An injured toenail often results from sudden, blunt trauma like dropping an object or a forceful stubbing. The immediate goal is to maximize the chances of the nail plate remaining attached and ensure the nail bed heals correctly beneath it. Taking swift, proper action can significantly influence the outcome, helping to prevent detachment and setting the stage for healthy regrowth. This guidance focuses on managing the injury and avoiding the common complications that lead to nail loss.
Immediate First Aid and Stabilization
Controlling bleeding and stabilizing the toe is the first step toward prevention. Gently apply pressure with a clean cloth or sterile gauze until bleeding subsides. Clean the wound thoroughly with mild soap and water to wash away debris and reduce the risk of bacterial introduction.
After cleaning, gently pat the area dry and elevate the foot above the heart to minimize swelling and pain. If the nail plate is visibly loose but still connected, stabilize it using a secure, non-adherent dressing or medical tape. This holds the loose nail plate down against the nail bed, providing a natural splint. Avoid wearing tight footwear and consider an open-toe shoe to prevent further trauma.
Recognizing and Managing Subungual Hematoma
A primary cause of toenail detachment is the buildup of blood underneath the nail plate, known as a subungual hematoma. This blood pooling creates intense pressure, manifesting as throbbing pain and a dark discoloration beneath the nail. Small, painless hematomas covering less than 25% of the nail surface usually resolve on their own as the nail grows out.
If the hematoma causes significant throbbing pain or covers a large portion of the nail, the pressure must be relieved to prevent the nail from lifting off the nail bed. This relief is achieved through trephination, where a medical professional creates a small hole in the nail plate to drain the trapped blood. Attempting to drain a hematoma at home is not recommended due to the high risk of introducing infection or causing further damage.
When Professional Medical Attention is Necessary
While many minor toenail injuries can be managed at home, certain signs indicate the injury requires medical evaluation. Seek professional care if the subungual hematoma covers 50% or more of the nail plate, even if the pain is manageable. A large hematoma suggests a higher likelihood of an underlying nail bed laceration or a fracture of the toe bone (distal phalanx), both of which require professional assessment.
Immediate medical attention is necessary for clear signs of infection, including increasing redness or warmth, visible pus or fluid draining, or a fever. Also seek care if the nail plate has a deep laceration extending into the surrounding skin, or if bleeding is profuse and does not stop after sustained pressure.
Care for the Nail Bed If Detachment Occurs
If the injured nail partially or completely detaches, the focus shifts to protecting the newly exposed, sensitive tissue. The nail bed must be kept clean to prevent infection. Wash the exposed area gently with mild soap and water, then apply a thin layer of antibiotic ointment or petroleum jelly.
Cover the exposed tissue with a non-stick dressing, as regular gauze or adhesive bandages can stick to the wound and cause pain upon removal. Change the dressing daily or whenever it becomes wet or soiled, continuing this routine until the skin hardens sufficiently (typically seven to ten days). Expect the new toenail to grow in slowly, often taking six to twelve months to fully replace the lost nail.