A bruised toenail, medically known as a subungual hematoma, is a common injury that often prompts concern about whether the nail will detach. This condition occurs when blood collects beneath the nail plate, leading to discoloration and sometimes pain. Understanding its causes and resolution can alleviate anxieties about potential nail loss.
Causes of Bruised Toenails
A bruised toenail primarily results from trauma that causes blood vessels under the nail to rupture. This can happen from a single, significant impact, such as dropping a heavy object on the toe or stubbing it forcefully. Such incidents lead to immediate bleeding and pressure buildup beneath the rigid nail plate.
Repeated, minor trauma can also cause a subungual hematoma. This is frequently observed in individuals who wear ill-fitting shoes or in athletes who engage in repetitive foot impact, like running or playing tennis. In these cases, the persistent pressure damages capillaries in the nail bed, allowing blood to leak and accumulate.
Bruised Toenail and Nail Loss
The central question for many is whether a bruised toenail will fall off. In many instances, especially with minor bruising, the toenail will not fall off; instead, the discoloration will simply grow out with the nail. The nail plate is firmly attached to the nail bed, and while blood pooling underneath can create pressure, it does not always cause detachment.
However, if the trauma is significant and a large amount of blood collects under the nail, the pressure can indeed cause the nail to separate from its bed. This separation typically occurs as new, healthy nail grows from the nail matrix at the base of the toe, pushing the old, damaged nail forward. Nail replacement can take 9 to 18 months. If the nail matrix itself is severely damaged, the new nail might grow back with a different shape, thicker, or it might not grow back at all.
When to See a Doctor
While many bruised toenails can be managed at home, certain signs indicate the need for medical attention. Seek professional care if you experience severe or worsening pain, as this could signify significant pressure buildup that may require drainage. Signs of infection, such as increased redness, swelling, warmth, pus draining from the area, or red streaks extending from the toe, also warrant immediate medical evaluation.
A doctor should also be consulted if the bruise covers more than half of the nail, if the nail is significantly lifted, torn, or detached, or if you suspect a broken toe. Individuals with underlying health conditions affecting circulation or healing, such as diabetes, should seek medical advice for any toenail injury. A healthcare provider can assess the injury and, if necessary, perform trephination to relieve pressure by creating a small hole in the nail. This procedure must be performed by a medical professional.
Caring for a Bruised Toenail and Recovery
Managing a bruised toenail at home often involves simple measures to reduce discomfort and promote healing. Applying ice wrapped in a cloth to the affected toe for 20-minute intervals can help reduce swelling and pain. Elevating the foot can also help minimize throbbing and swelling by reducing blood flow to the area. Over-the-counter pain relievers like acetaminophen or ibuprofen can further manage pain.
Maintain good hygiene to prevent infection by gently cleaning the area around the bruised toenail with mild soap and water, ensuring it remains dry. Protecting the injured nail from further trauma is advisable; this includes wearing properly fitting shoes with ample toe room and keeping toenails trimmed. The healing process can be lengthy, with the discolored part of the nail gradually growing out over several months. Do not attempt to drain the blood yourself, as this can introduce infection.