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Ouch My Toe!

By Scott Hamilton, MD
September 15, 2022
Hamilton Blog Headshot Updated 12.21.21

This week's guest columnists are Aminah Phelps, MD, and Jacob Clement, MD, family practice residents at Ochsner University Hospital & Clinics.

Girls love pedicures, and some guys too! Feet don't get lots of pampering, so pedicures are a treat. Also, no one wants to show off gnarly toes in sandals. A mother decided to indulge her daughter on her 6th birthday with a mother-daughter foot spa day. A few days after, the girl came home from soccer practice walking gingerly and complaining that her big toe hurt. Mom pulled off her shoes and socks and saw the toe was swollen and red. There was also crusty dried blood and pus along the edge of the toenail. Afraid of infection and unhappy about her daughter's pain, mom brought her to the emergency department.

This is a common issue in kids and adults called paronychia, or an infected ingrown toenail or fingernail. Almost 20 out of every 100 kids get ingrown toenails. Sometimes toenails grow into the skin instead of on top of it, cutting into the skin to become a natural site for infection. Since our feet are covered with bacteria, when the skin breaks, bacteria get inside. We also often enclose our feet in dark, hot, sweaty shoes, brewing more bacteria. Fiddling with nails by over-manicuring, biting (some kids bite their toenails too!) and picking at hangnails all raise the risk of infection.

Our patient illustrates how paronychia can be prevented. First, pick your nail spa wisely. Inexpert manicures and pedicures can cause infection by pushing back cuticles (unnecessary!), trimming nails too aggressively, treating skin too rough and using unclean instruments. Also, tight shoes, like dance shoes or soccer cleats, can squeeze toes and push nails into the skin. When pointy dress shoes are in fashion, paronychia rates rise!

Dr. Hamilton has a few regular gags to get nervous kids to smile. He'll ask 9-year-olds if they smoke cigarettes, as if they were adult patients, and might say yes. When he takes kids' shoes and socks off, he'll usually go “Hooey!” and wave his hand in front of his face like the kids' feet stink, whether they do or not.

Some people have bad smelling feet no matter how clean their socks, shoes and toes are. Feet are also easily neglected - they're so far away, so much trouble to reach! Dirty feet are at a higher risk for paronychias, infected ingrown toenails, as we discussed above. Wearing shoes that aren't too tight, putting on clean socks and not over-trimming toenails can all prevent this.

If your child has a sore, red and swollen area around their toenail, there are several things you can do to treat pain and infection without needing medical expertise. Soaking the toe in warm soapy water for 15 minutes, two to three times per day, can provide pain relief and soothe inflammation. Use an anti-bacterial solution like Hibiclens in the soak. Apply over-the-counter antibiotic ointment and a bandage to lubricate and cushion the sore spot as it rubs on socks. This might also help prevent further infection and pus formation. Wearing open-toe shoes will keep toes cool and dry, but put on socks to keep dust and dirt off the infected toe. Ibuprofen and/or Tylenol can ease pain, particularly at bedtime.

If the toe doesn't improve with these measures, or if redness, swelling, and pain spread further up the toe, or there's pus, see your doctor. Antibiotics may be necessary, and planning future procedures to trim ingrown nails. Such nail trims must wait until the infection is cleaned up.