Copyright (c) 2010 Benjamin Marble

Pizza is, quite possibly, one of the most appealing foods on the planet. One of the charms of pizza is the sheer variety of forms it comes in: toppings of all sorts from gourmet cheeses to asparagus to sausage, a huge assortment of sauces (garlic, tomato, alfredo), variations like dessert pizza, and more! Sadly, there are some who would make of the noble pizza a war zone. Raging battles have been fought (kind of), brave men and women have given their lives (in a metaphorical sense) over the Great Pizza Question: whether it's better to have thick crust or thin.

Now, nails do nicely with a moderate sort of thickness. Get a nail too thin, and it's likely to be brittle and break, or be prone to injury. But if a toenail gets too thick, it becomes difficult to trim, can bump painfully against the inside of your shoes, and it can also look kind of awful and be pretty embarrassing.

Thick toenails don't come about because someone's clamoring for a deep dish pizza. But there are several other possible causes if your toenails start to thicken up. (If they start to grow pepperoni and olives, there probably isn't any good explanation at all.) Fungal infection of the toenail, psoriasis, hypothyroidism, bone spurs growing under the nail, and just plain old aging may all cause your toenails to bulk up, and they usually bring along other sets of symptoms as well. Or, if you've had trauma to the toe, your nail may fall off and simply grow in a bit thicker than it was before.

Symptoms that may accompany thickened toenails really depend on the cause. For instance, fungal infections of the nail tend to make the nail look yellowed, brittle, and foul-smelling. If psoriasis is causing your nails' thickening, you may also have patches of irritated skin (usually reddish, or silvery and flaky) on other parts of your body. Your nails may also develop pits or dents in the surface, and may come away from the nail bed. You may even develop psoriatic arthritis, which can feel a lot like rheumatoid arthritis. Hypothyroidism may be accompanied by weight gain, fatigue, feeling cold, and depression, among other symptoms.

Whether your podiatrist prefers thin crust or thick has really very little bearing on his or her ability to diagnose the cause of your thickened toenails (even though pizza preferences can make a fun conversational topic). So, instead of asking you about your personal pizza likes and dislikes, your podiatrist will probably inquire about your symptoms, such as when your nails started thickening, whether there are any other symptoms, etc. He or she will also take a look at your toenails to determine a likely cause. If your podiatrist suspects a fungal infection, he or she will likely get a scraping of your toenail for analysis.

Obviously, the treatment associated with your thickened toenails depends on the cause. Fungal infections can be treated with topical (applied directly to the nail) or oral anti-fungal medications. Psoriasis usually involves ointments and creams, oral medications or injections, phototherapy (careful exposure to ultraviolet light), and techniques for reducing stress (which may cause a flare-up). Hyperthyroidism is usually treated with oral medications.

Some causes of thickened toenails may require surgery to relieve your symptoms. Your podiatrist can discuss all treatment options with you. (Unfortunately, if your thickened nails are caused by aging, there really isn't a cure for getting older, but your podiatrist may recommend a few things if your nails are making you uncomfortable.)

There are a few things you can do to prevent some causes of toenail thickness. To maintain healthy nails, you'll want to do the following:

1) Keep your feet clean and dry. Wash your feet daily with soap and water, and dry your feet thoroughly. Wear socks that wick moisture away from your foot (synthetic fibers tend to do this better than cotton or wool). Change your shoes and socks regularly, preferably more than once a day. Wear shoes that allow your feet to breathe (leather seems to work pretty well).

2) Trim your toenails straight across and don't dig down the sides of the nail. Keep your toenails trimmed so that they don't extend beyond your toe. Also, don't trim your nails by tearing at them. Use clippers instead.

3) Keep your toenail trimmers and other pedicure tools clean and disinfected.

4) Never, ever, ever, put pizza sauce and toppings on your toes. Not that it'll hurt them, exactly. It's just kind of gross.