Healthy toenails are something you take for granted until you notice something is off with their coloration. Like, for example, you suddenly realize they have a white-ish hue. Weird? Yes. And this happens because toenails actually have a super-unique structure.
"The human nail is a complex structure generally made up of a collagen complex called keratin (the same cells that make up your hair). The visible portion of the nail plate that people see is actually comprised of dead cells, and that is a reason why they don’t typically hurt when you cut them," says Mark J. Mendeszoon, DPM, FACFAS, a podiatrist at Precision Orthopaedic Specialties in Ohio. "Healthy fingernails typically grow about 3.5 millimeters per month and toenails grow 1.5 millimeters per month."
So if you've noticed white spots or marks on your toenails the last time you were clipping your toenails, you might be a little concerned.
"At times, people may notice white discoloration on their nails, and this can become frustrating, concerning or even embarrassing to individuals due to the fact that once human nails develop issues," says Dr. Mendeszoon.
So what causes white toenails, and when do you need to see a doctor about them? Here's everything you need to know.
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One of the most common causes of white toenails or spots is a fungal infection (onychomycosis) or a yeast infection (Candida).
"Typically, these conditions are caused by trauma to the nail, which could be a significant injury like dropping a weight on your foot or from wearing shoes that are ill-fitting and thus cause micro-trauma to the nail," says Dr. Mendeszoon. "Once the cuticle (the protective barrier that protects the nail growth center) is damaged, the fungal elements reside and multiply at a significant rate."
Unfortunately, they overtake the normal nail cells and changes in the nails persist.
"Once someone sees a white change of the nails it is recommended that one sees a podiatrist, dermatologist, or family doctor to have the nail observed and potentially have a nail biopsy to confirm the fungal condition," says Dr. Mendeszoon.
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White toenails can also be caused by trauma.
"Trauma could cause white spots on the nails or even white lines (leukonychia)," says Dr. Mendeszoon. "Bumping one’s toe or being stepped upon may cause injury to the nail plate and dermis causing future nail changes."
Your latest pedi may have had your toes looking great post-spa day but have an unexpected side effect: White toenails.
"Folks who have pedicures and use colored nail polish or acrylics may notice changes in their nails over time," says Dr. Mendeszoon. "The pigments or adhesives with these nail treatments can cause reactions or damage in the nails."
Like any body part, the toe nails can be a clue into our overall health.
"Autoimmune conditions like psoriasis may cause white spots or pits in the nails," says Dr. Mendeszoon. "Horizontal lines may be indicative of heart disease, lung issues, chemotherapy cancer treatments, liver and kidney disease. It is important that if a patient is experiencing symptoms, weakness, reactions to medications, fatigue, weakness, shortness of breath or chest pains that medical help is immediately sought out."
A 2021 study showed that, in severe cases, white toenails were a flag of the deterioration of elderly patients' health. So, again, see a doc if you're concerned about yourself or a loved one.
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The outward appearance of the toenail may be an indicator that your menu needs some tweaking.
"Some vitamin and mineral deficiencies such as iron and zinc deficiencies," says Dr. Mendeszoon. "In addition to white discolorations of nails, iron deficiency could cause growth disturbances of the nail, such as a spoon-shaped nail (koilonychia)."
Treatment depends on the cause of white toenails, which can best be determined by a podiatrist. "Once nails start to display changes it is important to attempt treatment as soon as possible to give the best attempt to improve the appearance of the nail," says Dr. Mendeszoon.
If the cause is a fungus, topical anti-fungal medications may show some signs of improvement, but seldom eradicate the condition.
"Oral anti-fungal medications could be more successful in improving and curing the problem, but liver enzyme blood work testing is mandatory as these medications are broken down in the liver," says Dr. Mendeszoon. "Those folks with liver issues, on cholesterol medications or even folks who drink alcohol may not be able to take these medications."
He notes that besides oral medications, laser therapy may also be utilized for nail improvements.
Good feet and toenail hygiene are also important.
"Properly cutting your nails with clean and sterilized nail nippers (rubbing alcohol may be used). Change socks every day and if possible shoes as well," says Dr. Mendeszoon. "Use antibacterial soap for washing your feet. And drying between your toes is very important. Spray your shoes with an antibacterial spray daily, and occasionally let your feet be exposed to air."
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If you frequently get pedicures, you might want to take a break.
"A suggestion for those receiving routine pedicures is to take a 'nail vacation' for at least one week every three to four months so the nails could be free from the chemicals of the polish and acrylics," says Dr. Mendeszoon.
If these things fail, then surgical nail procedures to remove the nails permanently may be needed.
"Fake toenails may be applied if nails are removed. There are now relatively new resin compounds that could be used to create a cosmetically appealing nail," says Dr. Mendeszoon. "These ‘fake’ nails have to be reapplied or re-made periodically, as they are not long-lasting solutions."
Next up, learn about the importance of nutrition to reducing inflammation
Mark J. Mendeszoon, DPM, FACFAS, a podiatrist at Precision Orthopaedic Specialties in Ohio
Fungal Infections (Mycosis). Cleveland Clinic.
Leukonychia: What Can White Nails Tell Us? American Journal of Clinical Dermatology.
The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study. Healthcare (Basel).
Spoon Nails. National Library of Medicine.
