A bruised toenail, or subungual hematoma, is a common injury where blood collects under the toenail. It often results from trauma and causes discomfort.
Understanding a Bruised Toenail
A bruised toenail typically occurs from direct trauma, such as dropping a heavy object or forcefully stubbing your toe. Repetitive micro-trauma from ill-fitting shoes during activities like running or hiking can also cause it. Impact ruptures small blood vessels beneath the nail, causing bleeding and blood accumulation in the confined space between the nail plate and bed.
Blood collection under the nail creates pressure, causing throbbing pain that can intensify over time. The nail may appear discolored, black, blue, purple, or reddish-brown.
Home Care for a Bruised Toenail
For mild cases, home care can manage symptoms. Immediately after injury, apply ice for 15-20 minutes at a time to reduce swelling. Elevating the foot above heart level minimizes blood flow, reducing pressure and pain.
Resting the injured foot is important to prevent further trauma. Over-the-counter pain relievers, like ibuprofen or acetaminophen, can effectively reduce pain and inflammation. Keep the area clean and dry to prevent infection.
Wear open-toed shoes or shoes with a roomy toe box to alleviate pressure while it heals. Avoid tight footwear that could further irritate the bruised area. Monitor the toenail for worsening pain, increased swelling, or discharge.
When to Seek Professional Medical Care
While home care helps many, seek professional medical attention for certain signs. Consult a doctor if pain is severe and persistent, or if discoloration covers over 25-50% of the toenail. Signs of infection, such as increasing redness, warmth, swelling, pus, or fever, require immediate medical evaluation.
Seek medical care if the injury resulted from a crushing accident, or if the nail is jagged, broken, or appears to be separating from the nail bed. If you have diabetes or a compromised immune system, a healthcare provider should assess any toenail injury due to increased risk of complications. A doctor might perform trephination, carefully creating a small hole in the nail to relieve pressure by draining blood.
Healing and Future Prevention
The healing process for a bruised toenail is gradual, as the bruised nail grows out and is replaced by a new, healthy nail. This can take several months, typically 6 to 12 months. In some instances, the bruised toenail may eventually lift and fall off, with a new nail growing underneath.
Preventing future bruised toenails involves adopting practical measures to protect your feet. Wearing properly fitting shoes is important with adequate toe box space to prevent your toes from repeatedly hitting the front of the shoe during activity. For sports or activities that pose a risk of foot impact, wear protective footwear with reinforced toe caps. Regularly trim toenails straight across, rather than rounding the corners, to prevent trauma and ingrown nails.