Ava Monroe
Fingernail and toenail injuries are common and can be caused by a heavy object crushing or hitting the fingers or toes, or by cutting with a sharp object. Treatment depends on the type and severity of the injury, with some requiring medical attention and others being treatable at home. In most cases, a new nail will slowly regrow, pushing off the old nail as it grows. This process can take anywhere from 4 to 6 months for fingernails and up to 12 months for toenails.
| Characteristics | Values |
|---|---|
| What causes nail damage? | Blow to the nail, closing finger or toe in a door or drawer, cutting with a sharp object, pinching or crushing, dropping something heavy |
| What happens when the nail is damaged? | Bruising, ridges, discolouration, nail falling off, nail infection, change in texture, change in how the nail feels to the touch |
| What to do in the event of nail damage? | Treat bleeding quickly, remove jewellery, wash minor cuts, apply ice, seek medical attention if serious |
| How does the nail grow back? | The nail matrix heals, and the new nail grows in and replaces the old nail, pushing it off as it grows. |
| How long does it take for the nail to grow back? | 4-6 months for fingernails, 12 months for toenails |
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What You'll Learn
Nail injuries and treatment
A nail injury can occur when any part of the nail becomes injured, including the nail, nail bed, cuticle, and the skin around the sides of the nail. Smashing a finger in a door, hitting it with a hammer or another heavy object, or cutting it with a knife or another sharp object can cause a nail injury.
Treatment for nail injuries
The treatment for nail injuries depends on the type and seriousness of the injury. Many nail injuries are minor and can be treated at home. For more serious nail injuries, one should go to an urgent care center or the emergency room.
Home treatment
- If any part of the nail is hanging off, gently trim away the part not connected to the skin.
- Gently clean the wound using soap and water.
- If the wound is bleeding, do not put a dry bandage or gauze on top. Instead, apply petroleum jelly to keep the wound moist and then cover with gauze or a bandage. Repeat these steps every day while the wound heals.
- Do not put sticky products on your nail. Make sure to only apply sticky products, such as an adhesive bandage or medical tape, to the skin around your nail so you don’t irritate the injury further.
- Wrapping your wound with an elastic bandage is another good option, however, do not wrap the bandage too tightly.
- Apply a cool, damp washcloth to your wound to reduce swelling.
- Prop the arm or leg with an injured nail on pillows so the nail is higher than your heart. This helps reduce swelling.
- Taking ibuprofen or acetaminophen can help relieve pain and reduce swelling when your nail injury is new.
- Protect your nail while it heals. A nail injury can take several weeks to feel completely better. Even after your wound stops bleeding, keep a light dressing on the nail, such as an adhesive bandage or a small piece of gauze, to provide padding and protection.
- To prevent another nail injury, keep your nails short so they do not bend or catch on objects.
Medical treatment
- Doctors may treat a severe subungual hematoma by making a small hole in the nail and draining the pooling blood. This procedure is called nail trephination and must be performed within 48 hours of the injury, before the blood clots.
- If the collected blood covers more than half of the nail bed, the doctor may remove the nail and repair the nail bed and matrix.
- If the nail is damaged or torn, the doctor may remove it and repair the nail bed. They may also do so if the finger or toe is fractured.
- Doctors may use stitches to repair any laceration to the nail bed and reattach the nail, if possible, to provide protection and support while the new nail grows.
- Doctors may prescribe antibiotics to prevent infection.
- If you have a broken bone, doctors may need to place a wire in your finger to keep the bone in place.
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Nail matrix damage
The nail matrix is the "factory" where new nails are made. It is located at the base of the nail and is responsible for producing the cells that form your nails. The nail matrix has two parts: the germinal matrix and the sterile matrix. The former is responsible for about 90% of nail growth and gives a natural curvature to the nail, while the latter keeps the nail attached to the underlying skin.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. For example, a heavy object crushing or hitting the fingers or toes, or a cut from a sharp object can cause nail matrix damage. Certain illnesses, such as COVID-19 or pneumonia, can also interrupt nail growth and cause horizontal ridges in the nails. Minor damage to the nail matrix can cause temporary changes in the nail's appearance, such as ridges, discoloration, or a change in texture. Severe injuries, such as deep cuts or crushing injuries, may result in long-term or permanent effects if the nail matrix is significantly damaged. In some cases, the nail may fall off or stop growing temporarily as it recovers from the injury.
If you sustain nail matrix damage, it is important to seek medical attention to ensure proper treatment and healing. In some cases, a doctor may need to remove the nail and repair the nail bed and matrix. With the right treatment, healthy nails can often grow back, although it may take several weeks or even months for the new nail to appear. It is also important to protect your nails to reduce the risk of future trauma. This can include wearing protective gloves during repetitive tasks or heavy lifting and keeping nails trimmed and maintained.
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Subungual hematoma
A subungual hematoma is a type of nail bed injury that occurs when small blood vessels under the nail bed leak, and blood collects between the nail and the nail bed. This usually happens when the tips of the fingers or toes have been crushed or subjected to a heavy impact. Symptoms include intense pain and throbbing, caused by the pressure of blood collecting under the nail.
