The human body is prone to all manner of maladies and morbidities. From a stubbed toe all the way to a heart attack, medical care is required for a plethora of conditions, illnesses, and injuries, resulting in a list of ailments that is (unfortunately) nearly endless. Most of the medical problems we experience are the result of just a few factors, with an obvious one being physical trauma which, in all its myriad forms, can exact a great toll.

An easy choice for this accounting is genetics, the roll of the dice that is our inherited chromosomal constitution. Many diseases experienced by homo sapiens are passed down from a prior generation (or at least a predilection to getting the condition). And let us not forget the contributions of infectious disease, be it viral, bacterial, or fungal. Every human on the planet has been subjected to such a malady at some point, with the COVID pandemic being a particularly fresh experience.

When polled about their level of concern regarding various medical issues, the great majority will place a myocardial infraction, a heart attack, high on the list. Difficulty breathing would also prompt an immediate response. But a thickened toenail doesn’t generally elicit this kind of response. Certainly unsightly, many people find their toenails becoming yellowed or dulled but ignore it quite ably. Real problems can be associated with nail disease, pain included, but they take time to develop.

Nails change over time, becoming thickened or curled, yellowed or misshapen, at least for most of us. The nail root, the anatomic structure which actually grows the nail plate, receives some minor trauma during the course of the average day. If the toe becomes bent, e.g. a hammertoe, the end of the nail will experience pressure, not from the end of the shoe but the supporting surface. Over ten thousand steps a day, and the passing years, the trauma resulting causes changes to the root, and consequently to the plate itself.

Infections of the nail unit, most commonly the infamous fungus nail, are responsible for many an ugly toenail. These resistant organisms become well entrenched in all the tissues of the area, changing the color of the nail, the shape, even the curve of the nail. But numerous other conditions can result in changes to our toenails. Regardless, many of those individuals so afflicted are unconcerned since early on in this slow but inexorable process, there is no pain or problems.

These diseased toenails are usually hard and unyielding, quite capable of inflicting damage on neighboring structures. Depending on the positioning of the digits, and the configuration of the nail, the next toe over may experience considerable injury. A laceration (i.e. a cut) from a simple long nail can occur, and the inside of a shoe is typically not a great place for an opening in the skin. This is one of many situations leading to a bacterial infection, resulting from an abnormal toenail.

Diseased toenails, be it from a fungus or a psoriatic nail (commonly seen with psoriasis), or any of the many causes for abnormal toenails, too often end up leading to a bacterial infection. This frequently starts off as an infected, ingrown toenail, although the bacteria is merely a byproduct of the foreign body which is the edge of the nail. This is why antibiotics alone don’t lead to resolution of this extremely common condition.

For some people, bacterial access to your “insides” can be a life-altering event. Because diabetes interferes with the functioning of the immune system, this invasion can wreak havoc on local tissues, from bone to blood vessels. The nail root, the structure which grows the nail, sits directly on top of the bone. With progression of an ingrown nail infection, bone can, and has, become involved. The more abnormal the nail shape, the greater the opportunity for pathology and problems.

Under all that debris and detritus, bad things can happen. The bottom of these nails often have a rough, irregular surface which can wear on the skin immediately underneath. An opening in the skin may be produced, once again allowing bacterial invasion. And the nail unit can harbor a variety of microorganisms with these badly misshapen nails.

Although rarely suspected, the nail unit can also be the site of skin cancer. Few watch their toenails for spots and blemishes, but there is a form of malignant melanoma that originates in the nail. Few of us inspect these structures, so subtle aberrations from “normal” can easily go unnoticed. This deadly malignancy is not one to be trifled with, and early detection is critical.

Although not a consideration to the average citizen, abnormal nails can reveal the presence of a systemic condition. For example, As previously mentioned, psoriasis frequently includes changes to the nails but can cause arthritic changes to various joints, along with the skin changes the disease is known for. Certain liver conditions can lead to nail changes. More common are disfigured nails because of the presence of artery disease in the legs, even in the absence of the classic signs of PAD.

The more abnormal the nail, the greater the opportunity for problems. This tends to be applicable whether you’re talking about the physical consequences to the neighboring structures (skin, nerves, vessels, bone) or harboring more microorganisms (bacterial, fungal, viral, you get the idea!). But these changes are usually so gradual, they’re easy to miss or ignore.

Time is an issue, and the longer the problem exists, the more established it becomes. Some of the causes for nail changes don’t have cures, but there are solutions. Ignore these nail changes at your peril: there can be repercussions.

Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.