by Pain under the toenail of the big toe is a common concern that brings many patients to the podiatrist’s office. This discomfort can range from a mild annoyance to a severe, debilitating pain that affects daily activities. Several conditions can contribute to this type of pain, each with its own set of causes, symptoms, and treatment strategies. Understanding these elements is crucial for effective diagnosis and management. This article explores the primary causes of pain under the toenail of the big toe, diagnostic approaches, and current management strategies, providing a comprehensive overview for both patients and healthcare professionals.
Causes of Pain Under the Toenail
Several factors can lead to pain under the toenail of the big toe, including:
- Ingrown Toenails: This occurs when the edge of the toenail grows into the surrounding skin, causing pain, redness, and sometimes infection.
- Fungal Infections: Toenail fungus (onychomycosis) can make the nail thick, brittle, and discoloured, leading to pain and discomfort under the nail.
- Trauma: Dropping a heavy object on the toe, stubbing the toe, or activities that repeatedly put pressure on the toenail can cause subungual hematoma (A blood blister), where blood collects under the nail, causing pain. This usually appears dark, and it typically grows out. I see it a lot in my clinic.
- Nail Deformities: Conditions such as pincer or involuted nails can cause the toenails to grow abnormally, leading to pain under the toenail and often ingrown nails.
- Psoriasis: This skin condition can affect the nails, causing pitting, thickening, and pain under the toenail.
- Tumours: Though rare, benign and malignant tumours can grow under the toenail, leading to discomfort or pain. Always look out for an irregular shape, increasing size, or change in colour. See your podiatrist if you think you have a tumour.
Diagnostic Approach
A thorough history and physical examination are the first steps in diagnosing the cause of pain under the toenail of the big toe. The podiatrist may ask about the onset of pain, any preceding injuries, and the presence of systemic symptoms. A visual inspection can provide clues to the diagnosis, such as the shape of the toenail, colour changes, or signs of infection.
In some cases, further diagnostic tests may be necessary, including:
- X-rays: To rule out bone fractures, exitosis, or detect bone changes associated with chronic infections.
- Fungal cultures or PCR testing: To confirm fungal infections.
- Biopsy: Rarely, a biopsy may be needed to rule out malignancies or specific conditions like psoriasis.
Management Strategies
The management of pain under the toenail of the big toe depends on the underlying cause:
- Ingrown Toenails: Treatment may involve lifting the nail, partial or total nail removal, and, in some cases, surgery to prevent recurrence. Genetics, poor footwear, and poor nail cutting are the leading contributing causes in my experience.
- Fungal Infections: Antifungal medications, both topical and oral, are the mainstays of treatment. Laser therapy is also an option for some patients. Others have tried Vicks vapour rub, apple cider vinegar, tea tree oil, and even the original gold-coloured listerene. Note that while there is some evidence to support some of these treatment options, the science is still inconclusive.
- Trauma: Management of a subungual hematoma might include trephination, where a small hole is made in the nail to relieve pressure, or nail removal if the damage is severe. However, it can be left alone if it is mild, and it will grow out. If underlying illnesses are present, see a podiatrist.
- Nail Deformities and Psoriasis: Treatment focuses on managing the condition with topical treatments, systemic medications, or surgical interventions as necessary.
- Tumors: Surgical removal is usually required for tumors under the toenail.
Conclusion
Pain under the toenail of the big toe can significantly impact a patient’s quality of life. A detailed understanding of the potential causes and appropriate diagnostic measures is essential for effective management. With a tailored approach to treatment, most patients can achieve relief from their symptoms and a return to their normal activities. As always, consultation with a podiatrist is crucial for an accurate diagnosis and treatment plan tailored to the individual’s specific needs.
FAQs on Pain Under the Toenail of the Big Toe
1. Why does my big toe hurt under the toenail?
Pain under the toenail of the big toe can arise from several conditions, including ingrown toenails, fungal infections, trauma leading to a subungual hematoma, nail deformities, psoriasis affecting the nail, or in rare cases, tumors beneath the toenail. Identifying the exact cause requires a thorough examination by a healthcare professional.
2. Can wearing tight shoes cause pain under the toenail?
Yes, wearing tight shoes or footwear that places excessive pressure on the toes can contribute to the development of ingrown toenails and can exacerbate pain under the toenail. Tight shoes can also lead to trauma and deformities of the toenail over time, causing discomfort and pain.
3. How can I relieve pain under my toenail at home?
For minor discomforts, home care strategies can be effective:
- Soaking the foot in warm, boiled, salted water several times a day, especially for ingrown toenails.
- Wearing comfortable, well-fitting shoes that provide enough room for the toes.
- Keeping the feet clean and dry to prevent fungal infections. However, for persistent pain, swelling, or signs of infection, it’s important to seek professional medical advice.
4. When should I see a doctor for pain under my toenail?
You should consult a healthcare professional if:
- The pain persists or worsens over time.
- There is significant swelling, redness, or signs of infection (like pus and change in colour).
- You have an underlying condition like diabetes that could complicate foot issues or getting treatment for other severe diseases.
- Home treatments do not relieve your symptoms.
5. Are there any long-term complications from ignoring pain under the toenail?
Ignoring the pain can lead to worsening of the underlying condition, potentially resulting in more severe infections, chronic pain, and even the loss of the nail. In the case of fungal infections, delaying treatment can lead to the spread of the fungus to other nails or, in people with compromised immune systems, to other parts of the body. Early intervention can prevent these complications and ensure better outcomes.
References
1. Hare, A. Q., & Rich, P. (2021). Nail tumors. Dermatologic Clinics, 39(2), 281-292. https://doi.org/10.1016/j.det.2020.12.007
2. Leung, A. K. C., Lam, J. M., Leong, K. F., Hon, K. L., Barankin, B., Leung, A. A. M., & Wong, A. H. C. (2020). Onychomycosis: An updated review. Inflammation & Allergy – Drug Targets, 14(1), 32–45. https://doi.org/10.2174/1872213X13666191026090713