If you have a large bruise, your doctor may create a small hole in the nail to drain the blood and relieve the pressure and pain. This procedure is called trephination. Your doctor may numb the affected finger or toe with a nerve block before using a heated wire (electrocautery device), carbon laser, or needle to make the hole. If the bone is broken or the bruise is very large, the nail may need to be removed, and the nail bed repaired with stitches. In this case, the nail will usually fall off on its own after several weeks, and a new fingernail can regrow in as little as 8 weeks. Toenails may take up to 6 months or a year to fully regrow.
It's important to note that there is a small risk of infection associated with trephination. If you have not had an injury and notice a darkened area under your nail, you should see your doctor to rule out other possible causes, such as melanoma or a nevus.
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Nail bed repair
Nail bed injuries are common and can occur due to various reasons, such as crushing the fingers or toes with a heavy object, cutting with a sharp object, or pinching or crushing the finger. The treatment for nail bed injuries depends on the type and seriousness of the injury. Minor nail bed injuries can often be treated at home, while more severe injuries may require medical attention.
Home Treatment
For minor nail bed injuries, such as small bruises or cuts, you can treat them at home by:
- Removing any jewelry from your hand, especially rings, as the injured finger may swell.
- Gently washing any minor cuts or scrapes.
- Applying a bandage if needed.
- Applying ice packs or cold compresses wrapped in a cloth for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that.
Medical Treatment
For more serious nail bed injuries, it is recommended to seek medical attention. Doctors can provide various treatments depending on the type and severity of the injury:
- Trephination: For severe subungual hematomas (bruising under the nail), doctors may perform trephination by creating a small hole in the nail to drain the pooled blood and relieve pressure and pain.
- Nail Removal and Nail Bed Repair: If the nail is severely damaged, torn, or covers more than half of the nail bed, doctors may remove the nail to access and repair the nail bed. They may use stitches or special glue to reattach the nail or attach a synthetic nail if the natural nail is too damaged.
- Antibiotics: Doctors may prescribe antibiotics to prevent or treat infections that can occur with nail bed injuries.
- X-rays and Fracture Treatment: X-rays may be required to check for bone fractures. If a fracture is present, the doctor may place a wire in your finger to keep the bone in place.
- Stitches: Cuts or lacerations in the nail bed will be closed with stitches or other methods, such as Dermabond.
- Nail Replacement: Replacing the nail can preserve nail folds and prevent infection.
Recovery and Rehabilitation
The recovery time for nail bed injuries can vary. It typically takes about 7 to 10 days for the nail bed to heal initially, and a new fingernail will take about 4 to 6 months to grow back, while toenails can take up to 12 months. During this time, the nail may grow back with ridges or bumps, and it may take up to 9 months for a normal nail to return. To prevent stiffness in your fingers during recovery, it is recommended to do finger exercises, such as touching the tips of each finger to the thumb and moving the wrist forward and backward.
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Nail growth timeline
Fingernails and toenails are made of a protein called keratin, which is also found in hair and skin. Nails grow from the nail matrix, which is located under the base of the nail. The nail matrix produces 196 layers of cells that combine to make each fingernail and toenail.
The growth rate of fingernails and toenails varies depending on several factors, including age, sex, season, exercise level, diet, hereditary factors, and overall health. Generally, fingernails grow faster than toenails, with the average growth rate of fingernails being between 0.5 and 1.2 mm per week (approximately 0.1 mm per day or 3.47 mm per month), while toenails grow at an average rate of 1.62 mm per month.
If a fingernail or toenail is damaged or lost, it can take some time for it to grow back. Here is a timeline of the nail growth process after an injury:
- It takes about 7 to 10 days for the nail bed to heal after losing a nail.
- A new fingernail will take about 4 to 6 months to grow back completely, replacing the lost nail. During this time, the new nail may start to appear within several weeks, but it may take longer for the nail to fully grow back, depending on the severity of the injury.
- Toenails take longer to grow back, with a regrowth time of about 12 to 18 months.
It is important to note that the growth rate can vary from person to person, and the timeline for nail growth after an injury may be influenced by the severity of the injury, the treatment received, and individual factors such as age, health, and nutrition.
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Frequently asked questions
A nail matrix injury occurs when the nail matrix, the tissue inside the cuticle at the base of the nail where new nails are formed, is damaged.
After a nail matrix injury, the nail matrix needs to heal before a new nail can start to grow. In cases of severe nail matrix damage, some or all of the nail may not grow back.
A subungual hematoma is a type of nail trauma that appears dark red under the nail. It is caused by blood trapped under the nail, often due to a blow to the nail or a heavy impact.
A doctor may treat a subungual hematoma by creating a small hole in the nail to drain the blood and relieve the pressure and pain. If the nail is damaged, a procedure called nail trephination can be performed within 48 hours of the injury to help the new nail grow in correctly.
A new fingernail typically takes about 2 months to grow back, while a toenail can take about 4 months. The new nail may have grooves, ridges, or bumps and may be misshapen.
