4 Causes of Toenail Pain
What is toenail pain?
There are many habits and conditions that can make your toenails hurt. For example, wearing shoes that are too tight or cutting your toenails too short can make your toenails hurt for a few days.
Toenails may also hurt because of more serious conditions like infections. People who have diabetes or problems with decreased blood flow are more likely to develop foot infections that can cause toenail pain.
In many cases, toenail pain can be treated at home. But you should call your doctor if at-home treatments don’t work, your toenail pain worsens, or you notice drainage or pus around the nail.
Rarely, infections of the toe can become more serious and cause symptoms such as fever and nausea. In this case, you should go to the ER immediately.
1. Toenail trauma
- Painful toenail
- A reddish-black bruise under the nail (subungual hematoma)
- A feeling of pressure under the nail
- A visible separation between the nail and the skin
Toenail trauma can happen from dropping a heavy object on your foot, falling, stubbing your toe, or even wearing shoes that are too tight for a long period of time. You may also get it from repetitive exercises, like running.
Minor bruising should go away on its own. Wearing comfortable shoes can help ease pain while you heal.
If you have severe toenail pain, see your doctor. The physician can drain the blood from under the nail, which will help with pain. Don’t try to do this at home because you may cause an infection.
In some cases, your toenail may fall off. The nail should regrow within the next 6 months. If you do lose the nail, keep the toe clean and dry. Wear shoes that protect the more sensitive tissue that is usually covered by the nail. Closed toe shoes without a heel that are not tight on the toes will help avoid putting extra pressure on the toes.
Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Motrin) can help with the pain. Keeping your foot elevated can help decrease the amount of swelling in the toes or foot.
If the discoloration and pain don’t ease, or you see the darkened area “growing” under the nail, see your doctor to rule out skin cancer or a tumor.
2. Ingrown toenail
Some people believe that you can prevent ingrown toenails by trimming the corner of the nail. Instead, cut your nail in a straight line rather than cutting a curve shape or removing a corner of the nail. You should avoid cutting the nail too short. —Dr. Leila Mufdi
- Pain in the skin around the nail
- Redness around the nail
- A fluid-filled bump on the edge of the nail bed
An ingrown toenail occurs when the skin that surrounds your nail grows over the tip of the nail. Cutting your toenails too short or wearing shoes that are too tight may increase your risk of developing ingrown toenails. Left untreated, ingrown toenails can be uncomfortable and lead to a toenail infection such as paronychia.
Minor ingrown toenails without significant pain or signs of infection (such as warmth and drainage) may be treated at home. Soaking your feet in warm water several times a day can relieve redness and tenderness.
Taking over-the-counter pain medications and wearing shoes that don’t pinch the toes can provide relief while ingrown toenails heal.
If at-home remedies don’t help, see your doctor or a podiatrist. The doctor can trim or partially remove the nail. You should also call your doctor if you see signs that the condition is worsening. These signs include pus, discharge, and an unpleasant smell.
If you have an underlying condition such as diabetes, see your doctor at the first sign of an infected ingrown toenail. You’re at greater risk of developing more severe infections, so it’s important to get treated as soon as possible.
- Painful toenail
- Skin warmth and redness that may extend outward from toenail
- Swollen toe
- Pus coming from toenail
A paronychia is an infection of the skin around your nails. While it more commonly develops around the fingernails, a paronychia can also develop around the toenails, too.
Trauma to the toenail and ingrown toenails can increase your risk of developing a paronychia. Problems like these make it easier for bacteria to enter your body and cause infection.
Soaking your feet in warm water frequently can help ease pain and swelling. However, if your symptoms are worsening despite treatment at home over 3 to 4 days, if you see a collection of pus or an infection, or if you have diabetes or other immune system issues, you may need to see your physician to have the infection drained.
If you have a paronychia, watch for signs of cellulitis. This is a potentially serious bacterial infection that spreads to other tissues. Signs of cellulitis include pain, redness, and warmth of the affected skin. If you have these symptoms, see your doctor right away. You may need antibiotics.
If cellulitis becomes severe, you may experience symptoms such as red streaks on your leg, fever, nausea, and vomiting. In this case, you should go to the ER immediately.
4. Fungal infections
A fungal infection is the most common issue leading to the loss of a toenail. Exposure to sunlight and allowing your feet to air out by walking barefoot at home provide an environment that is less favorable to fungal growth. —Dr. Mufdi
- Toenail pain
- Thickening and discoloration of the toenail
- Splitting of the nail
- Painful or itchy toes or feet
- Peeling skin between the toes
Fungal infections may affect the toenails (called onychomycosis) or the skin of the toes and feet (tinea pedis or athlete’s foot).
Onychomycosis can cause thickening and discoloration of the toenail. Changes in the nail can also cause pain, especially with pressure on the nail while wearing shoes.
It can usually be treated with medicated nail polish—you can find it at your local pharmacy. If symptoms linger, see your doctor, who can prescribe antifungal medication.
Other possible causes
A number of conditions can cause toenail pain, but toenail pain may not be a primary symptom. These include chronic illnesses such as lung or liver disease, arthritis, bursitis, and skin conditions such as psoriasis.
When to call the doctor
It’s important to monitor both toe pain and any symptoms associated with it. Call your doctor if:
- Your toenail remains painful despite at-home treatment
- Your toenail pain affects your quality of life (prevents you from exercising, wearing shoes, etc.)
- There is pus or discharge coming from your toenail
- Your toenail has a foul odor
- You have red streaks on your foot
- You have toenail pain and are diabetic
Should I go to the ER for toenail pain?
You should go to the ER if you have any of these signs of a more serious problem:
- Persistent fevers
- Reddish streaks up the leg
Fungal infections are frequently described as burning and itching. Bacterial infections can be described with the terms swelling, redness, and drainage. —Dr. Mufdi
- Wear comfortable shoes that don’t constrict the movement of your toes.
- Warm foot soaks several times a day can reduce pain and tenderness.
- Avoid wearing nail polish while you heal.
- Keep your feet clean and dry.
Other treatment options
- Fluid drainage performed by your doctor
- Antifungal cream and nail polish
- Physical therapy
- Wearing comfortable, well-fitting shoes
- Eating a balanced diet. A diet with adequate vitamins and healthy proteins can provide nutrients necessary for nail growth and help prevent your nails from becoming weak, dry, or brittle.
- Surgery to remove the affected nail
Dr. Mufdi is a board-certified emergency medicine physician. She obtained her undergraduate degree in neurobiological sciences at the University of Florida. She attended Chicago College of Osteopathic Medicine and completed an emergency medicine residency at Albert Einstein Medical Center in Philadelphia. Recognizing the value of health literacy, she is happy to have joined Buoy Health in 2021.