Noah Sinclair
Trauma under the toenail, known as a subungual hematoma, occurs when blood vessels under the nail break and blood pools underneath. This can be caused by a blow to the nail, stubbing the toe, or wearing ill-fitting shoes. Depending on the severity of the injury, it can take anywhere from several weeks to a few months for the nail to heal and regrow. In some cases, the nail may be permanently malformed or cracked. To promote healing, it is recommended to rest, ice, compress, and elevate the affected toe. If the pain is severe or there are signs of infection, it is important to seek medical advice.
| Characteristics | Values |
|---|---|
| Medical term | Subungual haematoma |
| Cause | Blood vessels under the nail are broken, causing blood to pool |
| Symptoms | Severe throbbing pain, darkened area under the nail |
| Treatment | Resting, icing, applying compression, elevation, draining the blood |
| Healing time | Several months to years; faster for fingernails (8-9 months) than toenails (6-12 months) |
| Prevention | Keep toenails short and square-cut, wear properly-sized shoes |
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Subungual hematoma
A subungual hematoma is a common injury that occurs when there is bleeding under a fingernail or toenail, often due to a crush injury. It can cause severe throbbing pain and the affected area may appear dark red. The intense pain is caused by the pressure of blood collecting between the nail and the nail bed.
Small subungual hematomas may not require medical treatment. To reduce swelling and manage minor pain, it is recommended to ice and elevate the area, and take over-the-counter anti-inflammatory medications such as aspirin or ibuprofen. However, if the hematoma is causing severe pain, a doctor may perform a procedure called decompression or trephination to relieve the pressure and pain. This involves draining the blood that has collected under the nail. The doctor may numb the area with a nerve block before using a heated wire, carbon laser, or needle to create a small hole in the nail, allowing the blood to drain out.
After the procedure, the doctor will bandage the affected finger or toe, and you may be advised to use cold compresses and keep the area elevated for the first 12 hours. In some cases, a splint may be recommended for a few days until the tenderness subsides. There is a small risk of infection following decompression, and if there is significant injury to the nail bed, the nail may need to be removed and the area stitched. In most cases, the nail will fall off on its own after several weeks, and a new fingernail can regrow in about 8 weeks, while a toenail may take up to 6 months to fully regrow.
It is important to note that if there is no history of trauma and there is a darkened area under the nail, it is recommended to consult a doctor to rule out other possible causes, as it could be indicative of underlying conditions such as melanoma or a nevus. Additionally, if the bleeding under the nail occupies more than half of the nail area, it could signify a bone fracture or tissue tear, and prompt medical evaluation is necessary.
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Home remedies
Trauma under the toenail, also known as a subungual hematoma, is usually caused by trauma from dropping something heavy on the foot or from frequent rubbing or friction against a shoe. It occurs when blood vessels break open under the nail, causing blood to pool. Toenails take about four months to regrow, but in severe cases, it may take up to 12 months.
- Rest: Limit the use of your injured toe to reduce further trauma.
- Ice: Wrap a towel around an ice pack and gently press it onto the injury for 20-minute intervals each day to reduce pain and swelling.
- Compression: Apply a wrap to the area to reduce blood flow and limit pain.
- Elevation: Keep your foot elevated to reduce swelling.
- Soak your foot: Soak your foot in warm water with Epsom salts to soothe and soften the area. This will also encourage pus drainage and reduce pain.
- Combat infection: Apply antibiotic lotion or antifungal medication to the area to prevent infection.
- Medicate: Take over-the-counter pain medication to alleviate swelling and pain.
- Silicone or gel toe caps: Use toe caps to help cushion your toes and prevent nail trauma.
- Properly-sized shoes: Wear properly-sized shoes to prevent toenail trauma.
- Keep your toenails trimmed: Trimmed toenails can prevent trauma caused by ill-fitting shoes.
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Medical treatments
Trauma under the toenail, also known as subungual hematoma, is usually caused by blunt or crush trauma, such as a heavy object falling on the toe, or from chronic irritation, such as the nail rubbing against footwear. This results in blood collecting under the nail, causing pressure and severe, throbbing pain.
If you have a subungual hematoma, you should seek medical attention if the injury covers more than half of the nail area or is causing pain. Medical treatment for subungual hematoma involves relieving pressure by draining the blood trapped under the nail. This can be done through a simple procedure called trephination. If there is additional damage, such as a broken bone or deep cut, the nail plate may need to be removed to surgically repair the underlying tissues and support proper healing. Antibiotics may also be prescribed to prevent infection.
If the nail is severely damaged or torn, it may need to be removed by a healthcare provider. After removal, the provider may recommend keeping the nail bed dry or using a moisturiser or antifungal medication to prevent infection and promote healthy regrowth. In some cases, stitches may be required to repair the nail bed.
