There are few common occurrences more uncomfortable than having a splinter under your toenail. A foreign body lodged under a toenail exerts pressure, painfully forcing the nail plate away from the nail bed.
In some cases our attempts to remove the splinter only force it further under the nail, increasing our pain and distress.
The foreign objects that most frequently become lodged underneath toenails are splinters of wood, but similar injuries can occur with slivers of metal or glass, sewing needles, or cactus spines.
Self Treatment for a Splinter Under Your Toenail
If the end of the splinter is still sticking out from under the nail, you may be able to remove it yourself, without the need for any kind of medical intervention. The best tool to use for this purpose is a clean pair of tweezers.
It is important to remain calm while attempting this. If you yourself are the injured party, take a deep breath before attempting to retrieve the splinter from underneath your toenail.
If someone else is available to assist you, it may be better to enlist that person’s aid rather than attempting to remove the splinter yourself—the other person will have steadier hands, and they will be in a position to hold your foot still, preventing you from flinching and causing the splinter to break off under your toenail.
If the person with the splinter in their nail is someone else, the first thing you must do is make sure that person is not panicking; this is a particular concern for small children, who tend to have exaggerated perceptions of pain and injury.
Once the affected person is calm and you are sure they will be able to remain still, you can begin.
After cleaning them with alcohol, use the tweezers to gently but firmly grasp the end of the splinter that protrudes from underneath the toenail (if the visible end of the splinter is very small, a magnifying glass may be helpful).
If the object is glass or organic matter such as wood or a cactus nettle, you will need to be very careful not to break the end off it (a metal object such as a needle can be treated more firmly). Once you are sure you have grasped the object firmly with the tweezers, pull quickly, in the direction from which the object appears to have entered the skin, so as to minimize the chances of it breaking off at the end.
Once the object has been removed, disinfect the affected toe with alcohol and apply antibiotic ointment if any is available (most first-aid kits contain this item). Bandage the toe if there is any bleeding, and you’re done!
Be sure to watch the affected toe for a few days for signs of infection. If there is persistent redness and/or swelling, or if the affected person develops a fever, call your podiatrist immediately.
When to Seek Medical Attention for a Splinter Under Your Toenail
If the splinter or foreign object lodged under the toenail cannot be reached and grasped with tweezers, it may be necessary to seek medical attention.
In most cases it will not be necessary to go to the emergency room; a podiatrist will be well equipped to deal with this problem.
A metal object lodged under the toenail may not need medical attention if it is not painful—although in most cases it will be causing sufficient discomfort to require immediate attention.
Wooden splinters, cactus nettles, or other organic material, however, must be removed as soon as possible. These types of splinters under the toenail will cause inflammation and infection if they are not removed promptly.
What to Expect When Having a Foreign Object Removed From Under Your Toenail
If you need medical assistance to remove a splinter from under your toenail, the doctor or healthcare professional assisting you will most likely begin to remove part of the nail at the visible tip of the splinter.
With any luck, this will expose the splinter enough that it will be possible for the attending healthcare professional to grasp the end of the splinter and pull it out, just as you would have done yourself if it had not been so far beneath the nail.
If the splinter is buried in the soft tissue, however, it may be necessary to make a small incision in the toe in order to reach it.
In some cases, a doctor may use a scalpel to shave the toenail down in order to reach the splinter hiding underneath it. Regardless of which method is used, you may need a tetanus shot afterward if you have not had one recently.
In some cases it may also be necessary to conduct another such test after the splinter has been removed, in order to make sure that no piece of it remains.
Wooden or non-leaded glass splinters may present a problem in such cases, as they can be difficult to detect on x-rays, but they are easily seen using ultrasound if the physician is properly trained in this diagnostic technique.