Damaged and Deformed Fingernails
Is the injury recent? This is not the page you need. If you have hurt your finger in the last few days, if blood is building up under the nail, if the nail is torn or lifting off, if there is a cut across the nail bed, or if you cannot straighten or bend the finger, you need to be seen today. Go to your GP, an injury unit or an emergency department. There can be a fracture under the nail, and a nail bed that needs repairing does best when it is repaired early.
This page is for the stage after that, when the injury itself has healed but the nail has not come back the way it should.
Nails have long memories. A finger caught in a door, a hammer that missed, a ladder rung, a rugby match, any of it can heal perfectly well at the time and still leave you with a nail that grows back wrong for years afterwards.
Most people with a nail like this have been told to live with it. Very often nobody has ever properly looked at it. We will, and we take these cases rather than turning them away, including nails damaged years ago by a crush injury.
What we see
- A split or ridged nail. A line running the length of the nail that reappears every time it grows out.
- A thickened nail that is hard to cut and uncomfortable under pressure.
- A nail that lifts away from the bed, catching on gloves, clothing and hair.
- A nail that grows at the wrong angle, or is much narrower or wider than it used to be.
- A nail that keeps getting infected at the same spot where it was damaged.
- A painful nail, where pressure on the fingertip is genuinely sore long after the injury healed.
Why an old injury keeps showing up in the nail
Your nail is produced by a structure at its base called the matrix, most of which sits hidden under the skin behind the visible nail. The matrix is the factory. The nail you can see is the product.
If the matrix itself was damaged at the time of the injury, it can be left with a scar, and a scarred matrix produces a scarred nail. Every single time. That is why a nail can split in the same place for twenty years: the nail is not failing to heal, it is faithfully reproducing the damage upstream.
Swipe the diagram to see it all, or tap it to open full size.
The honest part
We would rather say this on the website than have you find it out in the chair.
Surgery on the nail cannot un-scar a matrix. If the ridge or split in your nail is coming from a scarred matrix, removing the nail will not change what grows back, because the same factory produces the same product. Any clinic that promises you a perfect nail from a scarred matrix is promising something it cannot deliver.
What we can do, and do regularly, is deal with the consequences, which is usually what is actually bothering you. A thickened nail that hurts under pressure. A lifting nail that catches on everything. An edge that keeps becoming infected. A nail that has simply become more trouble than it is worth. Those are all fixable, and fixing them is often the difference between thinking about your finger every day and never thinking about it again.
What we can offer
An assessment, on its own
Plenty of people come in simply to find out what is going on and what their options are, having never had it explained by anyone. That is a perfectly good reason to book, and you are not committing to surgery by asking.
Partial nail avulsion
Where one side of the nail is the problem: an edge that catches, digs in or keeps becoming infected. That side is removed and its matrix treated so it does not regrow, leaving the rest of the nail in place.
Total nail avulsion
Where the whole nail is beyond use, painful under pressure, or repeatedly infected. The nail is removed. Depending on what is found and what you want, it may be left to regrow, or the matrix treated so that it does not. This is a decision to make together, and it is worth thinking about before the appointment rather than on the day.
Old crush and impact injuries
A finger caught in a door, a hammer blow, a weight dropped on the hand. These often leave a nail that is permanently thickened, ridged or lifting, sometimes years later. We see these regularly and we do not turn them away. Bring it in, even if it happened a decade ago and even if you have been told nothing can be done.
Ongoing nail care
Not every damaged nail needs a procedure. Some simply need professional cutting back and thinning that you cannot do at home with the nail in that condition, done properly and at sensible intervals.
Swipe the diagram to see it all, or tap it to open full size.
When we would send you elsewhere
We take these cases, but not every finger problem is a nail problem. We will refer you on, rather than treat you, if:
- The fingertip or the bone itself is deformed, not just the nail
- You have lost movement or sensation in the finger
- You want the matrix surgically reconstructed rather than the symptoms managed, which is hand surgery
- There is anything suggesting an unhealed or badly healed fracture underneath
If that is where you end up, we will tell you plainly and point you at the right person. We would rather do that than take your money for the wrong procedure.
One thing to take seriously. A dark streak running the length of a single nail, a change in colour under the nail, or a nail change that has appeared without any injury you can remember, should always be looked at by a doctor. In the great majority of cases it is harmless. It is checked because of the small number of cases where it is not, and because checking is easy.
Common questions
My nail has been like this for years. Is it too late?
No. There is no time limit on being assessed. It does mean the shape of the nail is settled rather than still changing, which actually makes it easier to say what can and cannot be improved.
Will removing the nail make it grow back normally?
Only if the matrix underneath is healthy. If the matrix was scarred by the original injury, the new nail will carry the same features. We will look and give you a straight answer before anything is decided.
How long until the nail grows back after a total avulsion?
A fingernail grows around three millimetres a month. Regrowth usually starts within a few weeks, and full regrowth commonly takes in the region of four to six months.
Is this cosmetic?
Sometimes it is. More often people come because the nail hurts, catches or keeps getting infected. Both are legitimate reasons to do something about it.
What does it cost?
We give you the full price at the consultation, before anything is done, and it does not change afterwards. It is one all-inclusive fee covering the consultation, the local anaesthetic, the procedure, dressings and your aftercare. There is no separate consultation charge and nothing is added on later. If we assess your nail and agree that surgery is not the right answer for you, we will tell you that rather than proceed.