Toenails are dense, keratinized structures produced by the nail matrix, the growth center located beneath the skin at the base of the toe. Toenails grow slowly, averaging about 1.62 millimeters per month, roughly half the speed of fingernails. Because growth is already slow, any interruption can make it appear non-existent; a full toenail replacement takes between 12 and 18 months. When the nail matrix severely slows or ceases cell production, the perceived halt in growth is known clinically as onychomadesis. This cessation of growth is typically caused by external injuries, localized infections, or underlying health problems.
Physical Damage and Chronic Pressure
The most frequent causes of slowed or stopped toenail growth involve mechanical injury to the nail’s growth center. Repetitive, minor trauma, often called microtrauma, is a common culprit. This constant, low-grade stress is typically caused by ill-fitting footwear, such as shoes that are too tight, too short, or too narrow in the toe box.
This chronic pressure repeatedly impacts the nail matrix, disrupting cell production. The resulting damage can lead to a thickened, misshapen nail plate that appears to grow upward or outward, but not forward over the nail bed. A sudden, acute injury, or macrotrauma, such as stubbing a toe or dropping a heavy object, can also cause a temporary or permanent shutdown of the matrix.
Severe trauma can result in a subungual hematoma, a collection of blood under the nail plate that separates the nail from the underlying bed. If the matrix is deeply lacerated or crushed, scar tissue may form, permanently preventing a normal, smooth nail plate and halting future growth. The nail plate may also lift away from the bed, a condition called onycholysis, which complicates healthy growth and makes the area prone to secondary issues.
Fungal and Dermatological Conditions
Localized diseases frequently interfere with healthy toenail growth. The most common medical cause is onychomycosis, a fungal infection where dermatophytes, yeasts, or molds invade the nail structure. The fungus consumes the keratin protein, leading to destructive changes that mask or halt forward growth.
Infected toenails typically become discolored (yellow, white, or brown) and develop significant thickening, a process called hyperkeratosis. This thickening and the accumulation of debris push the nail plate upward and away from the nail bed, making it brittle and crumbly. This disfigurement makes forward growth highly irregular and slow, often appearing to stop entirely.
Other localized skin conditions can also inflame the nail matrix, distorting or arresting cell division. Psoriasis, an autoimmune condition, can target the nail unit, causing pitting, discoloration, and separation of the nail plate from the bed. Lichen Planus, another inflammatory skin condition, can damage the matrix, leading to thinning, longitudinal ridging, and a dramatic slowdown in growth.
Internal and Systemic Inhibitors
A persistent lack of toenail growth may signal an issue with the body’s overall health and circulation, as the nail matrix requires a steady supply of nutrients and oxygen. Peripheral Artery Disease (PAD) is a systemic inhibitor where narrowed arteries reduce blood flow to the extremities, starving the toe’s growth center. This restricted circulation prevents the matrix from maintaining its normal rate of cell division, leading to noticeably slower or arrested growth.
Chronic health conditions, such as diabetes, exacerbate poor circulation and increase the risk of fungal infections, which further hinder nail growth. Aging also contributes to a slower growth rate, as blood circulation decreases and the matrix’s cellular activity diminishes. This slowdown is a normal physiological change often perceived as a complete cessation of growth.
Nutritional deficiencies can also limit the building blocks necessary for new nail cells. A lack of specific micronutrients like iron, zinc, or the B vitamin Biotin can impair the quality and speed of nail production. Certain medications, particularly chemotherapy agents like taxanes, directly target and damage rapidly dividing cells, including those in the nail matrix, leading to a temporary halt in growth.
Determining When to Seek Professional Advice
It is advisable to seek professional help from a podiatrist or dermatologist when a lack of growth is accompanied by worrying symptoms or does not resolve on its own. Persistent non-growth, especially after a traumatic injury, should be evaluated if the nail has not shown signs of resuming growth after six months.
Immediate consultation is recommended if you notice accompanying pain, significant swelling, or redness around the nail folds, which may indicate a deep infection or paronychia. Individuals with chronic conditions like diabetes should seek prompt care for any toenail abnormality, as reduced sensation and circulation can quickly turn minor issues into serious infections.
A doctor can diagnose the underlying cause, which may involve laboratory testing for fungal infection or blood tests to check for systemic problems.