. There are also some health conditions that can turn your nails yellow.

Nail Psoriasis

Psoriasis is a skin condition that causes red, scaly skin. It is caused by fungal infection, although the infection is caused by a different kind of spore. 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 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.’
  • 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

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. 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.

Hyperthyroidism

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.

Subungual Hematoma

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. 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:

  1. 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.
  2. 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 before you use it. This a) sterilizes the instrument, and b) makes it easier for you to create a hole in your nail.
  3. After treatment, stem the flow of blood with the tissue. Dress the wound.

A subungual hematoma is relatively minor when you consider what else can go wrong with your nail. You can recover without recourse to a medical professional. However, you may not like the sight of blood or the idea of using needles/cautery.

Nail Laceration

It is possible to cut the nail all the way down to the cuticle and damage the nail bed/matrix in the process. 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.

  1. 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.
  2. They will clean the wound, release any blood from beneath the nail, and dress it.
  3. 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.

Nail Avulsion

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 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.

toenail fungus vs. toenail trauma

Treatment for Fungal Toenail Infection

There are home remedies that you can use to get rid of toenail fungus. Some of these use products that you may have at home already.

Tea Tree Oil

If you prefer to deal with your fungal infection naturally, tea tree oil for toenail fungus is likely to be the best choice. Tea tree oil is a proven antiseptic and antifungal solution.

Here’s how to use it:

  1. Purchase a high-grade tea tree oil online.
  2. Clip your nails and clean the affected area. This limits the work that the oil will have to do.
  3. Apply just a few drops to the affected area. Alternatively, use a Q-tip or cotton bud to apply it.
  4. Scrub the area to encourage it to soak in, and then let it air dry.
  5. Repeat the process at least twice a day. If you notice the skin around your nail drying up, you may be using it too often.

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. Whichever cream you choose, it can take many months to work, and may not work at all.

Home Laser Treatment

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 the individual spores of the fungus. This burns them and prevents them from spreading.

Here’s how it works:

  1. Hold the device and point it at your nail. If the device is a clip-on model, clip it over the toe.
  2. Direct 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.
  3. 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 at a local clinic, if you prefer.

Podiatrists are professional ‘foot doctors,’ and will have seen problems like yours a thousand times. That means that no matter what’s wrong, they will be able to heal your damaged nail bed or get rid of your fungal toenail infection once they’ve scientifically determined what’s wrong.