Toenail trauma is one of those things that can be anything from a minor annoyance to a seriously painful condition. Whether you stubbed your toe, dropped something heavy on your foot, or have been putting your feet through a lot of activity, toenail injuries are fairly common.
No matter how the injury happened, getting the right care quickly is key to preventing complications and making sure your toe heals properly.
This article will give you a complete look at toenail trauma, including what causes it, what the symptoms are, how to treat it, and what you can do to keep it from happening again. We’ll also cover when you can take care of it yourself and when you need to see a doctor.
What is toenail trauma?
Toenail trauma refers to any type of injury to your toenail, the nail bed underneath it, or the surrounding tissues. This can include injuries to the nail matrix, where your nail grows from.
Common causes of toenail trauma include:
- Direct impacts or blows to the toe
- Stubbing your toe
- Dropping something heavy on your foot
- Repetitive trauma from activities like running or hiking
- Wearing shoes that don’t fit properly
- Habits like biting your nails or picking at your cuticles
These injuries can result in:
- Subungual hematoma (blood under the nail)
- Nail lacerations or tears
- Nail avulsion (complete or partial detachment)
- Ingrown toenails
- Nail bed injuries
Symptoms of toenail trauma
If you’ve experienced toenail trauma, you may experience a variety of symptoms, including:
- Pain: You may have immediate pain or the pain may develop later. It may also throb.
- Discoloration: A bruise or bleeding under the nail, which causes it to look black or purple.
- Swelling: Inflammation around the nail and toe.
- Nail changes: The nail may split or crack. It may also start to lift away from the nail bed.
- Deformity: The shape or texture of the nail may change as it grows back.
Types of toenail injuries
Toenails can sustain a variety of injuries, including:
Subungual hematoma
- What it is: Blood trapped under the nail plate.
- What causes it: Direct trauma or repetitive small traumas.
- Symptoms: Pain, pressure, and visible bruising under the nail.
Nail laceration or avulsion
- What it is: A cut or tear in the nail plate, or the complete or partial separation of the nail from the nail bed.
- What causes it: Sharp trauma or catching the nail on something.
- Symptoms: Pain, bleeding, and an unstable nail.
Nail bed injury
- What it is: Damage to the tissue under the nail plate.
- What causes it: Often occurs with avulsions or severe lacerations.
- Symptoms: Significant pain, bleeding, and the potential for permanent nail deformity.
Ingrown toenail
- What it is: The nail grows into the surrounding skin.
- What causes it: Improper trimming, tight shoes, or trauma.
- Symptoms: Pain, redness, swelling, and infection.
When to seek medical attention
Most of the time, a traumatized toenail can be treated at home. But in some cases, you’ll want to see a doctor. Seek medical care for a toenail injury if you experience any of the following:
- Severe pain: If the pain is unbearable and over-the-counter pain relievers don’t help.
- Significant bleeding: If the bleeding won’t stop, or if you have a blood blister under the nail that covers more than 25-50% of the nail.
- Deep cuts: If the cuts extend into the nail bed or surrounding tissues.
- Nail avulsion: If the nail is completely or almost completely detached.
- Signs of infection: Increased redness, swelling, pus, or fever.
- Underlying conditions: “If you have neuropathy, diabetes or any condition that affects healing or circulation, it’s important to have your provider evaluate your toenail injury,” says Dr. Roeder.
- Injury to the nail matrix.
What are the treatment options?
The right treatment for a toenail injury depends on how severe the injury is.
Home care
You can treat minor toenail injuries at home.
- Cleaning: Gently wash the injured area with soap and water.
- Pain relief: Apply ice to reduce swelling and pain. Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can also help.
- Protection: Cover the injured toe with a bandage and wear comfortable shoes.
- Subungual hematoma drainage: Some sources suggest cauterizing a small hole to relieve pressure from small hematomas (blood blisters under the nail), but proceed with extreme caution and ensure proper sanitation to avoid infection.
Professional medical treatment
If your toenail injury is more severe, a doctor can help.
- Drainage of subungual hematoma: If the hematoma is large, a doctor may drain the blood to relieve pressure and pain. Don’t try this at home.
- Nail removal: In cases of severe avulsion (separation from the nail bed) or nail bed injury, partial or complete nail removal may be necessary.
- Nail bed repair: Lacerations to the nail bed may require stitches.
- Antibiotics: If there are signs of infection, antibiotics may be prescribed.
- Tetanus booster: If the injury involves a puncture wound, a tetanus booster may be recommended.
Prevention of toenail trauma
You can prevent toenail trauma with the following tips:
- Wear proper footwear: Make sure your shoes fit well and give your toes plenty of room. Shop for shoes later in the day, when your feet are at their largest.
- Trim your nails correctly: Cut your toenails straight across to avoid ingrown toenails and prevent issues like the free edge of nail growing down.
- Wear protective gear: If you play sports, wear shoes that will protect your toes.
- Avoid trauma: Pay attention to where you’re going so you don’t stub your toes.
- Keep your feet dry: Moisture can lead to fungal infections, which weaken your nails.
- Use toe caps: Silicone or gel toe caps can provide extra protection.
Frequently Asked Questions
Will a traumatized toenail grow back?
In most cases, yes, a traumatized toenail will grow back. However, it can take a considerable amount of time, typically several months to a year, for the nail to fully regrow. The new nail may also have a different appearance or texture compared to the original.
What happens if you don’t drain blood under your nail?
If you don’t drain blood trapped under your nail (subungual hematoma), it can cause significant pressure and throbbing pain. Over time, the blood may dry and harden, potentially leading to nail separation or even infection. Draining the blood can relieve the pressure and promote healing, but it’s best performed by a healthcare professional.
How do you tell the difference between nail fungus and nail trauma?
Nail fungus often presents with thickening, discoloration (yellowish or brownish), and brittleness of the nail. Nail trauma, on the other hand, usually involves a specific injury, such as stubbing your toe, dropping something on it, or wearing tight shoes. Trauma can cause bruising, bleeding under the nail, or nail separation. If you’re unsure, consult a doctor.
Should you keep your toenail covered if it falls off?
Yes, it’s generally recommended to keep the exposed nail bed covered with a sterile bandage to protect it from infection and further injury. Change the bandage daily and keep the area clean and dry. Avoid wearing shoes that put pressure on the exposed nail bed.
How long does toe trauma take to heal?
Healing time for toe trauma varies depending on the severity of the injury. A minor bruise might resolve within a few weeks, while a more severe injury, such as a fractured toe or complete nail avulsion, can take several months to heal fully. Nail regrowth, as mentioned earlier, can take up to a year.
Closing Thoughts
Toenail injuries are common and range from minor to severe. Knowing the causes, signs, and how to treat them is important to help you manage these injuries and prevent problems.
Minor injuries can often be treated at home. But if you have a severe injury or you think your toe is infected, see a doctor. You can prevent a lot of toenail problems by wearing shoes that fit well and taking care of your toenails.
Most toenail injuries heal well with proper care, but sometimes, the nail might look a little different even after it heals, in which case KeryFlex nail restoration may be an option.