Caleb Foster
There are several reasons why someone's toenail may grow back black. The most common cause is a subungual hematoma, which is a collection of blood underneath the toenail resulting from injury or repeated trauma to the nail bed. This can be caused by ill-fitting shoes, a heavy object falling on the toe, or repetitive microtrauma from activities like running or hiking. Other causes include fungal infections, bacterial infections, chronic ingrown nails, and systemic health conditions like diabetes, kidney disease, anemia, or heart disease. In rare cases, a black toenail may be due to melanoma, the most aggressive form of skin cancer, or vitamin B12 deficiency. Treatment for black toenails varies depending on the cause and can include drainage of blood, medication, or, in severe cases, surgical removal of the nail.
| Characteristics | Values |
|---|---|
| Cause | Trauma or injury, fungal infection, melanoma, bacterial infection, ingrown nails, vitamin B12 deficiency, diabetes, kidney disease, anemia, heart disease, psoriasis, lichen planus |
| Symptoms | Bleeding, bruising, discoloured cuticle (Hutchinson's sign), swelling, pain |
| Treatment | Rest, ice, elevation, compression, draining blood with a needle, prescription medication, ointments, creams, polishes, antifungal treatment, surgical removal, adjusting treatment for underlying conditions, keeping nails clean and dry, wearing properly-fitting shoes |
| Prevention | Wear properly-fitting shoes, keep toes dry and clean, cut toenails short, wear closed-toe shoes when working, wear sunscreen around toes |
| Complications | Permanent damage to the nail, nail growing back misshapen or thickened, toenail fungus spreading to other toes, melanoma spreading elsewhere in the body |
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What You'll Learn
Trauma or injury
In most cases of toenail trauma, the body will naturally reabsorb the hematoma, and the black nail will gradually grow out over a period of six to nine months. During this process, the nail may become loose and partially or completely fall off. However, if the nail matrix (the cells responsible for nail growth) is damaged, permanent nail changes can occur, and the nail may grow back misshapen or thickened.
If you experience severe pain, major nail bed injuries, uncontrolled bleeding, or significant pressure or pain, it is important to seek medical attention. A doctor may use a needle to drain the blood and alleviate pressure, or they may prescribe additional medication if an infection has developed. In some cases, the nail may need to be partially or completely removed.
To prevent toenail trauma, it is recommended to wear properly fitting shoes, keep your toes clean and dry, and avoid wearing open-toed sandals in places where your toes may be at risk of injury.
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Fungal infection
Toenail fungus is a common issue that can cause your toenail to turn black. Fungi thrive in warm and moist environments, making toenails particularly susceptible to fungal infections. This is because socks and shoes create an ideal environment for fungi to grow and spread.
Fungal nail infections are often caused by fungal organisms called dermatophytes. These organisms can enter through cuts or cracks near the nail, and sweaty feet contribute to a favourable environment for their growth. Certain underlying health conditions, such as diabetes, vascular disease, or a weakened immune system, can also make individuals more vulnerable to toenail fungus.
To prevent toenail fungus, it is recommended to keep your nails clean, dry, and cut short. Wearing properly fitting shoes and avoiding walking barefoot in damp, public places can also help reduce the risk of fungal infections.
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Underlying health conditions
In some cases, black toenails can be symptomatic of underlying health conditions. These include:
Diabetes
Diabetes can cause toenail discolouration, which tends to be yellowish in colour, although blackening can occur in some cases. Diabetics are also more vulnerable to toenail fungus, which can cause black toenails.
Vascular disease
Vascular disease can cause discoloured toenails.
Kidney disease
Kidney disease can cause discoloured toenails.
Heart disease
Heart disease can cause discoloured toenails.
Psoriasis
Psoriasis can affect the nail's colour and structure, leading to darkening or discolouration.
Lichen planus
Lichen planus can affect the nail's colour and structure, leading to darkening or discolouration.
Anemia
Anaemia can cause discoloured toenails.
Malignant melanoma
Melanoma is a rare but serious type of skin cancer that can appear as a dark brown misshapen spot. It can also occur underneath nail beds. Melanoma causes the skin to develop one or more patches of dark, irregular-looking skin. In some cases, the patch of darkened skin grows beneath the nail bed. Melanoma develops slowly and without other symptoms, so people often do not notice it in the early stages, especially if it originates under the toenail.
If you are experiencing black toenails and suspect it may be related to an underlying health condition, it is important to consult a doctor or healthcare provider for a proper diagnosis and treatment.
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Treatment and prevention
Black toenails are usually caused by an injury, but they can also indicate an underlying fungal infection, vitamin deficiency, or a medical condition like diabetes or cancer.
If you have a black toenail, it's important to see a healthcare provider, especially if you aren't sure of the cause, to ensure you get the right treatment. A healthcare provider can examine your toenail and ask about any recent injuries, activities, and footwear. Depending on the symptoms, they may also test for underlying conditions.
If you have a sudden, unexplained black toenail or if it does not heal with time and at-home treatments, it is best to contact a doctor.
Treatment
If your black toenail is the result of a blunt force injury, a doctor may use a needle to make a small hole in the nail to drain the blood and alleviate the pressure. If an infection has developed, a doctor may prescribe medication to help the injury heal. If the black toenail is caused by a fungal infection, treatments include topical and oral antifungals, which may be available over the counter.
In rare cases, a black toenail may be due to subungual melanoma, the most aggressive form of skin cancer. If this is the case, the treatment is usually surgical removal of the growth.
Prevention
You can't always prevent black toenails, especially those caused by a sudden injury. However, there are steps you can take to reduce the likelihood of developing a black toenail:
- Wear properly fitting shoes.
- Keep your toes dry and clean.
- Avoid wearing open-toed sandals, especially in places where your toes might get stubbed or stepped on.
- Avoid exposing your feet to the sun. When applying sunscreen to your feet, make sure to include your toes.
- When trimming your toenails, cut straight across the nail to prevent an ingrown toenail.
- If you have an underlying condition such as diabetes, make sure it is well-managed.
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Melanoma
The treatment for melanoma of the toenail typically involves surgical removal of the growth. If the melanoma has spread beyond the nail or toe, other treatment options may be considered. It is important to note that most cases of black toenails are not due to melanoma but rather trauma or fungal infections. However, it is always advisable to consult a doctor if the cause is unknown or if there are concerns about potential melanoma.
To prevent melanoma of the toenail, it is recommended to reduce direct sun exposure to the feet and wear sunscreen around the toes. Additionally, keeping the nails clean, dry, and properly trimmed can also help reduce the risk of melanoma and other nail conditions. Wearing properly fitting shoes and avoiding open-toed sandals in hazardous environments can also help prevent trauma to the toenails.
While rare, melanoma of the toenail can occur and should not be ignored. It is important to be vigilant about any changes in the appearance of the toenails and to seek medical advice if there are any concerns. Early detection and treatment are key to managing melanoma effectively.
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