Symptoms A-Z

Toenail Pain Symptoms, Causes & Common Questions

Toenail pain often comes along with a bruise under the nail, a black toenail, or infected skin around the toenail. The most common cause of toenail pain is an ingrown toenail, a fungal infected toenail, or a trauma-related injury to the toenail which can also cause blood under the nail. Read below for more information on additional causes and how to treat a painful toenail.

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Common Toenail Pain Symptoms Explained

Certain conditions can cause mild to severe pain under and around a toenail. The pain can make it difficult to put on shoes and walk around. Often the nail fold, meaning the skin just around the toenail, is involved as well. Luckily, many causes of toenail pain can be easily treated and then prevented from recurring. [1]

Symptoms that can be associated with toenail pain include: [1,4,5]

  • Drainage
  • Swelling
  • Redness of surrounding skin
  • Toenail thickening
  • Toenail crumbling
  • Yellow toenail
  • Red/black toenail
  • Separation of the toenail from the toe
  • Unpleasant smell

What Causes Toenail Pain?

Ingrown toenail:

  • When a toenail grows back after being cut, the edge can grow into the surrounding skin. This results in pain, swelling, and redness. Sometimes the injury to the nail fold will lead to infection and chronic inflammation. [1]

Infectious causes:

  • Bacterial infection: An acute or chronic bacterial infection of the nail fold can cause pain, redness, and swelling, along with pus visible under the skin right next to the toenail. [2]
  • Fungal infection: An infection of one or more toenails by fungus is a common condition (onychomycosis). The affected toenails will be thick and yellow in color and may start to crumble. In severe cases, the toenails will also become painful. It can be difficult to completely get rid of a fungal toenail infection. [2]

Trauma-related causes:

  • Foreign body: A sharp object, such as a wooden splinter, can become wedged under a toenail and cause severe toenail pain. [3]
  • Bleeding under the toenail: Trauma to the toenail can result in blood collecting beneath the nail, creating a red/black color. Increased pressure beneath the toenail caused by the blood can be very painful. [4]
  • Other injury: The toe can be cut or crushed by an object, leading to a painful injury involving the toenail. Some or all of the toenail may get ripped off from the toe. [5]

Tumor-related causes:

  • Multiple types of benign tumors can form underneath the toenail, causing pain and separation of the toenail from the toe. [6]

Systemic disease causes:

  • Some chronic diseases can affect the skin and toenails, causing pain and changes in the structure of the nails. These include sarcoidosis and psoriasis. [7]
  • Other systemic diseases, particularly those that cause decreased functioning of the immune system, can cause a predisposition to painful toenail problems such fungal infection. [7]

8 Possible Toenail Pain Conditions

The list below shows results from the use of our quiz by Buoy users who experienced toenail pain. This list does not constitute medical advice and may not accurately represent what you have.

Nail infection (paronychia)

Paronychia is an infection of the skin of the fingers or toes, at the place where the skin folds down to meet the nail.

Acute, or sudden onset, paronychia is caused by the staphylococcus bacteria. The organism can gain entry if the nail is cracked, broken, bitten, or trimmed too closely.

Chronic, or ongoing, paronychia is caused by a fungus. Anyone whose work requires their hands to be wet much of the time is susceptible.

People with diabetes or a weakened immune system are more susceptible to nail infections.

Symptoms include sore, reddened, swollen skin around the nail, sometimes with pus collecting under the skin.

Diagnosis is made through physical examination and sometimes skin culture to identify the organism involved.

Treatment for acute paronychia involves having a medical provider clean the wounded nail and drain any infection, and sometimes provide a course of antibiotics.

Treatment for the chronic form involves keeping the skin dry and using an antifungal medication on the affected nail.

Rarity: Rare

Top Symptoms: spontaneous finger pain, fingernail pain, fingernail swelling

Urgency: Phone call or in-person visit

Chronic idiopathic peripheral neuropathy

Peripheral neuropathy refers to the feeling of numbness, tingling, and pins-and-needles sensation in the feet. Idiopathic means the cause is not known, and chronic means the condition is ongoing without getting better or worse.

