toenail pain

by Lauren
(Orange County, CA)

I work for Costco, and the holidays have us running around literally non-stop. One of my toes got bumped pretty hard by a shopping cart, and though it didn't crack, it's painful enough that I've had to miss two days of work. Both of my toenails are intact but have matching colors/bruises(changing from pink-to-purple-to-grayish yellow), but my left big toe is in much more pain. Toward the base I have a reddish spot beneath the nail so I'm wondering if it's a hematoma, and the lateral left edge of the toenail has lifted from the nailbed. The skin around the edge is red, warm, and sensitive to touch, but it doesn't appear to be spreading.

I can deal with all of these things. The real issue is that I need to work, and I have no idea how to protect my toe so I can get back to work. I don't feel I can miss another day as I was hired on as a seasonal employee, and I'd really like to be kept on permanently. Based on the feedback I was getting prior to injury, I know my hard work has gotten me noticed, and now it's going to be bungled by this?! We all wear running shoes, but the thought of putting mine on --along with a short practice test to go to Starbucks earlier today-- has me wondering how the heck I'm going to work. From the limited research I've done online, marathoners will wake up with black toenails at some point in their training, and though mine are more grey than black, I'm certain this was a combination of my Nikes and the concrete floors. The toe itself is definitely not broken. The pain is always present, but especially if I touch the top of the nail.

I'm applying Neosporin and Vicks intermittently. I've cut down the top of the toenail. Not sure if I should try to trim the side. Is there some way I can wrap the proximal part of the toe to try to create more space in the running shoe for the toe tip? Also, I'm definitely going up half a size. Ugh, I really need this job. Any advice would be much appreciated.

PS I'd include a photo, but it's hard to see where the edge has lifted from the nailbed....much easier to feel.

RESPONSE

Hi Lauren,

Let me start by saying the best advice I could give you would be to see a local foot specialist who could examine you and determine the actual degree of damage to your toe and the nail; but you already knew that.

So, I will create a worse case scenario and give you some direction in how to treat the problem.

Just because you did not hear a crack does not mean you did not fracture the toe bone, only an x-ray will tell you that. For that reason I am going to assume there is a possibility that there is a small crack in the bone.

Secondly, you mention that part of the nail is coming loose. This tells me that there may be bleeding underneath the nail. This scenario tells me that there is a chance of infection. Usually infections manifest themselves within 36-72 hours after the trauma and it sounds like you are beyond that point right now, but if the nail is lifted up, there is still a focal point for possible infection going forward.

So with all that in mind, here is my suggestion.

I would recommend soaking the toe in table salt and warm water in an effort to dry out any drainage that may exist under the nail. After soaking for 15 minutes, then apply neosporin or bacitracin and cover the nail with a bandaid. Do this every day for 10 days.

Since there is also the possibility that the bone is fractured, I would recommend wearing a stiff soled shoe that has limited "bend" in the ball of the foot. Shoes with too much bend, too flexible, will cause the toe to move excessively and the more motion of the toe results in more pain.

At some point the partially loose nail will further loosen and will have to be removed. You might get lucky and it will just fall off by itself, or you may have to see a doctor.

Now you can try my suggestions for a few days and if your symptoms do not worsen and hopefully improve, you should be ok. However, if these suggestions do not help and the toes seems to be worsening, then you have no choice but to see a doctor.

Marc Mitnick DPM
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