Common Nail Pathologies

image of healthy feet with blue sky background

While function of our toenails has decreased as we’ve evolved, they still have the job of protecting the ends of our toes from injury.

Nails can be affected by a number of different pathologies. Luckily, we’re here to help you these!

Learn about some of the common nail conditions we see at our podiatry clinic and discover how we can help!


Ingrown Nails

Most people have heard about ingrown toenails, but don’t know how they happen and just how much pain they can cause.

Luckily you can find out all about ingrown toenails and how they can be treated here in our in-depth blog “Ingrown toenails – What can I do?“.


Fungal Nails

Fungal nails are a common presentation to podiatry clinics AND are notoriously difficult to treat!

This is due to the opportunistic and very resilient nature of the fungus.

Despite this, there are a number of treatment options available.

There are also lots of things you can do to help prevent fungal infections from occurring.

Learn more about fungal nails in our article “Condition Spotlight: Fungal nails (onychomycosis)“.



Paronychia involves the inflammation of the tissues surrounding the nail plates.

The cardinal signs of infection – pain, swelling, redness, heat, and pus – are present when someone has paronychia.

Paronychia can be very painful if not treated appropriately and may lead to more severe infections.

It can be caused by acute or chronic trauma, including appropriate footwear, ingrown toenails, or direct trauma, such as something falling onto the nail.

Patients with paronychia often describe significant pain being present on light touch, as well as a throbbing sensation caused by a bacterial infection.

Treatment of paronychia by a podiatrist can include draining the pus, flushing the site with saline and applying betadine and a bandaid or other appropriate dressing.

Daily salt water baths will also assist with reducing the infection.

Antibiotics from a GP may also be required to help fight off the bacterial infection.



Onycholysis involves the nail becoming detached from the nail bed.

It can be caused by a variety of reasons, including a fungal nail, subungal exostosis (we’ll talk about this later), exczema or psoriasis, trauma to the nail or poor blood flow.

It is generally painless, however it may become painful if it is getting caught on your socks and sheets.

Treatment of onycholysis usually involves cutting the nail back to where it is adhered to the nail bed.  This will help avoid it becoming caught on something and being ripped off.

Regularly cutting the nails can prevent any problems with an onycholytic nail.


Onychauxic nails

Onychauxic nails are essentially thickened nails that are usually accompanied by discolouration.

They are often misdiagnosed as fungal nails, however, there is not always a fungal component present.

They often occur due to repetitive trauma.  The repetitive trauma causes the nail to thicken in order to protect itself.

Treatment of onychauxic nails includes regularly cutting and filing the nails.

When treating people for onychauxic nails, we will also assess your footwear to determine whether this is a contributing factor.



Koilonychia involves a convex curvature of the nails and is more common in the fingernails.

They are commonly referred to as “spoon nails”.  It can be present in those with thin nails and iron anemia deficiency.

Treatment involves regular appropriate cutting of the nails.



Also known as “ram horns nails”, onychogryphosis refers to nails which are deformed and thickened.  The affected nail may also be discoloured and have ridges through the nail.

The big toenail is the nail most commonly affected, however it can also occur on the other toes.

It is thought to be caused by constant trauma to the nails, such as when the nails are not cut regularly.

Treatment of onychogryphosis includes regularly cutting and filing the nails, as well as footwear education and advice.


Subungual melanoma

Most people have heard of melanomas but they don’t realise that they can also develop on the feet and nails.

Subungual means under the nail and they can present as discoloured lines or irregular shape underneath the nail.

Subungual melanoma nails can often be misdiagnosed as bruising underneath the nail.  It is important to identify whether you can recall a traumatic incident that may explain this discolouration.

If there is concern that you have a subungual melanoma, we will advise you to consult your GO or dermatologist for further investigation.

If you notice any discolouration underneath your nail, which changes in colour, size, or shape, it is important to get this checked.

If the nail is simply bruised, the discolouraton will ‘grow out’ as the nail grows, whereas a melanoma will not.


Subungual exostosis

A subungual exostosis occurs when the bone underneath the nail plate grows upwards and disturbs the nail itself.

It is most common on the big toenail and generally occurs due to either acute or repetitive trauma.

This outgrowth of bone forces the nail to become elevated and detached, which can result in a significant amount of pain.

It can be diagnosed via an X-ray.

Initial treatment can include nail management, footwear advice, and padding to protect the site.

The best treatment option is surgery, where the bone growth is removed.


As you can see, many different things can affect our nails! If you are experiencing any of the nail conditions we’ve mentioned today, or any pain or discomfort in your feet, nails, or lower limbs, book in to see us here at Watsonia Podiatry. Call us on (03) 9432 2689 or book an appointment online here.














Aaron Dri