Why Your Toenail May Fall Off and What to Do

Medically Reviewed By Adam Hotchkiss, DPM
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Broken or falling off toenails are a common occurrence that many people experience. Several situations can cause a toenail to fall off. The most common causes are injury, fungal infections, or nail psoriasis. A toenail falling off is not typically a serious condition. The toenail usually grows back within 18 months.

This article explores what causes toenails to fall off, what you should do if this happens, and what you can expect the regrowth process to be like.

It also discusses when to contact a doctor, what complications can arise when a toenail falls off, and how you can prevent your toenail from falling off.

What can cause a toenail to fall off?

A person is checking their toe.
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A toenail can fall off for several reasons.

The most common reasons include injury to the nail bed, fungal infection in the nail, and nail psoriasis. 

Uncommon reasons include rare side effects of some medications and several rare medical conditions. 

Injury

Toenail injuries are common, such as when the toe gets trapped under or crushed by a heavy object. This is particularly common in childhood, according to experts. Toenail injuries can also occur during sports.

If you experience a toenail injury, you may feel pulsing pain in your toe. You may also notice the skin turning dark purple or black due to bleeding under your nail.

Medical professionals call this bleeding a subungual hematoma. The buildup of blood may slowly separate your nail from the nail bed, making it eventually fall off. 

Learn more about subungual hematoma.

Contact your doctor if you notice the bruising covering more than one-quarter of your toenail or if the throbbing pain will not stop. Your doctor can perform a simple procedure to relieve the built-up pressure. 

Sometimes you may not see any visible signs of injury. Yet the nail bed under the nail may still experience damage, and this may cause the nail to grow irregularly or fall off. 

Learn about common foot injuries.

Fungal infection

Toenail fungus is common, according to the American Academy of Dermatology (AAD). An existing fungal infection on your foot can spread to your toenails.

Toenail fungus appears as white or yellow nail discoloration, along with a thickening of the nail. As the infection progresses, it can cause the nail to lift or crumble and sometimes fall off.  

Causes of toenail fungus include:

  • having an existing fungal infection, such as athlete’s foot
  • being in warm, moist areas, such as a locker room, public shower, or pool deck
  • working in environments where your feet are frequently wet
  • wearing the same boots daily, particularly if your feet get sweaty

Keeping your feet clean and dry helps prevent fungal infections from starting. Several treatments are also available, including oral antifungal medications and topical ointments you can apply to your toenails.

Learn more about toenail fungus.

Nail psoriasis

Psoriasis is a common skin condition where your body makes new skin cells every few days rather than every few weeks. These new skin cells build up on the surface of the skin and cause thin scaly patches. 

People with psoriasis can sometimes get the condition in their nails as well. Psoriasis in the nails may look like:

  • white, yellow, or brown discoloration of the nail
  • nail pitting, which is when tiny dents form in the nails
  • crumbling nails
  • nails separating from the fingers or toes
  • thickening under the nails
  • blood under the nails

If you see these changes in your nails, make an appointment with a dermatologist. A dermatologist is a doctor who specializes in skin and nail conditions.

Without treatment, nail psoriasis may get worse. This may cause the nail to fall off and make walking difficult. 

Per the AAD, treatment may include daily topical medications or stronger treatments given in the dermatologist’s office, such as: 

  • corticosteroid injections into or near the nails
  • laser treatments
  • PUVA, which involves soaking the feet in a medication called psoralen, followed by exposure to UVA rays
  • oral medications, for severe skin and nail psoriasis

The recovery process is sometimes difficult and can take time. For best results, be sure to consistently follow your dermatologist’s directions.

Learn more about nail psoriasis.

What do I do when my toenail falls off?

If your toenail falls off and there is no open wound, keep your toe clean and dry. You should then keep it covered until the nail grows back.

If an open wound is present or if the skin is very tender, clean the skin with a saline solution, tap water, or an alcohol-free wipe, the U.K.’s National Health Service (NHS) suggests.

