What could be causing the tenderness in the corner of my right big toe?

Tenderness in the Corner of the Right Big Toe

You most likely have an ingrown toenail, which requires prompt evaluation to prevent progression to infection or chronic complications.

Most Likely Diagnosis: Ingrown Toenail

The corner tenderness you describe is the classic presentation of an ingrown toenail (onychocryptosis), where the nail edge penetrates the surrounding skin causing localized pain and inflammation 1.

Key Clinical Features to Assess

When you're examined, the provider should specifically look for:

• Erythema (redness) extending >0.5 cm around the affected corner 2
• Local swelling or induration at the nail fold 2
• Warmth at the site 2
• Purulent discharge (indicates infection has developed) 2
• Point tenderness specifically at the lateral or medial nail gutter 3

Why This Matters: Infection Risk

If you have ≥2 of the inflammatory signs listed above, you have developed a soft tissue infection that requires antibiotic treatment 2. The presence of purulent discharge is particularly concerning and definitively indicates infection 2.

Immediate Management Steps

If No Signs of Infection Present:

• Conservative management with proper nail trimming - keep toenails trimmed straight across 2
• Warm saline soaks to soften the nail and reduce inflammation 2
• Open-toed or roomy footwear to eliminate pressure on the affected corner 4
• NSAIDs (ibuprofen or naproxen) for pain control 5

If Infection Is Present (≥2 inflammatory signs):

• Immediate medical evaluation is required 2
• Wound cultures should be obtained if purulent discharge is present 2
• Antibiotic therapy will be necessary 2
• Possible nail avulsion (partial or complete nail removal) may be needed 1

Critical Warning: Don't Ignore This

Untreated ingrown toenails can progress to severe complications 1. One documented case showed chronic ingrown nail leading to a massive hypertrophic scar (7 × 4 × 8.5 cm) that mimicked a tumor, causing severe functional impairment 1. This emphasizes the importance of early, appropriate treatment.

When to Seek Urgent Care

You need same-day evaluation if you develop:

• Fever or chills (suggests systemic infection) 3
• Red streaking extending up from the toe (lymphangitis) 2
• Inability to bear weight 3
• Diabetes or immunosuppression (dramatically increases infection risk) 2, 3

Alternative Diagnoses to Consider

While ingrown toenail is most likely, your provider should also evaluate for:

Fracture

• History of recent trauma or stubbing injury 6
• Pain with gentle axial loading (pressing down on the tip of the toe) 6
• Requires anteroposterior and oblique radiographs if suspected 6

Gout (Acute Gouty Arthritis)

• Sudden onset of severe pain (typically more dramatic than ingrown nail) 3
• Diffuse joint swelling and erythema (not just corner tenderness) 3
• Serum uric acid testing may be helpful 3

Infection Without Ingrown Nail

• Diabetes significantly increases risk 2, 3
• Probe-to-bone test should be performed if wound present to assess for osteomyelitis 2
• Elevated inflammatory markers (ESR, CRP) suggest deeper infection 2

Common Pitfalls to Avoid

• Don't attempt aggressive self-treatment - overdebridement or improper nail cutting can worsen the condition and increase blistering 2
• Don't delay evaluation if diabetic - diabetic patients can have serious infections without fever or systemic symptoms 3
• Don't ignore persistent symptoms - if conservative treatment fails after 6-8 weeks, referral to podiatry is indicated 4, 5

Bottom Line

Schedule an appointment within 1-2 days for proper evaluation and treatment. Corner tenderness of the big toe is typically straightforward to diagnose and treat when addressed early, but can lead to significant complications if neglected 1.