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Broken Toenail

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I am finally willing to seek help on my issue.
Over 2 years ago, I accidnelty hit the big toenail on my right foot on a counter, and it cracked at the base, it fell off a few months later, but ever since that, whenever a toenail would grow, it would crack at the base. Right now, it seems like there are 3 toenails all on 1 toe growing underneath each other. Whenever one would grow in, it would crack. It's been like this for years now, and I dont know what to do.
I took pictures, the links are below.

https://picasaweb.google.com/1062653565362 55515788/Toenail?authkey=Gv1sRgCKrf86GYiI2 YxAE#5616712450537624050

https://picasaweb.google.com/1062653565362 55515788/Toenail?authkey=Gv1sRgCKrf86GYiI2 YxAE#5616712450731551234

https://picasaweb.google.com/1062653565362 55515788/Toenail?authkey=Gv1sRgCKrf86GYiI2 YxAE#5616712458590937618
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replied June 10th, 2011
Especially eHealthy
lamar,

You have what is called a nonadherent nail. In the toenail complex, the nail plate is made in an area called the germinal matrix. This is located at the base of the nail , just under the cuticle. As the plate grows, it continues on out onto the sterile matrix. This is the tissue that is between the plate and the bone. Its main function is to hold the plate down, onto the bone. Otherwise, as you have noted, the plate rises up and comes off.

It appears that you have a scar in the sterile matrix, just past the cuticle. The plate will adhere, sort of, but any type of small trauma causes it to detach at the base, but remain adherent distally (towards the tip of the toe). Nail plate material is made continuously, so the new nail plate starts to grow out, Thus you get the overlapping appearance.

This is usually treated by excising the scar tissue in the sterile matrix. If the area is too large to close primarily, a tissue graft may have to be placed.


You should probably see a podiatrist, orthopedic foot and ankle surgeon, or a plastic surgeon. It needs to be a surgeon who has training in correcting disorders of the nail complex.

Good luck.
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replied June 12th, 2011
Would taking off the toenail do anything? It seems like the toenail that is still attached is breaking off the one(s) that are growing in. If so, how would I remove it?
Would leaving this untreated do any (more) harm?

I appreciate the help.
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replied June 12th, 2011
Especially eHealthy
Lamar,

Taking the nail plate off may allow the new one growing in a chance to grow out without disruption. Hopefully, the new nail plate will be adherent enough. But, it sounds like any little trauma causes the nail plate to break and then set up the overlapping.

Getting a nail plate off, without damaging the nail bed is not easy. It requires local anesthesia (think of bamboo shoots under the fingernail) and then a set of surgical instruments to elevate the nail plate, while leaving the nail bed alone. The nail bed is very vascular, so it will bleed like crazy.

But, unfortunately, just taking the plate off won't address the scar tissue in the nail bed.

Usually, in these cases, the patient is taken to the surgical suite (it can be done in an outpatient setting) and anesthesia is provided. The nail plate is removed. Then, under magnification, the scar tissue is delineated. It is removed and the surrounding nail bed elevated a little. The defect is then closed with very fine absorbable sutures. An artificial nail is used temporarily to hold the nail fold open and protect the nail bed, till the new nail has begun to grow in. If the defect can't be closed primarily, then a graft from another toe is taken (just like a skin graft).

So, as you can see, it's not really an easy problem to take care of. But, maybe, it can be taken care of with just a simple nail plate excision. The only way to know is to have it looked at. I wouldn't suggest trying to take the nail off yourself, it would be very painful.

Good luck.
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