The condition is most often found in people over age 60. Idiopathic neuropathy has no known cause.

Symptoms include uncomfortable numbness and tingling in the feet; difficulty standing or walking due to pain and lack of normal sensitivity; and weakness and cramping in the muscles of the feet and ankles.

Peripheral neuropathy can greatly interfere with quality of life, so a medical provider should be seen in order to treat the symptoms and reduce the discomfort.

Diagnosis is made through physical examination; blood tests to rule out other conditions; and neurologic and muscle studies such as electromyography.

Treatment involves over-the-counter pain relievers; prescription pain relievers to manage more severe pain; physical therapy and safety measures to compensate for loss of sensation in the feet; and therapeutic footwear to help with balance and walking.

Rarity: Rare

Top Symptoms: distal numbness, muscle aches, joint stiffness, numbness on both sides of body, loss of muscle mass

Urgency: Primary care doctor

Skin infection of the foot

An infection of the skin of the foot is almost always either fungal or bacterial. A fungal infection of the foot is called tinea pedis, or athlete's foot. It is caused by different types of dermatophyte fungus and is commonly found in damp places such as showers or locker room floors. A bacterial infection anywhere on the skin is called cellulitis if it extends under the skin. It can develop after a break in the skin allows bacteria to enter and begin growing. These bacteria are most often either Streptococcus or Staphylococcus, which are found throughout the environment.

Most susceptible are diabetic patients, since high blood sugar interferes with healing and wounds can easily become chronic and/or deeply infected. Diagnosis is made through physical examination by a medical provider.

Treatment for either a fungal or bacterial infection involves keeping the skin dry and clean at all times. A fungal infection is treated with topical and/or oral antifungal medications, while a bacterial infection will be treated with topical and/or antibiotic medications.

Rarity: Uncommon

Top Symptoms: fever, foot pain, foot redness, warm red foot swelling, swollen ankle

Symptoms that always occur with skin infection of the foot: foot redness, foot pain, area of skin redness

Urgency: Primary care doctor

Toe bruise

Toe contusion (bruise) is the damage of the blood vessels (veins and capillaries) that return blood from your tissues back to the heart. The blood pools there and turns blue or purple. It's typically caused by a bump, hit, or fall.

Rarity: Rare

Top Symptoms: constant foot pain, toe injury, toe pain from an injury, swollen toes, toe bruise(s)

Symptoms that always occur with toe bruise: toe pain from an injury, toe injury, constant foot pain

Urgency: Self-treatment

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Tarsal tunnel syndrome

Tarsal tunnel syndrome refers to the symptoms that result from compression of the posterior tibial nerve. The posterior tibial nerve provides sensation to the bottom of the foot and controls some of the muscles involved in foot structure and movement.

Symptoms of tarsa...

Raynaud phenomenon

Raynaud phenomenon, also called Secondary Raynaud syndrome, is a condition that causes small arteries in the skin to abnormally constrict on exposure to cold water or air. This limits blood flow to the hands, fingers, feet, toes, nose, and ears.

Secondary Raynaud syndrome is rare and is caused by another underlying medical condition, often a connective tissue disorder such as rheumatoid arthritis, scleroderma, or lupus.

Women are more likely than men to be affected, especially if living in cold climates. Family history and smoking are also risk factors.

Symptoms include the hands and feet becoming numb and cold. The skin color changes from pale to bluish, and then to red as the skin warms again.

If not treated, patients may get ulcerated sores or deformities of the fingers and toes, or even gangrene, due to the lack of circulation.

Diagnosis is made through patient history, physical examination, and blood tests.

Treatment includes medications to help increase circulation; treatment of any underlying conditions; and lifestyle changes to gain better protection for the extremities in cold conditions.

Rarity: Common

Top Symptoms: distal numbness, cold toe, cold fingers, spontaneous toe pain, spontaneous finger pain

Urgency: Self-treatment

Athlete's foot (tinea pedis)

Athlete's foot is a common fungal infection of the feet and/or toes. Warm, moist environments and community showering are common causes of this type of infection.

