When to Seek Treatment for Toenail Trauma

If you stub your toe or drop something heavy on your foot, you may develop a subungual hematoma, which is blood and fluid trapped beneath the toenail. This gives the toenail a red, black, or purple discoloration. It is often called black toenail for that reason.

A subungual hematoma is usually caused by trauma from a heavy object, but a single incident isn't always the cause. It can also develop from frequent rubbing against a shoe. For example, people who do a lot of walking or running, such as marathon runners or hikers, are more prone to them.

This article will explore symptoms of subungual hematoma and when you should seek medical treatment.

Symptoms of Bleeding Beneath the Nail

A subungual hematoma can range from a small spot under the nail to a large area of discoloration. It can happen to toenails or fingernails.

The nail may hurt or feel tender when touched.

Depending on the amount of blood beneath the nail, the nail may come loose and fall off. But often the nail does stay intact, and the blood fades as the nail grows out.

When to See a Doctor

If a subungual hematoma is large and causing pain, medical treatment may be needed to drain the blood and relieve pressure under the nail.

If left untreated, the condition could damage the nail matrix, the area from which the nail grows, causing it to grow incorrectly or not at all.

If the nail is raised or cut, it could also increase the risk of a fungal or bacterial infection.

If you have bleeding under the nail or damage to the nail, it's a good idea to have you toe looked at by a medical professional within 48 hours. That way, the blood can be drained if needed.

Delayed treatment could increase your risk of permanent changes in the nail.

It is especially important to see a doctor for the following:

• You had blunt trauma to the toenail, such as a heavy object dropped on the toe, which may also include a broken toe bone that needs treatment or a cut that needs stitches.
• There is severe swelling, pain, or redness of the toe.
• Discharge is draining out from under the toenail.
• The toenail becomes loose.
• You have neuropathy, diabetes, peripheral artery disease, or any condition that affects healing or circulation.
• The discoloration appears as a linear streak or a stripe along the length of the nail. Although a streak of pigment is often normal, in some cases it may be a sign of the skin cancer melanoma.

If the nail is raised, the doctor may relieve the pressure by drilling a hole through the nail. If it is loose, the nail may be trimmed or even reattached to protect the nail bed while the nail is regrowing.

You should avoid removing or drilling the injured nail yourself at home. Doing so could lead to infection and slow the healing process. If you are unable to see a doctor right away, bandage the nail and avoid trimming or cutting it.

Changes in Nail Structure

Nail damage may also lead to changes in the nail's structure. These changes may occur after an injury from a heavy object, chronic rubbing against the shoe, or in response to irritation from infections.

Some of the most common changes in nail structure are:

• Nail thickening: This is caused by damage to the nail's growth center. It responds by producing a thicker nail.
  
• Nail loosens or falls off: Sometimes the entire nail or a portion of it will loosen or fall off. This is called nail avulsion. It's often a temporary condition, and the nail will regrow over the course of a couple of months.
• Permanent nail changes: You may see permanent splitting or a decrease in size. If there is severe damage to the area where the nail starts to grow, it may not regrow.

Summary

Bleeding beneath the nail can happen after an injury, such as a heavy object landing on the toe, or from chronic rubbing within your shoes.

If it covers a large area of the toe or is painful, medical treatment may be needed to relieve pressure and help prevent permanent nail changes.

Sometimes bleeding under the nail can change the structure of the toenail for a period of time and may lead to the nail loosening or falling off. This is usually temporary, but if the trauma was severe it may be permanent.