A black toenail, medically known as a subungual hematoma, forms when blood collects beneath the toenail plate. This common condition results from direct trauma, such as dropping a heavy object on the toe or stubbing it forcefully. Repetitive microtrauma, often from wearing ill-fitting shoes during activities like running or hiking, can also cause blood vessels under the nail to break. The trapped blood causes discoloration and can lead to pressure and discomfort under the nail.
Initial Self-Care
For minor black toenail cases without severe pain or signs of infection, immediate self-care can help manage symptoms. Applying ice to the injured toe for 15 to 20 minutes several times a day can help reduce swelling and numb pain.
Elevating the foot above the heart can also help minimize swelling and throbbing. Gentle compression can reduce swelling. Over-the-counter pain relievers like ibuprofen or acetaminophen can alleviate discomfort.
Protecting the injured toe from further impact is important during the initial healing phase. Wearing closed-toe shoes with ample space around the toes can prevent additional trauma. Avoiding activities that put stress on the toe allows the area to rest.
Knowing When to See a Doctor
While many black toenails resolve on their own, certain signs indicate the need for professional medical evaluation. Severe or increasing pain and throbbing under the nail warrants a doctor’s visit. This can signal a significant amount of blood buildup that may require drainage.
Signs of infection, such as increasing redness, swelling, warmth, pus draining from under the nail, or red streaks extending from the toe, demand immediate attention. A fever accompanying a black toenail also suggests a possible infection that needs medical treatment.
If the discoloration covers more than half of the toenail, or if the nail appears to be detaching from the nail bed, seek medical care. A healthcare provider should also evaluate any suspicion of a fracture in the toe. If the black discoloration appeared without any known injury, or if you have underlying health conditions like diabetes or circulatory problems, seek professional assessment. These conditions can affect healing and increase the risk of complications.
Professional Treatment Approaches
When a black toenail causes intense pain due to pressure from accumulated blood, a medical procedure called nail trephination may be performed. This involves creating a small hole in the nail plate to drain the trapped blood, which can provide immediate pain relief. Healthcare providers use a sterile needle, a specialized drill, or an electrocautery device for this procedure.
If the nail bed is severely damaged, or if there is a significant infection, partial or complete removal of the toenail might be necessary. If a fracture of the underlying bone is suspected, an X-ray can confirm the injury. If an infection is present, the doctor may prescribe antibiotics. These procedures should be performed by a healthcare professional to avoid further injury or infection.
Recovery and Prevention
After the initial injury, the black toenail will slowly grow out, a process that can take several months to a year. As the new nail grows, the discolored portion will gradually move towards the tip of the toe. In some instances, the old, damaged toenail may loosen and detach completely, allowing the new nail to emerge.
Protecting the new nail growth is important. Continue wearing properly fitting footwear, ensuring there is ample room in the toe box. Regularly trimming toenails straight across helps prevent future trauma and ingrown nails.
Maintaining good foot hygiene can also help prevent complications. For individuals engaged in activities that frequently cause toe trauma, consider specialized footwear or protective toe caps. These measures contribute to long-term nail health and reduce the likelihood of recurrence.