What Is a Bruised Toenail?

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Medically reviewed by Sarah Richards

A bruised toenail, or subungual hematoma, is when the nail becomes injured from trauma (such as dropping a heavier object on your toe), causing blood to collect under the nail. The bleeding from the ruptured blood vessels causes a bruise, which appears as skin discoloration.

A bruised toenail is a common injury, especially among athletes and people who work in manual labor. You can typically treat a bruised toenail through self-care practices at home, but more severe cases may require medical care.

Bruised Toenail Symptoms

Toenails protect the tissues of your toes. Healthy nails are usually smooth and uniform in color. When trauma causes injury to the nail, there are a few signs that indicate you may have a bruised toenail. Symptoms of a bruised toenail include:

• Sudden or throbbing pain
• Discoloration of the nail, which can range from maroon to black or appear as a bluish-whitish color
• Bleeding under the nail
• A feeling of painful pressure under the nail bed
• Cuts or tears to the nail
• Partial or complete disconnection of the nail from the nail bed

What Causes a Bruised Toenail?

The primary cause of a bruised toenail is direct force (such as a heavy object falling onto your toes) that causes the blood vessels to rupture and pool under the nail bed.

You can also get a bruised toenail from repetitive stress, or repeated use of a certain body part. This typically occurs from participating in sports or other physical activities. For instance, going running regularly can put a strain on your feet and toes, which could lead to a bruised toenail.

Wearing shoes that don’t fit properly can also cause or contribute to a bruised toenail.

Risk Factors

Certain factors can increase your chance of getting a bruised toenail. These include:

• Taking part in sports activities that could cause repetitive stress or trauma to the toes, such as soccer, dance, and long-distance running.
• Wearing open-toed shoes or sandals frequently—for example, if you live in a warmer climate
• Working in jobs that involve repetitive motions, such as manual labor or construction
• Having a bleeding or blood clotting disorder, such as coagulopathy (an excessive bleeding disorder) or peripheral vascular disease (a progressive blood circulation disorder affecting blood vessels outside of the heart or brain)
• Having a health condition that alters the way pain is processed, such as diabetic neuropathy (a type of nerve damage caused by diabetes)

An altered pain response may lead to a delay in someone seeking treatment for nail injuries or trauma, which can increase the risk of complications.

Diagnosis

To diagnose a bruised toenail, a healthcare provider will look at your nails and ask questions about your symptoms. They may also ask about your habits and activities, or what might have caused injury to the nail.

Depending on the symptoms and potential causes, the provider may decide to order additional tests. These could include X-rays, blood tests, or a lab examination of the nail matrix (the area where your nails start to grow).

How To Heal a Bruised Toenail

Treatments for a bruised toenail are designed to reduce pain and pressure to heal the bruise and aid in nail regrowth over time.

Small bruises, which make up under 25% of the total nail area, will usually heal on their own with self-care and preventative measures. However, larger bruises may require urgent medical care or surgery to prevent complications such as recurrence or infection.

The exact treatment depends on the severity of the injury and the risk factors for complications.

Treatments include:

• Apply a cool, damp washcloth or ice: To reduce swelling after injury, apply a cool, damp washcloth or ice to the injured nail and place the leg with the injured nail on an elevated surface. When using ice, never apply it directly to the skin. Wrap the ice in a light cloth before applying.
• Take over-the-counter pain relievers: Taking Advil (ibuprofen) or Tylenol (acetaminophen) can help relieve pain and reduce swelling after your injury.
• Trephination: This is the standard surgical procedure for large or more severe bruises. A healthcare provider inserts a small hole in the nail using a needle or electrocautery (using heat from an electric current). This decreases nail pressure and drains blood. Blood will continue to come out of the nail for 1-2 days, so follow post-surgery instructions.

Prevention

Since trauma is the main cause of bruised toenails, it isn’t always possible to prevent it—especially when the cause is an accidental hit or blow to the nails. However, you can help prevent or manage recurrence by doing the following:

• Wear proper-fitting shoes that are comfortable and do not squeeze the toes together
• Stretch and recover your legs and feet after physical activity

Related Complications

In most cases, a bruised toenail can be healed with self-care practices and over-the-counter medications at home. In some cases, it can become chronic (long-lasting) or recur.

If a bruised toenail is left untreated or if symptoms get worse, potential complications could include:

• Nail avulsion: The partial or complete loss of a toenail
• Onycholysis: A condition that causes the nail to separate from the nail bed
• Nail dystrophy: Pressure from blood pooling under the skin that can lead to permanent changes in the nail and cause a condition called nail dystrophy (irregular changes in the nail growth, color, shape, and texture)
• Infection: Increased risk of bacterial infections, which could include cellulitis (a serious skin infection that causes redness, pain, and swelling) or osteomyelitis (swelling of bone tissue)

In some cases, a bruised toenail can indicate an open fracture in the surrounding area. This is a serious injury where the bone breaks through the skin or there is an open wound that exposes the bone through the skin. An open fracture requires immediate medical attention.

If you experience any serious complications such as intense pain, prolonged bleeding, or have a black or purple nail, see a healthcare provider promptly or go to your nearest emergency room.

A Quick Review

A bruised toenail, or subungual hematoma, occurs when blood becomes trapped underneath the toenail as a result of trauma, such as dropping a heavy object on your toe. Symptoms of a bruised toenail can include sudden pain, bleeding under the nail, discoloration, and pressure under the nail bed.

A bruised toenail can be treated and managed at home with self-care measures such as over-the-counter pain relievers, ice, and elevation. However, more severe bruised toenails may require a surgical procedure called trephination to drain the blood out to relieve pain and pressure and to speed up healing.

Seek medical care if you are experiencing prolonged or severe pain or bleeding alongside your bruised toenail.

Frequently Asked Questions

How can you tell the difference between a bruised toenail and melanoma?

A bruised toenail can closely mimic melanoma (skin cancer) of the nail, as both can cause a discolored nail. In nails, melanoma discoloration typically appears as a bluish-white color, whereas a bruised nail will typically appear darker red. It may include granular leukonychia, or nails that appear spotted and white on the bruise.

See a healthcare provider if your bruise does not start improving with treatment or if you are experiencing pain.

Can an ingrown toenail cause bruising?

An ingrown toenail, also called onychocryptosis, is a common nail condition where the nail plate grows into the surrounding skin and causes pressure and inflammation. It can become painful if left untreated and lead to infection, swelling, and redness.

Ingrown toenails typically do not cause bruising. However, bruising can be a side effect of surgeries that treat an ingrown toenail.

How long does it take for a bruised toenail to heal?

The healing time of a bruised toenail can vary depending on the severity of the bruise. Whether or not the nail is treated at home or with surgery, the bruised nail will need to grow out completely to heal. With proper at-home or post-surgery care, a bruised toenail will typically heal and grow out within 6-9 months.

Read the original article on Health.com.