A bruised toenail, or subungual hematoma, occurs when blood collects beneath the nail plate. This typically results from trauma, such as stubbing your toe, dropping an object on it, or repetitive pressure from ill-fitting footwear. The injury ruptures small blood vessels, causing discoloration and pain as blood accumulates.
A subungual hematoma is a common, generally minor injury. Despite its dark appearance, discomfort typically improves within days. The trapped blood creates pressure, causing throbbing pain.
At-Home Care for a Bruised Toenail
Home care for a bruised toenail focuses on managing pain and swelling while protecting the injured toe. Immediately after injury, apply ice or a cold compress to reduce swelling and pain, wrapping it in a cloth to prevent direct skin contact. Elevating the foot above heart level also minimizes swelling and throbbing by decreasing blood flow.
Resting the injured toe prevents further trauma and allows healing. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can manage discomfort. Ibuprofen, an anti-inflammatory, may be helpful if swelling is present.
Protecting the nail involves wearing comfortable, loose-fitting shoes that do not press on the injured toe. Open-toed shoes or sandals provide ample space and reduce pressure. Keep the nail clean and dry to prevent complications. Soaking the foot in warm water, potentially with Epsom salts, can offer additional pain and swelling relief.
As healing progresses, trapped blood under the nail will darken, changing from red or purplish to dark brown or black. This discoloration will gradually grow out with the nail, or pressure from the pooling blood may cause the nail to loosen and fall off. A new nail will then grow in its place, a process that takes considerable time.
New toenails grow slowly, typically taking 12 to 18 months to fully regrow. Initial growth may be visible within two to three months, with half the nail regrown in six to nine months. This natural regrowth cycle varies by individual factors like age and overall health.
When to Seek Medical Attention
While many bruised toenails respond to home care, certain signs indicate a need for professional medical evaluation. Severe or persistent throbbing pain, especially if not relieved by home remedies, warrants medical attention. This suggests significant pressure under the nail or other issues.
Signs of infection also warrant consulting a healthcare provider promptly. These include increased redness, swelling, warmth, or pus draining from under the nail. A fever or red streaks extending from the toe indicate a spreading infection.
If significant bleeding under the nail does not stop, or if the hematoma covers more than 25% to 50% of the nail area, a medical professional may need to drain the accumulated blood. This procedure, known as trephination, involves creating a small hole in the nail plate to relieve pressure and pain. A healthcare provider must perform this procedure to prevent infection or further damage.
A medical assessment is also advisable if a toe bone fracture is suspected, which can occur with severe blunt trauma. Symptoms like toe deformity, inability to move it, or intense pain suggesting a break warrant a doctor’s visit. Individuals with underlying health conditions like diabetes, peripheral artery disease, or compromised immune systems should seek medical attention for any foot injury, including a bruised toenail, due to increased risk of complications.