Why is My Little Toenail So Small? Underlying Causes and Treatment

Examining Possible Reasons for a Small Little Toenail

A small little toenail, medically known as an dystrophic toenail, can be caused by a variety of reasons. The little toe, also called the fifth digit, is the smallest of the toes and its nail tends to be subjected to a lot of repetitive friction and pressure inside tight shoes.

Underlying Medical Conditions

Several underlying medical conditions may contribute to a little toenail failing to grow to an expected larger size:

• Fungal infections eat away at the toenail, causing thinning, fragility and shrinkage.
• Injuries or trauma to the little toe can damage the nail bed and disrupt proper nail growth.
• Poor circulation reduces blood flow to extremities like the little toe, impairing nail growth.
• Nerve damage in the little toe from conditions like peripheral neuropathy can affect nail growth.
• Skin problems like eczema or psoriasis cause inflammation and abnormal nail changes.
• Autoimmune disorders impacting the small toe and nail development.
• Congenital causes where the toenail fails to develop properly from birth.
• Chemical exposure to toxins disrupts nail plate growth and keratinization.

Extrinsic Factors Causing Size Issues

There are also external triggers that may cause a smaller than normal little toenail:

• Ill-fitting narrow shoes and socks put pressure on nails.
• Repeated injury or trauma when stubbing the little toe.
• Frivolous nail procedures like aggressive cutting or tearing.
• Allergic reactions to nail polish, gels, acrylics or adhesives.
• Exposure to harsh chemicals found in cleaning products.

Diagnosing the Exact Cause of a Small Little Toenail

Consulting a podiatrist is the best way to get an accurate diagnosis for a small fifth toenail. The podiatrist will examine the toenail and digit to check for any visible signs of infection, inflammation, injury or deformity. Generally the following diagnostic methods may be used:

• Medical history to uncover associated medical conditions.
• Physical examination of the entire foot and digits.
• Microscopic exam to help identify fungal infection.
• Blood tests to diagnose systemic diseases.
• Biopsy for abnormal looking nail cells.
• Imaging tests like X-rays or MRI for structural issues.

Most Common Causes

The most prevalent causes for little toenails to become thin, fragile, misshapen or shrink in size generally includes:

1. Onychomycosis: Fungal infections of nails, predominantly caused by dermatophytes, are highly pervasive due to communal showers, locker rooms and swimming pools. They thrive on warm, moist environments like the insides of shoes and socks. Left untreated, the fungus continues to eat away at the protein keratin making up the toenail plate. This gradually causes the nail to become brittle and crumbly, with debris accumulating under the tips which become thick and distorted. The shrinking little toenail may become discolored - typically yellowish-brown or white.
2. Repeated trauma: Habitual injury from ill-fitting shoes causes bruising and damage to the nail plate and bed. This impedes normal nail growth and the nail tends to become fragile and warped over time. Those with longer second toes overlapping their little toes are especially prone due to the friction against shoes.
3. Poor peripheral circulation: Reduced blood circulations to the extremities, seen in diabetes, Raynaud's or blood vessel diseases limits nutrients and oxygen for healthy nail growth. The little toenails become thin and shriveled.

Treatment Options for a Small Little Toenail

Treatment is directed at the specific underlying cause for the abnormally small nail. Common treatment approaches include:

Medications

• Antifungal medicines: Prescription oral drugs or topical solutions to eradicate fungal infections depending on severity. Removing diseased debris and trimming the nail can combine with this.
• Medicated nail lacquers or creams: These combine antifungal agents in a film-forming base that is painted onto the affected nail.
• Immunomodulators: These regulate overactive immune responses from conditions like psoriasis or eczema that cause toenail changes.

Nail Procedures and Surgery

• Debridement to remove diseased nail: This is clipping away dead crumbly nail not attached to the nail bed for symptomatic relief and to allow antifungal penetration. Chemical cauterization may follow.
• Partial nail removal (onychectomy): This surgically extracts part of the nail plate and debris for refractory cases. The nail bed generating new nail growth is left intact.
• Complete nail removal with matricectomy: As a last resort, the entire nail unit including the matrix is removed to prevent recurrence. This is done with phenol or surgical matricectomy. Eventually the nail may regenerate.

Preventive Care

• Wear correctly sized footwear to avoid repetitively jamming toes
• Alternate shoes to give toes space to spread out
• Clip nails straight across to avoid ingrown corners
• Treat minor injuries promptly to avoid infection
• Apply antifungal spray or powder into shoes
• Keep feet clean and dry to discourage fungal infection

Learning more about what triggers abnormal little toenail shrinkage can help you seek appropriate treatment early to regain healthy looking nails.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.