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What do I need to know about toenail injuries?

man walking in flip flops

If you’ve ever snagged your toenail or had your nail grow into your skin, you know firsthand how painful it can be. With flip-flop season quickly approaching, it’s more important than ever to make sure your toenails are in tip-top health.

Two Roper St. Francis Healthcare affiliated podiatry experts, Dr. Sarah Cullen, DPM and Dr. Drennan Josey, DPM,  share what you need to know about maintaining toenail health – and when it’s time to see a specialist.

A few preventive tips can go a long way to help you avoid short-term and long-term toenail issues. Our experts suggest:

  • Cutting your toenails regularly: Trim your nails straight across, but not too close to the corners.
  • No digging: Avoid any digging into your nail beds, as it’s an invitation for bacteria to grow.
  • Make sensible shoe choices: Wear wide-toe shoes that don’t pinch. If you must wear tight-fitting shoes like high heels, switch into comfortable tennis shoes or sandals as soon as possible.

“Sometimes toenail issues are caused by biomechanical instability,” says Dr. Cullen. “Options like changing your shoes, adding in orthotics or wearing toe spacers at night can really make a difference.”

What causes ingrown toenails?

Ingrown nails are the most common toenail issue – and for something so small, they can cause a lot of pain with every step.  

There are two types of ingrown toenails: an ingrown toenail and an infected ingrown toenail. In both cases, ingrown toenails occur when your nail grows into the soft tissue of your nail bed, causing pain, redness and irritation. If the ingrown toenail has pus, it is infected with bacteria and should be seen by a doctor.  

Our podiatry experts suggest trying a few at-home remedies for non-infected ingrown toenails, including:

  • ● Epsom salt foot soaks (not recommended for diabetic foot care)
  • ● Antibiotic ointment with a bandage
  • ● Switching from closed-toed shoes to sandals, if the weather allows, or pick a shoe with a wide-toe box area

Dr. Josey recommends calling your doctor if your toenail shows signs of infection – or if it’s simply impacting your daily life. Similar to a toothache, an aggravated toenail can cause constant dull pain. Your podiatrist can evaluate your ingrown toenail to determine the best treatment option to help you feel better quickly.

An in-office procedure is the fastest way to treat a painful ingrown toenail. After injecting local anesthesia to numb the affected toe, your doctor uses a combination of tools to lift the part of the toenail that has grown into your skin. The ingrown portion of the nail is then cut back to the nail root, removing the entire nail border. For non-infected ingrown toenails, a chemical is applied to the nail root to prevent it from growing back. Patients with infected ingrown toenails will often start antibiotics to help completely clear the infection.

Common toenail ailments

If you’ve ever dropped something heavy on your toe and your toenail turns purple, you’re not alone. This common toenail injury is called a subungual hematoma, which means blood caught between the nail and the nail bed. It can be painful – and might need medical intervention.

“Sometimes the nail bed can lift off with a subungual hematoma,” says Dr. Cullen. “Patients can even have a fracture of the nail bed from something dropping on their foot.”

Bacteria can live in the pooled blood under the nail, increasing the chances of an infection that requires antibiotics. If you have a subungual hematoma, schedule an appointment with a podiatry expert to evaluate your toenail.

Other toenail ailments that can require medical attention include:

  • ● A fungal infection that causes toenail thickening
  • ● Nail bed lacerations
  • ● Nail infections that can spread to the bone, especially in patients with diabetes or a vascular disease

The podiatry experts at Roper St. Francis Healthcare can help with any bothersome foot, ankle or toenail concerns. Please call (843) 402-CARE or visit to schedule an appointment today with a member of our podiatry team. 

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  • Albertina J Holley
    April 17, 2022 at 1:14 pm

    Great articles! I wish I had the information earlier on ingrown toe nail. Nonetheless information is “POWER.” I am glad the information is printable. Any information on improving my health is welcome !

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