Sophia Delgado
Nail injuries are common and can be caused by a variety of factors, including accidents, fungal infections, and certain habits such as nail biting. Depending on the severity of the injury, treatment may range from at-home care to medical procedures. Minor injuries often heal on their own, while more severe cases may require antibiotics, surgery, or other professional treatments. After an injury, a new fingernail typically takes 4 to 6 months to grow back, while toenails can take up to 12 months. Proper care and treatment are crucial to ensure the nail bed heals appropriately and promote smooth nail growth.
| Characteristics | Values |
|---|---|
| What causes nail injuries? | Smashing fingers in doors, hitting with a hammer or other heavy objects, cutting with sharp objects, wearing ill-fitting shoes, keeping nails in water for too long, nail biting, etc. |
| What happens when a nail is injured? | Nails may separate from the nail bed (onycholysis), nails may be discolored, feature a wavy white line, or have blood underneath (subungual hematoma). |
| What to do when a nail is injured? | For minor injuries, bandages and ice packs can be used for treatment. For more serious injuries, urgent care may be required to stop the bleeding and clean the wound. Antibiotics may be prescribed to prevent infection. |
| How does a nail grow after an injury? | Nails will not reattach to the nail bed after they have separated but will regrow over time. The nail matrix, where new nails form, must be healed for regrowth to occur. |
| How long does it take for a nail to grow back after an injury? | A new fingernail takes about 4 to 6 months to grow back, while toenails take about 12 months. |
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What You'll Learn
Nail injuries and treatments
Nail injuries are common and can occur due to various reasons, such as crushing or hitting the fingers or toes with heavy objects, cuts from sharp objects, or even from wearing ill-fitting shoes. The treatment for nail injuries depends on the type and severity of the injury. Minor nail bed injuries, such as subungual hematomas (bruises under the nail), often heal on their own without any treatment. However, it is important to ensure that the nail is still attached to the nail bed and that there is no serious underlying injury, such as a bone fracture. For more severe injuries, it is recommended to seek medical attention to prevent infections and ensure proper healing.
One common nail injury is onycholysis, which is the separation of the nail from its nail bed. This can be caused by trauma to the nail, such as bumping or hitting the nails, or even from regular manicures. It can also be caused by a fungal infection, which can cause the nails to become thick, discoloured, and lifted from the nail bed. Treatment for onycholysis aims to keep new nail growth attached to the nail bed. If the condition is caused by an injury, the detached part of the nail will eventually grow out and can be cut away. Oral and topical antifungal medications may be prescribed if the cause is fungal.
Another procedure for treating nail injuries is nail trephination, which involves draining trapped blood under the nail. This procedure is beneficial for relieving pain and helping the new nail grow correctly. It must be performed within 48 hours of the injury, before the blood clots. In some cases, the nail may be too damaged to be reattached, and a doctor may replace it with a synthetic nail to act as a placeholder as the new nail grows. Antibiotics may also be prescribed to prevent infections, and pain relievers can be taken to reduce pain and swelling.
The nail matrix, the area where new nails are formed, can also be injured, resulting in temporary changes to the nail's appearance or even the nail falling off. In most cases, the nail matrix will heal with proper care, and the nail will start to grow back. However, severe damage to the nail matrix may result in permanent nail loss. To prevent nail matrix injuries, it is important to cut nails properly, especially toenails, which should be trimmed straight across to prevent ingrown toenails.
The recovery time for nail injuries can vary depending on the severity of the injury and the type of nail. A new fingernail typically takes about 4 to 6 months to grow back, while a toenail can take up to 12 months. The new nail may have grooves, ridges, or misshapen areas, which could be permanent. It is important to pay attention to your nails and seek medical advice if you notice any unusual symptoms or signs of infection.
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Nail matrix damage and healing
The nail matrix is the part of the body responsible for the growth of strong, healthy nails. Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Minor matrix damage can cause temporary changes to a nail's appearance, such as dents, horizontal ridges or lines, spots or streaks of colour, and texture changes. More severe injuries can cause the nail to fall off.
If you suspect damage to the nail matrix, consult a specialist who will assess the severity of the damage and decide on the best treatment. If a hematoma or pus appears after the injury, apply antiseptic agents to prevent infection. If the damage is serious, a doctor may decide on the necessity of nail reconstruction or surgical intervention. However, not every injury requires such measures. Injuries that are not permanent will heal spontaneously over time.
Among the methods of repairing the nail matrix and promoting faster regrowth of a healthy nail is the clearing of the space under the nail plate, allowing trapped fluid (blood, pus) to escape. Drainage involves making a small hole in the plate, which allows for its cleansing. If the nail begins to detach from the matrix or has cracked, it may be necessary to remove the entire plate.
In the case of a permanent injury to the nail matrix, its regeneration is impossible. All you can do is take external actions to improve the aesthetics and appearance of the nail using nail styling products. However, before opting for cosmetic treatment, consult a specialist to find out the actual condition of the plate and what you can do. If the damage to the matrix is not permanent, proper nail growth after treatment or a procedure is possible.
It is important to identify the problem as quickly as possible and apply appropriate, well-chosen methods to support regeneration of the nail and accelerate it as much as possible. Protect the nail and matrix with special dressings or protective gels for minor damage. Use regenerative preparations with ingredients such as vitamin E, biotin, and keratin. Apply ointments or take oral medications prescribed by a dermatologist or surgeon in the case of bacterial or fungal causes. Treatments at a podiatrist, including laser therapy, are also an option.
