Painful toenails

Different parts of the body have different sensitivities to pain stimuli.

A sensory homunculus, as shown on the right, illustrates really well how the brain prioritises sensory information. The feet look big because the brain devotes more processing power to them. The brain really pays attention when the feet and hands say that they’re sore. That’s why painful toenails can be excruciating!

What are painful nails?

Painful nails have various causes.

• An Involuted Nail is where the nail plate has too much curve and can become painful when it presses on the skin of the toe. Otherwise known as Pincer Nails, involuted nails tend to be partly hereditary and partly due to environmental factors such as tight shoes, types of activity, and history of injuries.

• Fungal Infection is when fungus takes hold and can cause the nail to become thicker, uneven and crumbly. 

• An Ingrown Nail is when the nail injures the skin causing a graze or cut, or a spike of nail punctures the skin. This more often than not becomes complicated with bacterial infection. Ingrown nails are most often extremely painful. 

• Trauma can be a one-off injury or an ongoing micro-trauma problem (e.g. tight or ill-fitting footwear) causing the nail to bruise, thicken or lift off. 

• Paronychia is when the skin surrounding the nail becomes infected (most commonly bacterial infection) and causes redness, swelling and pain; this can also disrupt nail growth in the long term. 
  

How do we treat painful toenails?

When thickened and curved nails press on the nail bed and surrounding skin, they can become painful. Even the slightest pressure from shoes can make this much worse, making it really painful just to go about daily life. Sometimes sleep can even be disrupted when the bedsheets press on the sore toe. Thick nails can be reduced down and tidied by filing with a nail file or a drill. The edges and corners of curved nails need to be carefully managed by your Podiatrist or FHP.  If you try to treat a curved nail yourself, cutting down into the groove could lead to a painful, ingrown nail.

Ingrowing nails are most commonly caused by faulty nail cutting, but many other factors might be involved, which you should discuss with your Podiatrist. When exacerbated by bacterial infection, this causes acute swelling and redness. The area begins to weep and, as the body continues to fight the infection, pockets of pus start to form. If the offending nail is not dealt with soon, the infection can potentially spread and become a serious risk to health. Most of the time, treatment by a Podiatrist or Foot Health Practitioner (FHP) will remove the offending edge or spur of nail and the infection will clear up on its own. Occasionally, antibiotics may be needed. If the condition doesn’t get better, nail surgery might be suggested. (Nail surgery is when a Podiatrist numbs your toe with local anaesthetic and removes all or part of a nail, usually permanently.)

Fungal infections are not an immediate risk to health and, although they can be unsightly and sometimes cause discomfort, there is generally less urgency in advising treatment. The thickness of the nail that occurs with these infections is usually the culprit for any discomfort, and your Podiatrists or FHP can easily thin this down to make things more comfortable for you. Treatment options vary depending on the pattern of infection, so speak to your professional to discuss the best options for you. 

Trauma or injury to the nail can happen when, for example, they get bashed or something heavy drops on them. We all know the experience of catching our toes on the bed frame or a step! Micro-injuries can happen when shoes are ill-fitting, when you go on a long walk or run, and every step causes a small trauma. Injury can cause a few different symptoms, namely bruising, thickening and ridges, and lifting of the nail plate. They often resolve themselves over time but this can potentially take months or years.  Sometimes these nails can lead to other conditions such as fungally infected nails or ingrowing nails, so keep a close eye on them as the nail bed recovers and the new nail grows in. 

Paronychia happens when the skin around the nail becomes infected with bacteria, often through damaged or missing cuticles. The skin becomes red and swollen, and is sometimes painful. The condition can also lead to spread of bacterial infection into the foot and leg. Consequently, it is important to resolve paronychia as soon as possible. Washing or bathing the affected toe with salt water twice a day is the best start to any intervention. This helps to draw out infection and debris.  Your Podiatrist can help diagnose the cause and tailor treatment to suit. Antibiotics are sometimes needed. 

Warning:

If your toe is acutely red, hot to the touch and/or weeping, immediately begin twice daily washing with salt water and make an appointment with your Podiatrist asap. 

Nail Care and Painful Nail Prevention

• Don’t let your nails grow too long. Trim nails straight across and avoid cutting down the edges to reduce the risk of ingrown toenails.

• Wear shoes with adequate toe room and made with breathable materials to minimise pressure and moisture buildup.

• Keep feet clean and dry; change socks regularly and consider antifungal powders if prone to fungal infections.

• Occasionally use a soft nail brush to clear away debris. Avoid sharp instruments under the nails to prevent cuts and bacterial entry.

• If you feel that your nail care is beyond your abilities or you just don’t like doing it, make an appointment to see your Podiatrist or FHP, who can help you keep your trotters happy and healthy!
  

When to Seek Professional Care

• Pain or tenderness along the edges of one or both sides of your nail.

• Redness or swelling of the skin surrounding the nail.

• A sensation that the nail is “digging in” to the soft tissue.

• Persistent pain, redness, swelling, or discharge despite self-care - this may indicate an ingrown nail requiring medical removal or antibiotic therapy.

• If you suspect you might have a fungal nail infection. 

• If you find it difficult to cut your nails or can’t reach them, or can’t keep them in check yourself, it’s a good time to ask for help. 

If you’re noticing any combination of these symptoms, we would strongly recommend making an appointment with your Podiatrist, especially if your symptoms have been present for a week or more.