Pain in the toenail can occur at any age, in any person without any previous illnesses. Mostly the pain does not only affect the toenail but also the surrounding area. The toenail itself is not sensitive to pain, since the nail itself does not contain any pain fibers. This is a good thing, because otherwise we would have pain every time we cut our toenails. The pain therefore occurs in the surrounding skin area of the toenail and can have many different causes.
Causes
Pain in the toenail is very stressful for the patient, as he or she often cannot walk without pain. The causes for the pain are manifold. We have compiled an overview of the most common causes for you.
- Ingrown toenail
- Foot or nail fungus
- Nail bed inflammation
- Bruise under the toenail
The term “ingrown toenail” is self-explanatory: the nail does not grow forward, but into the lateral nail edge, which can lead to severe pain. In medical terminology, the term Unguis incarnatus is also used as a synonym. Some patients are predestined for ingrown toenails due to their anatomical toe shape, while other patients are spared such problems.
The most common risk factor for the development of an ingrown toenail is incorrect nail cutting. Incorrect means that toenails are cut too short and rounded at the corners. It is correct to have straight toen the toenails so that the corners also tend to end at the tip of the toenails.
Furthermore, shoes that are too tight can provoke the development of an ingrown toenail. Patients with diabetes mellitus are also particularly at risk. Since the blood circulation of the feet is not optimally guaranteed in diabetics, the supply of oxygen to the tissue can be reduced particularly quickly.
This leads to an inflammatory reaction, which can then lead to an ingrown toenail in addition to an inflammation of the nail bed. The inflammatory tissue is usually swollen, reddened and overheated. The pain is typically pulsating and can be aggravated by pressure.
There is always the possibility that the inflammation develops into an inflammation with pus formation or that it spreads to surrounding and deeper structures. Accordingly, the pain increases and there is a risk of so-called phlegmons forming. This is a soft tissue infection that is caused by a bacterial inflammation of the connective tissue.
Mostly the big toenail is affected, although it cannot be ruled out that the smaller toenails may also grow in at some point. A nail fungus is also called nail mycosis or onych mycosis in the medical field. In the presence of a nail fungus, an infection has occurred due to a certain fungus in the toe nail area.
In general, the nails on the toes are more frequently affected than the fingernails. Different pathogens can be the trigger in each case: Thread -, yeast – and molds. The last two mentioned fungi tend to be the cause of a nail fungus rather more rarely.
If a nail fungus develops on the ground of a thread-fungus-population, one can speak also of a so-called Tinea unguium in this special case. The fungal infection usually spreads from the front edge of the toenail towards the nail bed and initially only affects one toenail. Besides the pain on affected toenails, a discoloration, usually white, yellow or grayish, is typical.
In addition, the toenail is also dull and brittle, so that crumbly decay can occur. The pain is a secondary cause of the nail fungus. On the one hand, the nail architecture can change as described above and additionally become thicker.
This leads to an increased pressure load in the nail bed, which is accompanied by a painful stimulus. In addition, due to the spatial proximity, the pathogens can also spread to the skin of the toes and cause inflammation there. This also triggers pain.
Small lesions, which have often been considered the entry point for the pathogens, can also turn into inflammatory tissue and be painful. The pain of nail fungus is therefore generally considered to be a symptom in the late stages.Therefore it is important to recognize and treat a nail fungus in time by the visible changes of the nail. Risk factors for the development of a nail fungus are too tight shoes, malpositioning in the foot and toe area and certain pre-existing conditions such as diabetes mellitus and circulatory disorders.
An aggravation of the symptoms, especially the pain, of already existing nail fungus can be provoked by the following factors: too tight shoes, heavy perspiration, inflammation of the skin, small injuries/open spots in the toe area and diseases that weaken the immune system. Nail bed inflammation can also be the cause of severe pain in the toenail. As the word implies, an inflammation in the area of the nail bed occurs due to a viral or bacterial infection or due to an infestation with fungi.
In contrast to an ingrown toenail, which can be confined locally to one area, an inflammation of the nail bed often spreads over the entire area of the toenail and may be surrounded by pus foci. If a toenail turns blue or bluish-violet, this indicates a bruise, i.e. an accumulation of blood, under the toenail. This change in the toenail is very often accompanied by pain.
The causes of a blue toenail are manifold. However, the mechanism is usually that the toenail is exposed to increased pressure over a longer period of time. Such pressure is very often caused by incorrect footwear.
A shoe that fits too tightly means there is little room for the feet, so that after long walking, frictional pressure on the toenail provokes a bruise. But shoes that are too big can also be harmful. Particularly when walking downhill, affected persons slip a little bit forward in the shoe with every step, so that the toes touch the tip.
Pain in the toenail with accompanying blue discoloration can also be the result of trauma. A very banal situation is the bumping of the toenails on a step or edge or the falling of heavy objects onto the toenails. This leads to an immediate perception of pain, which diminishes somewhat over time.
If there is a pronounced bruise, pain can be relieved by piercing the toenail in the area of the bruise with a small sterile needle. This allows the bruise to drain off and the pressure pain subsides due to the volume reduction. In addition, the toenail can be preserved with this procedure, otherwise the toenail usually falls off. In general, a blue toenail either falls off or the bruise grows out. In summary, it can be said that pain with a blue toenail can be caused by blood deposits under the toenail itself (pressure pain), or secondarily by an inflammatory change (inflammation pain) or swelling of the surrounding tissue (pressure pain).
