It’s late at night, you’re half-asleep fumbling in the dark, and bam! You slam your big toe into something hard. You think, “How can something so small hurt so bad?”
After the throbbing has subsided, you may be surprised to see that your toenail is black and blue and cracked down the middle the next day.
Do you wrap it up and let nature take its course, or do you call your health care provider?
While some nail injuries can be treated at home, there are some instances where you’ll need medical attention. Although your toes represent a small part of your body, a toenail injury can have a huge impact on your life.
Read on to learn more about toenail traumas, when to see a medical professional and how to prevent toenail traumas altogether.
What are common causes for toenail trauma?
Besides the rare instances where you stub your toe late at night (or during the day), most toenail injuries occur from repeated trauma.
“Athletes, runners and even hikers often get a condition called runner’s toe, which is a black toenail caused by repeated strain on your nail,” said Brett Roeder, DPM, a podiatrist and reconstructive rearfoot and ankle surgeon at Banner Health Clinic in Gilbert, AZ. “This type of trauma commonly results in blood under the nail, known as a subungual hematoma.”
[Also read “Happy Trails and Feet: 6 Tips to Prevent Blisters.”]
What type of toenail injuries can occur?
Almost everyone has somehow smashed a fingernail or toenail and later seen blood under their nail bed. A subungual hematoma is usually caused by trauma from dropping something heavy on your foot or from frequent rubbing or friction against a shoe. It occurs when the blood vessels break open under the nail, causing blood to pool. Your toenail may look like a black, blue or purple bruise.
Other nail trauma is painful and can cause your nail to accidently tear or split (lacerations), fall off completely (avulsion), or it can cause an ingrown toenail.
[Also read “Common Shoe Mistakes That Could Be Crushing Your Feet.”]
When should I seek medical attention for a toenail injury?
If the injury is minor, you may be able to care for it at home if you can stop the bleeding, the nail is not cut or torn and is still attached, a nail bruise covers less than a quarter of your nail and your toe isn’t bent or misshapen.
If blood under your toenail covers more than half of the nail area, you should go to your health care provider, urgent care or emergency room to drain the blood and relieve pressure under the nail. You should not try to drill or reduce pressure under your toenail on your own.
“If blood is not properly drained from under the toenail, you can develop infections,” Dr. Roeder said. “Occasionally, the nail may need to be removed so a deep tear can be repaired with stitches. This isn’t something you should try at home.”
For nail lacerations and avulsions, your nail may need to be removed by a health care provider. Then when the nail bed dries up, your provider may recommend moisturizer or antifungal medication (cream) to prevent fungal infections and keep the nail bed healthy as the nail grows back in. Your provider may also prescribe antibiotics to prevent infection.
If you are unable to see your provider right away, bandage the nail and avoid trimming or caring for it on your own.
“If you have neuropathy, diabetes or any condition that affects healing or circulation, it’s important to have your provider evaluate your toenail injury,” Dr. Roeder said. “In rare situations, it could lead to toe amputation if an injury is left untreated.”
Will my new toenail look deformed?
It may take a year or more for your toenail to grow back, and the new one may not look like it did before. Any type of nail damage may lead to changes in how your nail looks. You may notice the new nail has grooves or ridges and is somewhat misshapen. This can be temporary or permanent if there was severe damage to the area where your nail starts growing.
Is there a way to prevent toenail trauma?
You may not be able to prevent certain toenail injuries from occurring, but here are a few things you can do to protect your toes:
- Buy shoes that fit properly. It may help to go shoe shopping later in the day after your feet are swollen, measuring and fitting a shoe to the larger foot and finding a shoe that has good support and enough room in the toe box (the area at the front of the shoe).
- Wear close-toed shoes around the house. Generally, open-toed shoes aren’t recommended for people with diabetes.
- Keep toenails trimmed. Keep your toenails properly trimmed with a nail clipper to reduce your risk for rubbing or pressure.
- Control moisture if you have sweaty feet. It you’re prone to sweaty feet, it may help spraying your feet with antiperspirant prior to activities.
- Purchase silicone or gel toe caps. If you’re prone to toenail trauma, toe caps can help prevent blisters, rubbing, irritation and toenail loss.