Pressure under a toenail can manifest as throbbing, aching, or sharp pain, often accompanied by tenderness, swelling, and redness around the affected digit. This discomfort arises when the nail plate presses against or grows into the surrounding soft tissue. Common causes include trauma, such as stubbing a toe or dropping a heavy object, which can lead to bleeding beneath the nail, known as a subungual hematoma. Ill-fitting footwear, particularly shoes that are too tight or narrow, can exert repetitive pressure, contributing to the issue. Additionally, underlying nail conditions like ingrown toenails, where the nail edge curves and penetrates the skin, or fungal infections that can thicken and distort the nail, commonly result in this sensation.
Immediate Home Care Strategies
For mild cases of pressure under a toenail, several immediate home care strategies can offer temporary relief. Soaking the affected foot in warm water for 15 to 20 minutes, three to four times daily, can help. Adding Epsom salts to the water helps soften the nail and reduce swelling. After soaking, gently pat the foot dry. If the pressure stems from an ingrown nail, carefully lifting the visible edge and inserting a small piece of cotton or waxed dental floss underneath can help guide the nail’s growth away from the skin.
Wearing open-toed shoes or sandals, or comfortable footwear with ample space in the toe box, can significantly reduce pressure on the nail. Elevating the foot can help reduce fluid accumulation and alleviate discomfort. Applying an ice pack wrapped in a cloth to the affected area for 10 to 20 minute intervals can diminish swelling and numb pain.
Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can be taken to manage pain and inflammation. Applying an over-the-counter antibiotic ointment to the tender area can help prevent infection, especially if the skin is broken, and covering it with a bandage can offer protection.
When Professional Medical Attention is Needed
Certain signs indicate that professional medical attention is necessary. Severe or worsening pain that persists despite home remedies, or pain that impacts walking, requires evaluation. Signs of infection, such as increased redness, warmth, swelling, pus drainage, or a foul odor from the toe, also warrant immediate evaluation.
Numbness or tingling in the toe, which could suggest nerve involvement, also requires a medical assessment. If a large, dark bruise (subungual hematoma) forms under the nail, causing significant throbbing pain, especially if it covers more than half the nail, consult a healthcare provider to relieve the pressure. Individuals with underlying health conditions like diabetes, poor circulation, or a compromised immune system should seek prompt medical attention, as these conditions can increase the risk of complications and impede healing.
Medical Treatments and Interventions
A healthcare professional, such as a podiatrist, can provide specific medical treatments. For a subungual hematoma causing severe pressure and pain, trephination is a common intervention. This procedure involves creating a small hole in the nail plate to drain the pooled blood, instantly relieving pressure, using a sterile needle or specialized medical device.
For severe ingrown toenails, a partial or complete nail avulsion may be performed. This involves surgically removing the problematic portion of the nail, or the entire nail, after numbing the toe. If infection is present, a doctor might prescribe oral antibiotics to clear the infection. In cases of fungal infections, antifungal medications, either topical or oral, are prescribed to treat the underlying cause. For recurrent ingrown toenails, a matrixectomy, which involves removing a portion of the nail matrix (the tissue from which the nail grows), can prevent recurrence.
Preventing Future Occurrence
Preventing future occurrences of pressure under a toenail involves consistent foot care practices. Proper nail trimming is fundamental: toenails should be cut straight across, not too short, and avoiding rounded corners helps prevent the nail from growing into the skin. This technique guides the nail to grow outward rather than inward.
Wearing properly fitting footwear is also key. Shoes should have adequate toe box space. Avoiding high heels or pointed shoes that crowd the toes reduces repetitive pressure on the nails. Protecting feet during activities that might cause trauma, such as wearing safety shoes or appropriate athletic footwear, can prevent trauma.
Regularly inspecting feet for any early signs of issues, such as redness or tenderness, allows for timely intervention. Proactively addressing underlying conditions like fungal infections with appropriate treatment maintains nail health and reduces pressure.