Rarity: Common

Top Symptoms: foot redness, foot/toe itch, foot skin changes, spontaneous foot pain, peeling between the toes

Symptoms that always occur with athlete's foot (tinea pedis): foot redness

Symptoms that never occur with athlete's foot (tinea pedis): toe injury

Urgency: Self-treatment

Bunion

A bunion is a deformity of the joint at the base of the big toe. Certain footwear styles can worsen bunions.

Rarity: Common

Top Symptoms: bump on outside edge of big toe, big toe pain, toe pain that gets worse when wearing closed-toe shoes, foot ulcer, pain at the base of the toe

Symptoms that always occur with bunion: bump on outside edge of big toe

Urgency: Primary care doctor

When and How to Treat Toenail Pain

Most causes of toenail pain do not need require urgent treatment. However, some types of injuries should be evaluated quickly.

Seek immediate treatment if:

  • A foreign body has been wedged under the toenail, particularly a wooden splinter or other type of plant material like a thorn. These objects should be removed as quickly as possible to avoid severe infection and inflammation. [3]
  • An injury has caused part or all of the toenail to come off of the toe. [4]

In some cases, even though emergency toenail pain treatment isn't necessary, you should still seek medical evaluation. [4,5]

Make an appointment with your medical provider if:

  • You have diabetes, in which case any foot infection can become severe. [8]
  • You have any chronic medical condition that has affected your skin in the past, such as psoriasis. [7]
  • You have redness and warmth surrounding the toe. [8]
  • You notice pus draining from the toenail and surrounding skin. [2]
  • Your pain is associated with a growth underneath the toenail. [6]
  • Your toenails have thickened and changed in color. [2]

Your medical provider may prescribe one or more of the following toenail pain treatments, depending on the cause of the toenail pain:

  • A splint to help separate an ingrown toenail from the surrounding skin. [9]
  • Surgical removal of part or all of the toenail. [9]
  • Drainage of infected fluid. [9]
  • Oral antifungal or antibacterial medication. [9]
  • Antibiotic cream. [9]
  • Treatment for an underlying medical condition that is affecting the toenails. [7]
  • A tetanus shot may be necessary if a foreign body such as a splinter is responsible for the pain. [3]

Some home treatments may help with toenail pain symptoms.

  • Soak the toe in warm water. [1]
  • Wedge a small piece of cotton or dental floss underneath the edge of an ingrown toenail. [1]
  • Trim toenails regularly. Cut them straight across on top and do not attempt to trim around the edges. [1]
  • Wear shoes that are the correct size (your toes should have a little bit of wiggle room). [1]

FAQs About Toenail Pain

Here are some frequently asked questions about toenail pain.

Why do I keep getting a painful ingrown toenail?

Ingrown toenails are often caused by cutting the nails incorrectly. Make sure to cut toenails straight across the top and avoid rounding the edges. Ingrown toenails are also more likely to occur in the setting of sweaty feet and wearing shoes that are too small. Athletes may get ingrown toenails due to repetitive trauma from the toes hitting the front of the shoe. [1,10]

Can toenail pain be caused by an infection?

Yes, a bacterial infection of the skin surrounding the toenail can be very painful. In this case there will be redness and swelling around the toenail, as well as pus visible beneath the skin and possibly drainage. The infection often starts due to an ingrown toenail. A severe fungal infection of the toenail can also be painful. [9]

Can painful toenail conditions be caused by chronic medical problems?

Certain chronic medical conditions can cause abnormalities of the fingernails and toenails along with pain. For example, psoriasis is an inflammatory skin condition that can cause thickening, pitting, and separation of the nails. Chronic conditions that cause decreased blood supply to the feet, such as peripheral arterial disease and diabetes, can make the toenails more vulnerable to injury and infection. [7]

What should I do if I have toenail pain because of a splinter?

