We are pretty conservative about toes. A damaged toenail will be shed and regenerated naturally with no help from the medical profession. As long as it is kept clean and infection is watched for, then it should take care of itself. The toenail will show horizontal (90° across the nail) ridges where the growth of the nail was disturbed, but eventually these grow out. Longitudinal ridges imply there may have been partial destruction of the nail generating plate itself, and these could persist. This deformity is only of cosmetic significance.

Sometimes blood (subungual hematoma) or pus collects under the nail and throbs painfully. That is relieved by drilling a hole in the nail (a painless procedure).

As for possible minor fracture of a toe, this too is almost always left alone. About all that is ever done is to tell the patient to wear a stiff shoe or to buddy-tape the injured toe to a healthy neighbor as a natural splint. Really painful toe fractures may need a cast, but that is unusual in clinical practice.

If an injured toe appears to be healing well to you, it probably is. If you have doubts about it, and especially if your child can't walk on it without limping in just a couple of days, see your doctor. A handy trick to know about for more minor cuts and scrapes of the toes that do not need major medical attention is to disinfect the foot by soaking in weak bleach solution. This is a wonderful disinfectant, used frequently in burn units because it kills essentially all germs upon contact. Several capfuls of bleach in a quart of water as a five or ten minute soak cleans and disinfects. Be sure to remember to rinse the bleach solution off thoroughly before you let Junior run around the house - he could leave bleached footprints on your carpet!

Toes that curl and partially overlap congenitally are ordinarily no cause for concern. Likewise for partially webbed toes, seen fairly often in normal children, and sometimes familial.

Soft, crinkly little newborn toenails that seem to almost bend back on themselves are also of no concern. As your child gets older, the toenails will stiffen and straighten. If you pick at them, you are more likely to cause an infection. Leave them alone - nature will straighten them.

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