Experiencing needle sticking pain under my toe nail next to my big toe, right foot.

by Huie Douglas
(Philadelphia PA USA)

This afternoon I started experiencing this pain coming from my toe. It felt as if it was coming from under the toe nail. As if someone was sticking a needle between the nail. I came home, trimmed the nail, examined the toe and nail for possible puncture, but found nothing. This pain radiates every 60 seconds. The pain comes for a second or two; it goes away but returns within a minute. What is causing this?

RESPONSE

Hi Huie,

Let me start off by saying that since the problem only started today, There is always a good chance that it could be gone by tomorrow. I generally do not get too concerned about foot pain that has just come on insidiously, as many of these problems will disappear as quickly as they started.
Having said that my first thought would be the possibility of a neuritis or nerve irritation. Obviously, the nerves coming down the spinal column end at the toes. Sometimes a nerve can become irritated just from something like excess pressure against the toe from a shoe.
The opposite can also occur where the nerves leave the spinal column. Sometimes a nerve will be irritated as it leaves the spinal column and will manifest itself with abnormal sensation in the foot.
Another thought might be a vascular problem. If there is a regular rhythmic episodic "pain" then there is always the possibility of vascular compromise. One question I would have for you is whether or not you have noticed any discoloration in the affected toe, compared to the other toes on the same foot.
Since I know nothing about your medical history including your age, whether or not you are a diabetic or even smoke, I cannot give you insight as to the probability of this being your issue.
Some of the more simpler possibilities would include an ingrown nail on either side of the nail. You mention that you cut back the nail but do not mention if you cut down the side of the nail or just cut the end of the nail. An ingrown nail in many instances may cause a throbbing type pain in the toe which could cause have a rhythmic tone to it.
Along the lines of nail involvement sometimes the nail may be too thick either due to a nail fungus or perhaps trauma to the nail. As the nail grows the thickened nail may irritate the nail bed even creating a callus on the nail bed which will then hurt when pressed upon or in a closed shoe. In many instances over the years this has been the case. I will cut back the nail, probably further than you did and will notice a corn in the nail bed. Once the corn is removed, the pain disappears.
So, as you can see there are a multitude of possible causes for your toe pain, but as I also mentioned, I would give it a day or so to see if it goes away on its own. If not, then I would suggest you consult with a foot specialist in your area. One caveat, if you have noticed a discoloration in the affected toe, or if you are diabetic, I would suggest you consult a foot specialist immediately.

Marc Mitnick DPM
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