A splinter or any other object wedged beneath the toenail can be extremely painful. It is important to get treatment quickly to remove any type of vegetation, such as a wooden splinter or cactus spine. These objects can cause severe inflammation and infection. A medical provider may cut a triangle shape out of the nail in order to completely remove the splinter. [3]

Why is my painful toenail changing color?

There are a couple of conditions that can cause both toenail pain and color changes. A fungal infection can cause the toenail to turn a yellow/brown color, and can be painful. One type of bacteria that causes infection of the toenail and surrounding skin, called pseudomonas, can cause part of the toenail to turn a greenish color. In addition, a collection of blood under the toenail caused by trauma can make part or all of the toenail appear red or black in color. [11]

Questions Your Doctor May Ask About Toenail Pain

To diagnose this condition, your doctor would likely ask the following questions:

  • Have you ever been told you have flat feet?
  • How would you explain the cause of your foot pain?
  • Did you recently injure your foot?
  • Has a bunion formed on your foot?

The above questions are also covered by our A.I. Health Assistant.

If you've answered yes to one or more of these questions

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Toenail Pain Symptom Checker Statistics

People who have experienced toenail pain have also experienced:

  • 28% Big Toe Pain
  • 5% Toe Pain
  • 4% Swollen Toes

People who have experienced toenail pain were most often matched with:

  • 40% Chronic Idiopathic Peripheral Neuropathy
  • 40% Skin Infection Of The Foot
  • 20% Nail Infection (Paronychia)

People who have experienced toenail pain had symptoms persist for:

  • 32% Over a month
  • 26% Less than a week
  • 22% Less than a day

Source: Aggregated and anonymized results from visits to the Buoy AI health assistant (check it out by clicking on “Take Quiz”).

Toenail Pain Symptom Checker

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References

  1. Hronek A. Caring for an Infected or Ingrown Toenail. Intermountain Healthcare. Intermountain Link. Published June 4, 2018. Accessed October 5, 2018.
  2. Learn About Nail Problems (Ingrown nails, Athlete's foot, nail fungus). Lehigh Valley Health Network. Lehigh Valley Link. Accessed October 5, 2018.
  3. Skin Foreign Body or Object. Seattle Children's Hospital Research Foundation. Seattle Children's Link. Revised March 31, 2018. Reviewed October 5, 2018.
  4. Subungual Hematoma. American Osteopathic College of Dermatology. AOCD Link. Accessed October 5, 2018.
  5. Blahd WH, Husney A, Romito K, Healthwise staff. Nail Problems and Injuries. Michigan Medicine: University of Michigan. Michigan Medicine Link. Published November 20, 2017. Accessed October 5, 2018.
  6. Poojary SA, Halwai V. A Tumor Hidden Beneath the Nail Plate: Report of A Rare Case of Onychomatricoma with Three-Dimensional Histopathological Analysis and Immunohistochemical Study. Indian Journal of Dermatology. 2015;60(2):212. Indian J Dermatol Link. Published Mar-April 2015. Accessed October 5, 2018.
  7. Singal A, Arora R. Nail as a window of systemic diseases. Indian Dermatology Online Journal. 2015;6(2):67-74. Indian Dermatol Online J Link. Published Mar-April 2015. Accessed October 5, 2018.
  8. Gemechu FW, Seemant F, Curley CA. Diabetic Foot Infections. American Family Physician. 2013; 88(3):177-184. Am Fam Physician Link. Published August 1, 2013. Accessed October 5, 2018.
  9. Nail Problems (Ingrown nails, Athlete's foot, nail fungus). Lehigh Valley Health Network. Lehigh Valley Link. Accessed October 5, 2018.
  10. Teens: Ingrown Toenails. Carolina HealthCare System: Levine Children's Hospital. Levine Children's Link. Accessed October 5, 2018.
  11. Nail Problems (Ingrown nails, Athlete's foot, nail fungus). Lehigh Valley Health Network. Lehigh Valley Link. Accessed October 5, 2018.

Disclaimer: The article does not replace an evaluation by a physician. Information on this page is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes.