From the Guidelines
Toe pain can be caused by various conditions, including injuries, ingrown toenails, bunions, gout, arthritis, or infections, and proper diagnosis and treatment are crucial to prevent complications and improve quality of life. According to the most recent guidelines, patients with peripheral artery disease (PAD) are at increased risk of foot ulcers, infection, and amputation, and foot care is an essential component of their care 1. The presence of foot ulcers is associated with anxiety, depression, and reduced quality of life, and patients with PAD should have their bare feet routinely inspected by clinicians during office visits 1.
Some common causes of toe pain include:
- Injuries, such as stubbed toes, fractures, or sprains
- Ingrown toenails
- Bunions
- Gout
- Arthritis
- Infections
For minor pain, rest, ice application, elevation, and over-the-counter pain relievers like acetaminophen or ibuprofen can help. Proper footwear with adequate toe room is essential for prevention and treatment. For ingrown toenails, soaking in warm water with Epsom salt and gently lifting the nail edge can provide relief. Gout attacks may require prescription medications like colchicine or allopurinol.
Toe pain persisting beyond a few days, accompanied by severe swelling, inability to bear weight, or signs of infection, warrants medical attention. These symptoms could indicate serious conditions requiring professional treatment, such as antibiotics for infections or proper alignment for fractures. Patients with PAD and diabetes mellitus should be counseled about self-foot examination and healthy foot behaviors, and biannual foot examination by a clinician is recommended for patients with PAD and diabetes mellitus 1.
In patients with PAD, prompt diagnosis and treatment of foot infection are recommended to avoid amputation. Foot infections may include cellulitis, abscess, fasciitis, tenosynovitis, septic joint space infection, and osteomyelitis, and clinicians should maintain a high index of suspicion for these conditions 1.
Overall, proper diagnosis, treatment, and prevention of toe pain are crucial to improve quality of life and prevent complications, especially in patients with PAD and diabetes mellitus.
From the Research
Causes of Toe Pain
- Ingrown toenails are a common cause of toe pain, accounting for approximately 20% of foot problems in primary care 2
- Improper trimming of the toenail, repetitive or inadvertent trauma, genetic predisposition, hyperhidrosis, and poor foot hygiene are thought to contribute to ingrown toenails 3
- Wearing shoes that do not fit properly can also cause ingrown toenails by altering the proper fit of the nail plate in the lateral nail groove 4
- Other factors such as nail care habits and footwear can also contribute to the development of ingrown toenails 2
Symptoms of Ingrown Toenails
- Pain, inflammation, and localized cellulitis are common symptoms of ingrown toenails 5
- Drainage and infection can also occur in more severe cases 4
- Lateral wall hypertrophy can develop in stage 3 disease, characterized by worsening of symptoms 4
Treatment Options
- Conservative treatment approaches include soaking the foot in warm, soapy water, placing cotton wisps or dental floss under the ingrown nail edge, and gutter splinting 3
- Surgical approaches include partial nail avulsion or complete nail excision with or without phenolization 3
- Electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix are also options for treating ingrown toenails 3