Injury to big toe

by Julie
(MO)

A week and a half ago, I opened a door and the corner of it went under the nail on my big toe. It bleed a lot at first and then off and on the rest of the night and throbbed something awful. For the next few days it would bleed a little bit more but nothing like at first and only after walking too much (I have 3 kids, sitting doesn't happen much around here). My toe swelled a little and showed some bruising under the nail. Ten days later the toe still hurts when I walk or when I touch the top of the nail or the tip of the toe. I have not been able to wear closed toe shoes at all as it is very painful. Am I just being impatient and need to give it more time to heal or could there be more injury than I first realized? I'm a runner and really want to get back to running but I can't even put on my running shoes at the moment because anything touching the top of the toe hurts.

RESPONSE

Hi Julie,

Assuming you are in otherwise good health and I certainly assume you are young as you are chasing around three kids, I am fairly comfortable stating that your pain is more than just a bruise. If it was nothing more than a bruise, all things being equal, the toe would have been healed.

So your obvious question is why does it still hurt? According to you the mechanism of injury was that the door lifted the corner of the nail off the nail bed. Enough so that the area, at least initially, bled fairly profusely but gradually bled less and less (but still hurts).

So, here is some of the possibilities.

1. You lifted the nail far enough up off the nail bed that bleeding occurred underneath the nail and as the days go by, this blood is drying out and is making the toe more sensitive when you press against it.

2. Taking that scenario one step further, once the nail lifted off the nail bed, it becomes very easy for bacteria to get underneath there and cause an infection, which of course will make the toe very sensitive.

3. There is also the possibility that part of the nail embedded itself into the skin and is "stuck" there which will also make the nail very sensitive.

4. Lastly, and this may be a bit far-fetched, but if the door hit the toe hard enough, you might have broken the toe. It sounds like, from your narrative, that the door essentially traveled over the toe and just hit the nail.

Your question might have been much easier to answer had you included a picture. I am wondering if the nail is loose, is the toe swollen, is it redish-blue in color, is their any oozing? Knowing the answers to this would have made my job a bit easier.

Additionally, you do not mention what first aid you have been doing for the toe. Have you been soaking it in salt water, washing the toe with soap and water, putting an antiseptic like neosporin on the area?

I suppose without even knowing the answers to those questions it would seem to me that if the toe is still very tender after ten days, chances are it is not going to get better on its own. If you are looking to get back to running as quickly as possible, then is going to require some medical care.

I would suggest you make an appointment with a podiatrist in your area. Many times the nail, because it is loose, can be cut away painlessly, even without anesthesia. Just by removing the offending part of the nail, that can be enough to clear up whatever is going on with your toe. In some cases the whole nail may have to be removed if the doctor finds that it is too loose. It is something you would want to have done anyway, because if the nail is excessively loose it will eventually fall off and you would rather have the doctor remove it then you accidently pulling it off when removing your sock. Trust me on that one.

Although fairly uncommon particularly in young healthy individuals, if the toe is infected and not treated in a timely manner, the infection can spread to the bone and then that changes the dynamics of this problem from a nuisance to a major medical issue.

Go see a doctor.

Marc Mitnick DPM
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