Nail Pain: Why Your Fingernail or Toenail Hurts

Causes of nail pain

Ingrown toenail

An ingrown toenail grows into the skin at the side of the nail, usually the big toe. It causes pain, redness and swelling, and can become infected with pus and overgrown tissue. Causes include cutting nails too short or curved, tight shoes, sweaty feet, injury and naturally curved nails. It is especially common in teenagers.

Paronychia (nail fold infection)

Paronychia is an infection of the skin around the nail.

• Acute paronychia: develops over hours to days, often after biting nails, picking a hangnail, a manicure or a splinter. The fold becomes red, hot, swollen and throbbing, and a yellow pocket of pus may appear. Usually caused by staph or strep.
• Chronic paronychia: lasts 6 weeks or more, with puffy, tender nail folds and lost cuticles. Common in people whose hands are often wet, such as cleaners, bartenders and dishwashers. Irritation and yeast play a role. The nail may become ridged.

Nail injury

Slamming a finger in a door or dropping something on a toe can cause bleeding under the nail (subungual hematoma): a red-black patch with intense throbbing pain from pressure. A clinician can release the blood through a small hole in the nail (trephination), which brings immediate relief if done within about 48 hours. Large hematomas or crushed fingertips may hide a fracture or nail bed laceration. See nail trauma.

Repetitive pressure, such as running downhill in tight shoes ("runner's toe"), can also bruise the nail.

Fungal nail infection

Onychomycosis makes nails thick, yellow, crumbly and lifted from the nail bed. It is usually painless at first, but thickened toenails press in shoes and can become painful or lead to ingrown nails.

Felon

A felon is an abscess in the pad of the fingertip. The pad becomes tense, swollen and severely painful with throbbing. It needs drainage by a clinician.

Herpetic whitlow

Herpetic whitlow is a herpes simplex infection of the finger. It causes burning pain followed by clusters of small blisters near the nail. It must not be cut open. Antiviral medicine helps.

Other causes

• Psoriasis: pitting, lifting and thickening, sometimes painful
• Gout: a big toe joint flare can make the whole toe, including around the nail, exquisitely tender
• Glomus tumor: a small benign growth under the nail causing a pinpoint spot of severe pain, sensitivity to cold, and a bluish-red discoloration
• Subungual exostosis: a bony growth under the toenail, often in young people, lifting the nail
• Nail cancers: rare. Subungual melanoma shows as a dark streak, often widening, with pigment spreading to the skin fold
• Raynaud's and poor circulation: pain and color changes in the fingertips with cold

Comparing common causes

How doctors diagnose nail pain

A doctor or podiatrist will look at the nail and surrounding skin and ask about injury, nail care and other conditions. They may:

• take an X-ray after a crush injury
• swab pus or clip nail for culture
• swab blisters for herpes
• use ultrasound or MRI for a suspected glomus tumor
• biopsy a pigmented streak or unusual growth

Treatment

Home care for mild nail pain

• Warm soaks: soak the finger or toe in warm water, with or without Epsom salts, for 10 to 15 minutes, 3 to 4 times a day.
• Ingrown toenail: after soaking, gently lift the nail edge and place a small wisp of cotton or dental floss under it. Wear roomy shoes or open-toed sandals.
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose.
• Protect the area with a bandage, and keep hands dry if paronychia is chronic.

Do not try to cut out an ingrown nail yourself, or lance pus pockets.

Medical treatment

• Paronychia with pus: a small incision to drain it, with antibiotics if redness spreads.
• Chronic paronychia: keep hands dry, wear gloves for wet work, and use a steroid or antifungal cream.
• Recurrent ingrown toenail: partial nail removal under local anesthetic, often with a chemical (phenol) to stop that edge regrowing.
• Subungual hematoma: trephination to release the blood. Nail bed repair for lacerations.
• Fungal nails: oral antifungal medicines such as terbinafine, or topical treatments for mild cases. Treatment takes months.
• Felon: surgical drainage and antibiotics.
• Glomus tumor: surgical removal.

Preventing nail pain

• cut toenails straight across, not too short, and do not round the corners
• wear shoes with enough toe room
• avoid biting nails and picking hangnails, and push cuticles back gently instead of cutting them
• wear gloves for wet work
• keep feet dry and change socks daily

Frequently asked questions

Why does the skin around my nail hurt?

Pain in the skin around a nail is most often paronychia, an infection of the nail fold after nail biting, a hangnail or a manicure. An ingrown nail is the other common cause. Warm soaks help mild cases. Pus or spreading redness needs a doctor.

What causes pain under a fingernail?

Pain under a fingernail usually follows an injury that causes bleeding under the nail. Without injury, consider an infection, a splinter or, rarely, a glomus tumor, which causes pinpoint pain and cold sensitivity. A felon causes pain in the fingertip pad rather than under the nail.

How do I treat a painful ingrown toenail at home?

Soak the foot in warm water 3 to 4 times a day, gently tuck cotton or floss under the nail edge, wear open or wide shoes, and use over-the-counter pain relief. See a doctor for pus, spreading redness, or if you have diabetes.

Can nail fungus be painful?

Yes. Fungal nails often start painless, but as they thicken and lift, they press against shoes and the nail bed, causing discomfort. They also make ingrown nails more likely. Treatment takes several months as healthy nail grows out.

When should I see a doctor for nail pain?

See a doctor for pus, spreading redness, fever, a throbbing fingertip, severe pain after a crush injury, recurring ingrown nails, or a new dark streak in the nail. People with diabetes should get any painful or infected nail checked promptly.