Toe nail pain is very common, and it can have numerous causes. Ranging from simple issues to situations needing immediate medical care, toe nail pain is often ignored until it can no longer be tolerated. Prompt treatment for the underlying cause may be the key to quick healing and reduction of the pain.



Most toe nail pain is caused by ingrown nails. Ingrown nails may be inherited genetically, and may also be seen later in life due to gradual damage to the cells under the skin that grow the nail (nail matrix). Repetitive injuries to the toe, such as heavy objects falling on it, pressure from poorly fitting shoes, nail fungus, or toe bruising (common in athletes) may cause irreversible changes to the nail matrix. In time, the nail may abnormally grow inward due to these changes. Less commonly, poor nail trimming technique may leave a spike of nail that may protrude into the skin as the nail grows outward. The skin against the nail is perfectly suited to tolerate the presence of the nail growing into it. However, once the skin becomes inflamed and swollen due to infection of bacteria trapped between the skin and nail, or due to the inflammation caused by the minor injury of nicking the skin when the nail is cut, pain will develop. Regardless of its cause, an ingrown nail will involve pain and inflammation, and will cause chronic symptoms that come and go frequently. If untreated, the infection may potentially spread at any point and may eventually involve the toe bone underneath. Temporary treatment of acute flare-ups may consist of regular soaking in warm, soapy water, application of antibiotic ointment, and the use of antibiotic medication to control the infection. The offending nail border must be removed to fully resolve the condition. This is accomplished through a short office procedure where the nail border is removed under local anesthesia and a mild acid is used to prevent the nail matrix from ever growing the nail back into the skin. Recovery is generally quick, only requiring home soaking once per day and keeping the toe covered with antibiotic ointment and a band-aid. Activities are not restricted as pain after the procedure is rare. Home based "bathroom surgery" is not recommended as this may significantly worsen the condition.

Other causes of nail pain can include nail fungus infection, which may cause the nails to become thickened, loosened, discolored, and crumbly. The nail thickness causes pain when it strikes the shoe during activity. Fungus is a small organism that also causes athlete's foot. When present on the skin, it can potentially spread under the toenail to infect the skin under the nail. Treatment requires prescription medication to eliminate the infection, and usually needs oral medication to get the medication to the hard to reach area under the nail. Over-the-counter topical medications are virtually ineffective against nail fungus, despite their advertising claims, and will generally do nothing for the fungus infection itself. Other potential treatment for nail fungus pain can simply include smoothing out the nails to reduce the prominence in one's shoes, or even removing very painful nails via a simple and relatively painless office procedure.

Not all thickened nails have fungus in them. Sometimes, nails simply become thickened and painful due to long term pressure and damage to the nail root from shoe pressure or injury, much like how ingrown nails can develop. The nails can be sore in shoes and with activity. Treatment can include smoothing the nails out or using medication to soften the nails. Nail removal can be performed in severe cases.

Another common nail problem seen in runners, walkers, and treadmill users is bruising and loosening of the toenails. When shoes are a little too long, the foot will piston in and out of the shoe, resulting in low level injury to the toe tips. This can also occur in shoes that are too tight. The nails will subsequently bruise and loosen. This can be prevented by wearing properly sized shoes. Many times, bruised nails can also be the result of injury, such as stubbing the toe or dropping an object on it. If the bruise is small, then one can simply wait and allow the nail to grow out as long as any pain goes away after a few days. If the bruise covers more than a third to one-half of the nail itself, then one will need to have that nail evaluated as there may be a cut in the skin under the nail and the pressure may need to be released in order for the toe to heal properly. In some cases, a fracture may have formed in the bone under the nail, and a piece of the bone may have cut the skin from below. This situation requires immediate attention to avoid infection to the bone.

Nail pain can be seen in other less common conditions, such as various skin diseases like psoriasis, as well as other more serious conditions like melanoma around the nail. If one has developed a dark pigmented area on the nail and surrounding skin, this needs to be evaluated immediately. Melanoma to the nail region is rare, but does occur. Other conditions like benign or malignant skin and soft tissue tumors, cysts, and nerve disturbances can cause nail pain. Each of these, while uncommon, has their own treatment available in the hands of a good foot specialist.

As one can see, nail pain has numerous causes, all of which are treatable. Having one's foot evaluated in a timely manner can prevent having to endure pain unnecessarily, and allow a quick return to full activity.