Foot Health Toenail Problems When to Seek Treatment for Toenail Trauma By Catherine Moyer, DPM Catherine Moyer, DPM, is a podiatrist experienced in the diagnosis, treatment, and prevention of disorders of the foot and ankle. Learn about our editorial process Catherine Moyer, DPM Medically reviewed by Medically reviewed by Casey Gallagher, MD on November 07, 2019 Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor. Learn about our Medical Review Board Casey Gallagher, MD Updated on November 23, 2019 Print If you stub your toe or drop something heavy on your feet, you may develop a subungual hematoma, which is blood 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 blunt trauma from a heavy object or chronic friction from rubbing against the shoe. Acute trauma isn't necessarily the cause. People who do a lot of walking or running are more prone to subungual hematomas because of increased shoe friction. Marathon runners and hikers are very familiar with this malady. Verywell / Jessica Olah Symptoms A subungual hematoma can range from a small spot under the nail to a large area of discoloration. Depending on the amount of blood beneath the nail, the nail may come loose. But often the nail does stay intact, and the blood fades as the nail grows out. If a subungual hematoma is large and causing pain, medical treatment may be needed to relieve pressure under the nail. If left untreated, the condition could damage the nail matrix, causing the nail to grow incorrectly or not at all. When to See a Doctor It's time to go from self-care to seeing a medical professional if any of these six conditions apply in your case. Blunt trauma to the toenail, such as a heavy object dropped on the toe, which may need to have a fracture or wound treatedSevere swelling, pain, or redness of the toeDischarge from under the toenailToenail becomes looseIf you have neuropathy, diabetes, peripheral arterial disease, or any condition that affects healing or circulationDiscoloration appears as a linear streak or a stripe going with 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 at home. Doing so could lead to infection and slow the healing process. If you are unable to seek immediate care, bandage the nail and avoid trimming or cutting of any sort. Changes in Nail Structure Nail trauma may not always lead to bleeding beneath the nail but to other predictable changes. These changes may occur due to chronic rubbing against the shoe or in response to irritation from a fungal or bacterial infection. Some of the most common changes are: Nail thickening: This is caused by damage to the nail's growth center, called the nail matrix. It responds by producing a thicker nail.Nail dystrophy: You may see permanent nail changes such as splitting or a decrease in size.Nail avulsion: Sometimes the entire nail or a portion of it becomes loose or falls off. This is often a temporary condition and the nail will regrow over the course of a couple of months.Permanent nail loss: This can happen due to damage to the nail matrix. The toenail may not regrow. How Subungual Hematomas Are Treated Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Pingel C, McDowell C. Subungual Hematoma Drainage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Richardson M. Selecting a treatment option in subungual haematoma management. Nurs Times. 2004;100(46):59, 61, 63. Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr. Chapter 196. Subungual Hematoma. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. eds. The Color Atlas of Family Medicine, 2e. New York, NY: McGraw-Hill; 2013. Bharathi RR, Bajantri B. Nail bed injuries and deformities of nail. Indian J Plast Surg. 2011;44(2):197-202. doi:10.4103/0970-0358.85340 Additional Reading Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr. Chapter 196. Subungual Hematoma. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. eds. The Color Atlas of Family Medicine, 2e. New York, NY: McGraw-Hill; 2013.