We are all too aware of the signs of aging on our faces. Loss of volume creates accentuated hollows and wrinkles and a change in texture becomes apparent from collagen breakdown. Few, however, are aware of the fact that our nails also age. These age-related changes are apparent on both the fingernails and toenails.
As we age, our nail physiology actually changes as part of the nail growth plate (nail matrix) begins to thin. This phenomenon results in the development of vertical ridges along the nail. Compromised circulation or less efficient blood flow to our extremities can also contribute to nail ridging. These ridges are called onychorrhexis, a clinical sign of brittle nails. Interestingly, we see the effects of circulatory compromise in patients who are paralyzed on one side, or even in patients who have one arm in a cast for an extended period. The extremity that has a compromised range of motion will often have brittle nails while the opposite, functional extremity will have normal nails.
Nail growth rates also affect the appearance of the nail. As we age, our nails grow at a slower rate. In fact, studies have shown statistically significant differences in growth rates before and after age 40. As our nail growth rates slow, the nails are exposed to considerably more environmental influences and these exposures over time can affect the overall appearance and strength of our nails.
One of the most common age-related nail changes is onycholysis. Onycholyis is separaton of the nail from the underlying nail bed. With age, nails fail to adhere to nail beds as firmly. Consequently the slightest trauma, such as overly vigorous cleaning under the nail with a tool, can result in the nail lifting off of the nail bed.
Not every yellow toenail is nail fungus! In fact, often, these patients don’t have any evidence of nail fungus; instead they have nail dystrophy — thickening and yellowing of the nail. As we age, our feet change due to years of repetitive micro trauma. Other factors that affect our feet and our nails include gait, postural alignment, weight, and weight distribution changes. The trauma is not usually anything “traumatic.” In contrast, it is due to years and years of friction and rubbing within our shoes. Chronic, repetitive, micro-trauma directly affects the nail because the nail growth begins anatomically between the distal joint and the cuticle. Therefore any repetitive trauma at that region will affect the way the nail grows and appears. Usually these changes result in a thickened, mal-aligned toenail. As our feet change, our toenails follow suit.
Compromised circulation or less efficient blood flow to our extremities can contribute to onychorrhexis (nail ridging). Other age-related toenail issues include subungual hemorrhage. This occurs when the toe is stubbed or injured and blood collects under the nail forming a blue, violaceous patch at the nail. This phenomenon is more common in people who are taking blood thinners. These medications are extremely common among an older population.
Subungual hemorrhages occur when the toe is stubbed or injured and blood collects under the nail. This phenomenon is more common in people who are taking blood thinners.
As we age, it often becomes more challenging to physically reach our toenails as well as to manually handle a nail clipper. Proper foot care often suffers as a result. The elderly can consequently be predisposed to nail abnormalities such as onychocryptosis (ingrown nails) as well as onychogryphosis (curved nails that look like a ram’s horn). Seeing a podiatrist for regular foot and nail care becomes important to prevent these issues and to maintain healthy feet in an elderly population.
When caring for toenails, they should be cut straight across as opposed to on a curve to prevent the formation of ingrown nails. When using a nail clipper, make sure that it is replaced periodically, as the blades dull and oftentimes we don’t realize we are using a clipper that is 10 years old. Dull implements are more difficult to use, especially when toenails are thick and brittle. If an individual is not physically able to cut his or her toenails, then regular podiatric care becomes essential.