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Onychia and Paronychia of the Toe – What You Can Do

Reviewed by
Dr. Benjamin Weaver

The terms onychia and paronychia refer to a type of bacterial or fungal infection that strikes the fingernails and toenails. Onychia is an infection of the nail itself, which causes inflammation of the nail and swelling of the surrounding tissue.

Paronychia is an infection of the surrounding tissue, where the nail meets the skin; a paronychia infection causes inflammation, and may also lead to the formation of pus-filled abscesses.

Symptoms of Onychia and Paronychia You Should Know About

If you are suffering from onychia or paronychia that has been caused by bacterial infection resulting from an injury, the folds of skin and tissue at the base of your toenail will begin to appear red and swollen within two to five days following the injury.

In most cases, there will also be pain. Abscesses may form under the nail, and the pus that forms there may eventually begin to lift the nail from the nail bed, causing additional pain.

To some extent, the progression of onychia and paronychia symptoms will depend on the cause of the infection. Bacterial paronychia infections will appear suddenly, whereas fungal infections will take more time.

In rare cases, the infection may eventually spread to the bones, tendons, or bloodstream, or it may result in permanent malformation of the toenail.

What Causes Onychia and Paronychia?

The most common cause of onychia and paronychia is trauma—that is, a break in the skin. The injury does not have to be a serious one, and indeed it usually isn’t. The cause can be a hangnail, a splinter, or a badly stubbed toe.

Bacteria (most commonly Staphylococcus aureus) can enter the body through such small wounds if they are not properly disinfected. Cases of onychocryptosis (ingrown toenail) can sometimes lead to bacterial infections of the toenail.

Onychia and paronychia sometimes result from unsanitary conditions in nail salons—usually manicuring implements that have not been properly disinfected.

This is not to discourage our readers from getting pedicures, which can be beneficial in many ways; it is important, however, to choose a reputable salon, and it may be advisable to bring your own implements.

Acute and Chronic Paronychia – What to Know

Doctors divide paronychia into two classes: acute and chronic paronychia. Chronic paronychia is often caused by multiple factors, and is usually a reaction to allergens or to persistent irritants.

Recurrent acute paronychia can sometimes evolve into chronic paronychia (this is often seen in patients who take poor care of their feet). Chronic paronychia is a common complication of diabetes.

What Are My Treatment Options For Onychia and Paronychia?

If you have been experiencing symptoms of paronychia—such as redness and pain around the base of your toenail or pus oozing out from underneath it—you should seek medical attention as soon as possible; your doctor will want to examine you in order to make a diagnosis.

In most cases, your doctor will be able to diagnose onychia or paronychia just by looking at your toe, but determining the extent of the problem will require further examination.

The doctor will take your toe between his or her fingers and apply a little bit of pressure, causing the skin under the toenail to blanche. If there is an abscess, this action will reveal the outline of it.

If an abscess has not formed, your doctor may merely advise you to apply warm compresses to the toe or to soak it in warm water—or maybe in vinegar or Burrow’s solution (aluminum acetate dissolved in water).

Your doctor may also prescribe non-steroidal anti-inflammatory drugs (NSAIDs) for the pain. If you are diabetic, however, you may be advised not to soak your foot, although there is still some disagreement within the medical profession about why this precaution is necessary, if at all.

If there is an abscess, the doctor will drain the pus from it (this may require a small incision), and he or she may want to take a sample of the pus for a biopsy in order to determine the nature and cause of your infection.

If there has been no improvement after two days, further intervention may be necessary, possibly including a deeper surgical incision and removal of part of the nail plate.

In some cases, if the condition resists treatment, surgical excision of the proximal nail fold may be necessary.

Another surgical option that may be considered is eponychial marsupialization, which involves the removal of a narrow strip of skin next to the nail. The purpose of this procedure is to make the nail folds less vulnerable to infection.

Other treatment options for infections of the toenail and the base of the nail may involve antibiotics (for a bacterial infection) or topical antifungal cream (for a fungal infection).

Prevention Tips For Onychia and Paronychia

While onychia and paronychia can happen to anyone, there are precautions you can take in everyday life to prevent them:

  • Wash your feet every day.
  • Bring your own pedicure tools to nail salons.
  • Do not use cuticle removers—trimming the cuticle damages the skin at the nail base.
  • Trim your toenails about once a month, cutting them straight across, without rounding the edges.
  • Always trim your toenails immediately after taking a bath or shower; they are softer at this time, and you are less likely to cut yourself.

Questions to Ask Your Doctor about Onychia and Paronychia

  • Are the redness and pain in my toe the result of an infection?
  • Is it a bacterial infection or a fungal infection?
  • Are there any non-surgical remedies for this condition?
  • If surgery is necessary, how long will it take for my toe to heal?

Medical References:

    Nails Magazine Cleveland Clinic Podiatry Today National Institutes of Health The American Academy of Family Physicians Beauty and the Bath John Hopkins,P00302/ Baran R, Barth J, Dawber RP. Nail Disorders: Common Presenting Signs, Differential Diagnosis, and Treatment. New York, NY: Churchill Livingstone; 1991:93–100.

This page was last updated on October 2nd, 2015

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