Toenail pain mostly involves some form of disruption of the outer hard nail and the inner smooth surface.
Consequently, part of any therapy involves safety of the nail and the surrounding region from damaging irritants and trauma.
There should be routine avoidance of grease-cutting agents, such as soap and detergent.
An emollient should be used as a soap substitute followed by a moisturizer.
These measures are fundamental to the care of the nail, and should be part of all therapies.
With toenail pain, avoidance of physical trauma is an important aspect of therapy treatment.
In most cases causes include occupational hazards, irregular foot shape and footwear.
It is therefore essential to anticipate these issues to avoid problems.
The common problems with footwear are summarized below.
When the foot position, such as hallux valgus, flat foot, and digital deformity, predisposes to toenail pain, in-shoe devices may help to redistribute foot pressures, realign toes and relieve trauma to the nails.
Pain in the toenail can occur due to certain mechanisms which are discussed here.
Improper fastening causes the foot to move forward in the shoe, thereby causing the end toes to push against the hard shoe surface.
If the shoe is loose, toes will claw to maintain stability, further compromising nail structure.
Excessive heel height forces the foot forward into the shoe, and causes excessive pain and damage to the toenail.
Inadequate toe box depth or width causes compression of the toes, causing discomfort.
Constriction of the toe can result in increase shoe temperature, sweating and microbial growth.
These are mostly secondary causes of the pain.
Common symptoms occurring with toenail pain actually depend on the cause.
If pain is due to trauma, accompanying bleeding, swelling, and blackening of the nail will occur.
If infection is the cause of the toenail pain, then nails usually turn yellow.
Moreover, swelling, tenderness, redness of the skin and purulent discharge may also be present.
Different fungal infections discolor the nails with different colors.
In Pseudomonas infection, the nail is usually green and extremely painful.
Pseudomonas is a bacterial infection of the nail, and can be treated effectively with broad-spectrum antibiotics.
An ingrown nail can also cause severe toenail pain by growing into the lateral nail fold, causing trauma, inflammation and secondary infection.
Ingrown nails are usually attributed to poorly fitting shoes, sports, or other trauma.
There is a basic disproportion between the nail and lateral nail fold, resulting in damage to the latter which causes the toenail pain.