A purple toenail can be startling, often signaling blood beneath the nail or reduced oxygen supply. While alarming, causes range from minor occurrences to serious health conditions. Understanding these reasons helps determine the appropriate course of action.
Everyday Reasons for Discoloration
Trauma or injury frequently causes purple toenails, resulting in a subungual hematoma. This occurs when blood vessels under the nail break, collecting blood beneath the nail plate. Activities like stubbing a toe, dropping heavy objects, or wearing ill-fitting shoes can cause this bruising. The trapped blood initially appears reddish-purple, darkening to brown or black as it clots.
Pressure from footwear is a common culprit. Tight, narrow, or ill-fitting shoes can repeatedly press against the toenail, leading to micro-traumas or bruising. This constant pressure damages blood vessels beneath the nail, causing blood leakage and discoloration. Such issues are common with high heels or pointed shoes that force toes into unnatural positions.
Repetitive stress, common in athletes, can cause purple toenails. Activities like running, hiking, or sports involving sudden stops and starts subject toes to repeated impact against shoes. This continuous friction and pressure can injure the nail bed, resulting in a subungual hematoma, sometimes called “runner’s toe.” The discolored nail typically grows out over several months as the nail plate replaces itself.
Temporary purple or blue discoloration can occur due to cold exposure. When temperatures drop, blood vessels in the extremities constrict to preserve body heat. This reduced blood flow leads to a temporary bluish or purplish tint under the nails, usually resolving once feet are warmed.
Underlying Health Conditions
Beyond injuries, purple toenails can indicate systemic health issues. Circulatory problems are a concern; reduced blood flow or oxygenation can cause the nail bed to appear bluish-purple, known as cyanosis. Conditions like peripheral artery disease (PAD) or Raynaud’s phenomenon, involving narrowed blood vessels, can lead to insufficient oxygen reaching the extremities, including the toes.
While typically yellow or white, severe fungal infections (onychomycosis) can result in purplish hues. This may occur due to debris accumulation under the nail or secondary bruising from the thickened nail pressing against the nail bed. The infection can alter the nail’s structure and color.
Certain medications can cause nail discoloration as a side effect. Chemotherapy drugs, antibiotics, and blood thinners may lead to changes in nail pigmentation, including bluish or brownish tints. These changes typically resolve after the medication is discontinued.
In rare instances, a dark streak or discoloration under the nail could be subungual melanoma, a type of skin cancer. Unlike a bruise that grows out with the nail, a melanomic streak often appears as a dark, vertical line that may widen or change over time and is not typically associated with injury.
When to Consult a Doctor
While many purple toenails are harmless and resolve on their own, certain signs warrant medical evaluation. Seek attention if discoloration persists and does not grow out with the nail, or if there is no clear injury history. A persistent or unexplained purple color could indicate a more serious underlying condition.
Accompanying symptoms like pain, throbbing, swelling, or pus around the toenail should prompt a doctor’s visit. These might suggest an infection or severe nail bed injury requiring intervention. If the toenail lifts or separates from the nail bed without a clear cause, assessment is important.
Unusual changes in nail texture, such as thickening, crumbling, or deformation, alongside purple discoloration, should be evaluated. If discoloration appears without known trauma or is accompanied by systemic symptoms like shortness of breath, coldness in extremities, dizziness, or chest pain, seek immediate medical attention. These could indicate a circulatory or cardiac issue. Individuals with diabetes or circulatory problems should consult a healthcare provider for any toenail changes.
Maintaining Nail Health
Preventing purple toenails and promoting nail health involves several steps. Proper footwear is important; shoes should fit well with adequate toe room, allowing toes to move freely. Measure both feet and try on shoes later in the day when feet are slightly swollen to ensure the best fit.
Proper nail trimming plays a role in prevention. Trim toenails straight across, not too short, to avoid ingrown nails and reduce friction against footwear. Use appropriate clippers and file any sharp edges to prevent trauma.
Good foot hygiene, including keeping feet clean and dry, helps prevent fungal or bacterial infections that can lead to discoloration. Regularly inspect feet and nails for changes to allow for early detection of issues. Protect feet with appropriate footwear during activities like sports or manual labor to reduce injury risk. Moisturizing nails and cuticles helps maintain their flexibility and health.