To prevent toenail trauma, it is recommended to wear properly sized shoes and socks made from synthetic fibres to prevent moisture accumulation. Silicon gel toe caps can also help cushion the toes and reduce the risk of trauma. Keeping your toenails trimmed and avoiding nail biting or cuticle biting can also help prevent trauma and potential infections.
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Toenail loss
Trauma under the toenail, known as a subungual hematoma, can cause the toenail to fall off. This condition is usually the result of an injury, such as dropping something heavy on the toe or stubbing it hard, causing blood to collect and pool beneath the nail. As the blood builds up, it separates the nail from its bed, and the toenail may fall off after several weeks. During this time, the toenail may appear black, purple, or dark red.
If you experience a subungual hematoma, it is important to monitor the affected area for any signs of infection. You should also keep your toenail clean and trimmed, and consider using a nail file to smooth any sharp or jagged edges. If the subungual hematoma covers more than a quarter of your toenail, or if you experience intense pain or throbbing, seek medical attention. A doctor may be able to relieve the pressure by creating a small hole in the toenail to drain the blood. In some cases, antibiotics may be prescribed to prevent or treat an infection.
If your toenail falls off due to trauma, it is important to take steps to prevent further injury and support healthy regrowth. This includes wearing well-fitting shoes and socks, keeping the nail bed clean, and avoiding pulling or cutting any remaining parts of the nail. Depending on the cause and severity of the nail loss, your doctor may recommend additional treatments to ensure proper regrowth.
It can take anywhere from six months to two years for a toenail to completely grow back after falling off. During this time, you may notice cosmetic changes to the nail, such as ridges or splits, especially if the injury included the base of the nail. In some cases, the nail may not grow back properly or at all, especially if the underlying cause is not addressed. Fungal infections, for example, may require topical creams, oral antifungal medications, or even surgery to remove the nail and prevent regrowth.
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Preventative measures
While it is not always possible to prevent toenail injuries, there are several measures you can take to reduce the risk of trauma to your toenails. Here are some preventative measures to consider:
Wear Properly Fitting Shoes: Ill-fitting shoes are a common cause of toenail trauma. Shoes that are too tight or too loose can lead to increased pressure, friction, and irritation on the toenails. When buying new shoes, ensure they have sufficient room in the toe box and provide good support. It is recommended to go shoe shopping later in the day when your feet are slightly swollen to ensure a more accurate fit.
Trim Your Toenails Regularly: Keeping your toenails properly trimmed can reduce the risk of them rubbing against your shoes or other toes. Trimmed nails are less likely to get caught or torn during daily activities or injuries.
Protect Your Toes: If you are prone to toenail trauma or have sensitive toes, consider wearing toe caps or silicone gel protectors. These can help shield your toenails and toes from direct impact and reduce the risk of injury.
Control Moisture: Sweaty feet can increase the risk of toenail trauma by causing excess moisture and softening the nails. If you have sweaty feet, consider using antiperspirant sprays or powders to keep your feet dry. This can help reduce friction and the risk of toenail infections.
Be Mindful of Your Surroundings: Be cautious of your surroundings to avoid accidental impacts or dropping heavy objects on your toes. This is especially important in environments where heavy objects are present or during activities that involve constant pressure on the toes, such as sports or hiking.
Maintain Good Nail Habits: Avoid habits such as nail biting or cuticle biting, as these can weaken the nails and cuticles, making them more susceptible to trauma. Instead, focus on maintaining proper nail hygiene and keeping your nails clean and healthy.
Remember, while these preventative measures can help reduce the risk of toenail trauma, accidents can still happen. It is always important to seek appropriate medical attention for any nail injuries and to prioritize proper healing and nail regrowth.
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Frequently asked questions
A subungual hematoma is a condition where blood collects and becomes trapped under the nail, causing severe pain and throbbing. This usually happens when the nail gets crushed or due to repeated trauma caused by ill-fitting shoes.
A subungual hematoma on a toenail can take around 6-9 months to heal and for the new nail to grow out. In some cases, it may take even longer or the nail may fail to regrow.
If you experience a subungual hematoma, you should first elevate and ice the affected area. If the pain is severe or the injury is accompanied by broken bones or damage to the nail bed, you should seek medical attention immediately.
Yes, home remedies such as resting, icing, applying compression, and elevating the affected area can help encourage healing. Keeping your toenails trimmed and wearing properly sized shoes can also help prevent subungual hematomas.
If left untreated, a subungual hematoma can lead to permanent cosmetic changes, such as deformities in the nail. In rare cases, it can also be a sign of melanoma, a type of skin cancer, so it is important to monitor the condition and seek medical advice if concerned.