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Onycholysis and nail separation
Onycholysis is a condition in which the nail separates from the skin beneath it, or the nail bed. It is usually painless but can be painful if acute or inflammatory. Onycholysis can be caused by a variety of factors, including:
- Injuries or trauma: Bumping or hitting the nails, wearing tight shoes, or keeping nails submerged in water for extended periods can cause onycholysis. Regular manicures and the force applied during trimming, buffing, and polishing can also contribute to this condition.
- Chemical exposure: Reactions to chemicals in nail products like nail polish, gloss, hardeners, and removers can lead to onycholysis.
- Fungal infections: Fungi entering through cracks or cuts can cause thick, yellow nails with white spots and streaks.
- Medications: Chemotherapy, light sensitivity-inducing drugs, tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens, and oral retinoids (vitamin A derivatives) are associated with onycholysis.
- Nail psoriasis: This condition alters nail structure and may result in onycholysis.
- Iron deficiency and hyperthyroidism: Lack of iron in the diet and overactivity of the thyroid gland are potential causes of onycholysis.
Onycholysis rarely affects all nails simultaneously, and there is no cure for the detached section. However, treatment can ensure that new nail growth remains attached to the nail bed. Proper nail care involves clipping the affected nail area and maintaining short, trimmed nails to facilitate new growth. Avoiding activities that traumatize the nail and irritants such as nail products and detergents is crucial. In some cases, antifungal or topical medications may be prescribed to address the underlying cause.
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Subungual hematoma and bruising
Subungual hematoma is the medical term for bleeding and bruising on the fingernail or toenail. It is typically the result of some form of injury to the blood vessels under the nail bed. For example, blood vessels can break and leak blood into the area underneath the nail when a heavy object crushes a finger or toe. Subungual hematomas can also occur when a person repeatedly jams their toes into the toe box of a tight shoe. This is especially true when the person wearing the ill-fitting shoe engages in sports with a lot of stop-and-start action, such as tennis, soccer, or basketball.
The first symptom of a subungual hematoma is throbbing pain in the nail area due to the pressure of blood pooling under the nail bed. The second symptom is nail discolouration. What starts as reddish-purple will eventually turn dark brown and black as the blood clots. The pain typically goes away in a few days, but the nail itself will take longer to recover. The discoloured nail will eventually grow out or, in some cases, fall off or need to be removed and be replaced by a new, healthy one. It could take anywhere from 4 to 6 months for a fingernail to grow out or 12 to 18 months for a toenail.
If you have a bruised nail but no other apparent damage, you can care for yourself at home by applying ice to the area. Wrap the ice in a soft cloth before applying it to your skin. Ice should help ease swelling and pain. Over-the-counter pain medications can also relieve discomfort, and some will even help reduce inflammation. You may need medical treatment if your symptoms are intense or persist beyond a couple of days.
To relieve the pressure and pain caused by a subungual hematoma, a healthcare provider can perform a simple draining procedure known as nail trephination. Providers must perform this procedure within 48 hours of the injury, before the blood clots. The doctor may numb the affected finger or toe with a nerve block before using one of the following decompression methods:
- Cautery: The doctor uses a heated wire (electrocautery device) or carbon laser to burn a hole or holes. The heated tip of the wire is cooled by contact with the hematoma, which prevents injury to the nail bed.
- Needle: The doctor uses a needle to make a hole in the nail.
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Nail growth after severe injuries
Fingernails and toenails can be injured by a blow to the nail or by crushing one's finger or toe in a door or drawer. This kind of trauma commonly results in blood under the nail, called a subungual hematoma. Nails can also be accidentally torn or split, or a splinter can get under the nail. Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Minor damage to the nail matrix can temporarily change the nail's appearance. A severe injury could cause the nail to fall off. Once the nail matrix heals, the nail will usually start to grow again. It may take several weeks before a new nail appears. In cases of severe nail matrix damage, some or all of the nail may not grow back. The nail matrix has two parts: the germinal matrix and the sterile matrix. About 90% of nail growth comes from the germinal matrix.
If the nail is torn or jagged, it should be trimmed to avoid further injury. If the nail lifts completely off the nail bed, it may be most comfortable to replace the nail and hold it in place with a bandage. Nails will not reattach themselves to the nail bed after they have separated from it, but in most cases, a new nail will slowly regrow. If blood under the nail occupies more than half of the nail area, a physician should evaluate the finger because it could signify an underlying bone fracture or tissue tear.
If a nail is lost, it will take about 7 to 10 days for the nail bed to heal. A new fingernail will take about 4 to 6 months to grow to replace the lost nail. Toenails take about 12 months to grow back. The new nail will probably have grooves or ridges and be somewhat misshapen. This may be permanent. If a bone in the finger or toe was broken along with the nail injury, it will take about 4 weeks to heal.
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Frequently asked questions
The nail matrix is where your fingernails or toenails form. It has two parts: the germinal matrix and the sterile matrix. About 90% of your nail growth comes from your germinal matrix.
Nail injuries can occur due to a blow to the nail, closing your finger in a door or drawer, or a cut from a sharp object. They can also be caused by nail biting, cuticle biting, or ill-fitting shoes.
Treatment depends on the type and seriousness of the injury. For minor injuries, you can treat them at home by washing any minor cuts or scrapes and applying a bandage if needed. For more serious injuries, you should seek medical attention to stop the bleeding and clean the wound.
It typically takes about 4 to 6 months for a new fingernail to grow back, and 12 months for a toenail. The new nail may have grooves or ridges and be misshapen.
Onycholysis is when your nail separates from its nail bed due to injury, fungus, or a reaction to chemicals. Treatment options include oral or topical antifungal medication, and trimming the affected nail as it grows out.
