Isla Bennett
Nail bed pressure can cause a subungual hematoma, which looks like a bruise. This occurs when small blood vessels under the nail bed leak and blood pools between the nail and the nail bed. This can be caused by blunt force trauma, crush injuries, or repetitive pressure over time. The pooling blood can cause the hard part of the nail to lift up from the tissues underneath. This can be very painful and lead to permanent damage to the nail.
| Characteristics | Values |
|---|---|
| Definition | Nail bed pressure occurs when blood vessels in the nail bed are injured and start to leak blood, which builds up underneath the nail plate |
| Appearance | A subungual hematoma looks like a bruise |
| Causes | Blunt force trauma, crush injuries, repetitive pressure over time (e.g. running in tight shoes) |
| Symptoms | Pain, nail sensitivity, separation of nail plate from nail bed, throbbing, sensitivity to touch, permanent damage to the nail |
| Treatment | Trephination procedure to drain the hematoma and ease pain and pressure |
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What You'll Learn
Subungual hematoma: bleeding and bruising under the nail
Subungual hematomas are injuries to the nail bed, which can be caused by blunt force trauma, crush injuries, or repetitive pressure over time. They occur when small blood vessels under the nail bed leak, and blood pools between the nail and the nail bed. This can happen when the tips of the fingers or toes have been crushed or subjected to a heavy impact, or when very tight-fitting shoes put pressure on the blood vessels and cause them to leak. As the blood clots, the colour of a hematoma can change from red or purple to brown or black.
The injury causes the nail to become very tender to the touch, and even gentle pressure might hurt a lot. The pressure from pooling blood may cause the hard part of the nail to lift up from the tissues underneath. As the blood accumulates in the small space beneath the nail, it puts pressure on the tender skin of the nail bed, which can cause continued throbbing or severe pain.
If the injury is causing severe pain, it means the blood is causing too much pressure, and the hematoma may need to be drained. This can be done through a trephination procedure, which releases trapped blood from under the nail to ease pain and pressure. Trephination rarely leads to complications, but it is possible to develop an infection or a minor injury to the nail bed.
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How to treat a subungual hematoma
Nail bed pressure refers to the pressure that builds up when blood leaks from injured blood vessels in the nail bed. This blood pools between the nail and the nail bed, causing pain and sensitivity. This is known as a subungual hematoma.
Subungual hematomas are usually caused by blunt force trauma or crush injuries, but they can also be caused by repetitive pressure over time, such as running in shoes that are too tight.
To treat a subungual hematoma, it is recommended to perform trephination, which releases trapped blood from under the nail to ease pain and pressure. Trephination uses a hollow-tip needle, electrocautery, or a heated paper clip to make a hole in the nail and drain the blood. This procedure rarely leads to complications, but there is a small risk of infection or minor injury to the nail bed.
If the subungual hematoma is small (less than 25% of the nail bed) and painless, it will usually reabsorb on its own and does not require any intervention. However, if it covers more than 25% of the nail bed or is causing pain, trephination or nail removal may be necessary.
To prevent subungual hematomas, it is recommended to wear shoes with a wide toe box and/or larger shoes, file toenails very short at a 45-degree angle, and use silicone toecaps.
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How to recognise a subungual hematoma
Nail bed pressure can cause a subungual hematoma, which is a bruise that forms when small blood vessels under the nail bed leak, and blood pools between the nail and the nail bed. This can happen when the tips of the fingers or toes have been crushed or subjected to a heavy impact, or even from repetitive pressure over time, like running in shoes that are too tight.
To recognise a subungual hematoma, look out for the following signs:
- Pain and discoloration. As the blood accumulates in the small space beneath the nail, it puts pressure on the tender skin of the nail bed, causing pain. The colour of a hematoma can change from red or purple to brown or black as the blood clots.
- Nail sensitivity. The nail may be very tender to the touch. Even gentle pressure might hurt a lot.
- Separation of the nail plate from the nail bed. The pressure from pooling blood may cause the hard part of your nail to lift up from the tissues underneath.
- Continued throbbing or severe pain. Without draining the hematoma, you may experience throbbing or severe pain.
- Permanent damage to the nail. This can include visible changes like ridges, splitting or changes in your nail shape.
- Signs of infection. Complications are rare, but it's possible to develop a bacterial infection in the area of the injury.
If you suspect you have a subungual hematoma, a healthcare provider will closely examine your finger or toe, including the nail plate and the areas where your nail plate meets surrounding skin (nail folds). They may ask you to move or bend your finger or toe so they can evaluate the extent of the injury. They may also recommend imaging tests, such as X-rays or ultrasound, to check for broken bones or other injuries that aren't visible on the surface of your skin.
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What causes a subungual hematoma
Nail bed pressure refers to the pressure that builds up when blood leaks from injured blood vessels in the nail bed and collects between the nail and the nail bed. This is known as a subungual hematoma.
A subungual hematoma is a type of nail bed injury that occurs when blood vessels under the nail bed leak, causing blood to pool and become trapped between the nail and the nail bed. This can happen when the tips of the fingers or toes have been crushed or subjected to a heavy impact, such as a blow or crush injury to the distal phalanx. Very tight-fitting shoes can also put pressure on the blood vessels and cause them to leak. As the blood clots, the colour of a hematoma can change from red or purple to brown or black.
Subungual hematomas usually happen from blunt force trauma, such as hitting your nail with a hammer, or crush injuries, such as slamming your finger in a door or dropping a heavy object on your toe. They can also occur from repetitive pressure over time, such as running in shoes that are too tight and press on one of your toenails.
In rare cases, a subungual hematoma may be due to a malignant tumour, such as melanoma or squamous cell carcinoma.
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How to prevent a subungual hematoma
Nail bed pressure refers to the pressure that builds up when blood leaks from injured blood vessels in the nail bed and becomes trapped under the nail plate. This can be caused by blunt force trauma, crush injuries, or repetitive pressure over time.
To prevent a subungual hematoma, you can take the following steps:
- Wear properly fitting shoes. Tight shoes can put pressure on the blood vessels in your nail bed and cause them to leak.
- Play sports on natural surfaces such as grass or clay, which will help reduce the friction between your shoe and foot.
- Protect your feet with heavy work boots or steel-toed shoes if you work in an environment where your feet are at risk of crushing injuries, such as construction or a warehouse.
- Buddy taping can help reduce friction if recommended by your doctor. This involves taping the problematic toe to the toe next to it.
- Avoid repetitive pressure on your nails, such as running in shoes that are too tight.
If you experience a subungual hematoma, you can manage the pain and swelling with over-the-counter pain relievers and the RICE method. If the pain is severe or there is significant damage to the nail bed, seek medical treatment.
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Frequently asked questions
Nail bed pressure is when blood vessels in the nail bed are injured and start to leak blood, which builds up underneath the nail plate.
A subungual hematoma looks like a bruise. The blood pools between the nail and the nail bed, and the colour can change from red or purple to brown or black.
Subungual hematomas are usually caused by blunt force trauma, crush injuries, or repetitive pressure over time. For example, hitting your nail with a hammer, dropping a heavy object on your toe, or running in shoes that are too tight.
Trephination is a procedure that can be used to treat subungual hematomas. It involves draining the trapped blood from under the nail to ease pain and pressure.