Once you have allowed the area to dry completely, you can apply a bandage. This helps prevent your tender skin from rubbing against your shoe.

If you do not know why your toenail has fallen off, make an appointment with your doctor. They will be able to determine why it has happened and advise on any steps you can take to prevent it from happening again.

What do I do if my toenail is falling off but still attached?

When a toenail breaks or is only partially attached, it is important to preserve as much of the remaining nail as possible.

Here are some home remedies you can try, according to the NHS:

  • cutting the nail back to where it is injured, if possible
  • applying a bandage to prevent jagged parts of the nail from attaching to socks
  • avoiding wearing footwear that is too tight or pinches your toes, which can affect the toenail
  • avoiding picking at the toenail or the skin around it
  • making sure you treat any existing foot conditions, such as athlete’s foot

Do I need medical treatment if my toenail falls off?

Most of the time, a toenail that falls off does not require medical treatment.

But the underlying cause may need treatment. It is important to contact your doctor if you do not know why your toenail has fallen off.

How long does toenail regrowth take after falling off?

Toenails take time to regrow. Depending on the extent of the damage, it can take up to 18 months for a nail to regrow. 

When should I see a doctor?

You should contact your doctor if you do not know why your toenail has fallen off. They will be able to carry out a physical examination and may run tests to help identify the cause.

You should also contact your doctor if you:

  • have a fungal infection that does not respond to treatment at home
  • experience a crushing injury and your nail turns black or purple in an area larger than one-quarter of your nail
  • experience pulsing pain following an injury to your toe or toenail
  • suspect you may have nail psoriasis

It is also important to seek medical advice if you notice signs of infection in or around the nail area. This can include:

  • redness
  • swelling
  • increased pain
  • warm skin
  • creamy pus-like discharge 

How do doctors diagnose the cause of a toenail falling off?

Your doctor will first review your medical history and ask questions about symptoms or any recent injury to your foot or toe.

If your doctor suspects you have a fungal infection, they will closely examine the nail and skin surrounding the area. They may choose to remove some debris from under your nail and remove some skin flakes to look at them under a microscope. 

If your doctor suspects nail psoriasis, they will perform a careful exam of your skin and nails. They may also examine a sample of skin under a microscope, the AAD says.

Learn more about different types of toenail issues.

Are there any complications of losing a toenail?

Typically, a toenail falling off is not a major medical concern.

Losing a toenail can cause pain. Over-the-counter pain medication can provide relief from mild toe pain.

Sometimes an infection may begin in damaged or detached toenails. If you suspect an infection, seek medical care for accurate treatments. 

How can I prevent losing a toenail?

There are steps that you can take to help to prevent losing a toenail. According to the NHS, these include:

  • wearing shoes that will protect your toes from injury when working with heavy items
  • making sure the fit of your shoe is correct to prevent nail damage from rubbing against the end of your shoe
  • making sure your socks and shoes are clean and completely dry before wearing them
  • keeping your nails trimmed short and straight across
  • sanitizing your nail clipper before using it by washing it in soap and water, then cleaning it with rubbing alcohol
  • wearing flip flops or sandals in public areas where there is warm water on the floor, such as locker rooms
  • moisturizing your feet after bathing or showering to prevent your skin from cracking

Summary

Toenails that break or fall off are a common occurrence that is usually not a medical concern. A toenail can fall off because of an injury to the nail bed. Other possible causes include nail fungus and nail psoriasis. 

Most of the time, you can care for a broken toenail at home by cleaning the area and protecting it with a bandage until the nail grows back.

If nail fungus or nail psoriasis is causing your nails to fall, contact your doctor for advice. They will also be able to determine the underlying reason your toenail is falling off if you do not know why it has happened.

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Medical Reviewer: Adam Hotchkiss, DPM
Last Review Date: 2022 Sep 21
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