ANDYou’re ready to throw on some summer sandals when you look down and realize that your long hike over the weekend left you with a new accessory: a bruised toenail. It may throb to the touch or just offer subtle pain, but you can’t ignore the bluish-purple tinge to your toe. Worse yet, you know that there is a chance that the nail will soon fall off completely.
Although bruised toenails usually resolve on their own, it’s important to know how to identify them and how to treat them. Not only can it help you avoid a painful situation in the present, but it could also prevent one in the future. After all, not all discolored toenails are a sign of bruising.
Why do toenails bruise?
According to board-certified nail dermatologist Dana Stern, MD, toenail trauma can occur due to repetitive pressure between the toe and the front of the shoe (which is common in activities like tennis, walking, and running, especially downhill). It can also occur from a sudden, one-time injury, such as stubbing your toe or dropping something on your foot.
“Any trauma to the nail can crush these small vessels and cause bleeding under the nail.” —Dana Stern, M.D.
“The nail bed is full of tiny blood vessels, and any trauma to the nail can crush these tiny vessels, causing bleeding under the nail,” says Dr. Stern. “This type of ‘bruise’ is called a subungual hemorrhage. Since the nail is firmly attached to the nail bed, there is not a lot of room for blood to collect and therefore if there is significant bleeding, the increased volume of fluid under the nail will cause the nail to lift up and separate, potentially painful.”
If you feel you are particularly prone to bruised toenails, you may be wearing shoes that are too small for your foot shape. Get in shape with a professional at the store to see if sizing can help solve your problem.
How to know if the toenail is bruised?
While bruised toenails are more common during the summer months because people are more active and wear open-toe shoes, nail bleeds can occur year-round, just like skin cancer. Because of this, it’s helpful to know which signs indicate a bruise, as well as which ones suggest something more serious.
“If a bruise doesn’t seem to resolve or grow, see a board-certified dermatologist,” says Dr. Stern, noting that toenails typically take four months to grow. “We can look at the pigment with a special magnifying glass to help decipher the blood (hemorrhage) from the pigment (potential melanoma).” Fungal infections and ingrowns are other possible reasons for discolored nails.
How to care for a bruised nail
Bruised toenails can be painful, but there’s not much you can do to treat them other than be patient and wait for them to grow back. That said, if more than half of your nail is bruised, Dr. Stern suggests making an appointment with your doctor.
“The nail can be trephined, in which a small hole is created to allow the blood that is collecting to escape,” he explains. “This will relieve pressure and therefore pain, and potentially prevent the nail from falling off.” While it’s safest to let a doctor perform this small procedure if you don’t have access to a health care provider, Dr. Stern says if you’re brave and careful, can Do it yourself with a hot paper clip, just make sure you don’t push too hard as that can cause more pain.
If you still find that the bruised toenail falls off, immediately or later in growth, Dr. Stern says to keep the nail bed clean. “Wash it with antibacterial soap and water,” he instructs. “If the area is tender, you can cover it with a Band-Aid for extra cushioning.” More importantly, he says he’ll want to avoid re-injuring him while he’s in a more vulnerable state: wear comfortable socks and slippers while he heals to keep him protected.
In the meantime, if you’ve nicked your toenail and your only concern is that it will look ugly, consider it the perfect excuse to get a new pedicure. “If the bruise is old and there’s no pain, it’s fine to cover it with polish, but never mask a potential medical problem with polish,” says Dr. Stern.
One more thing…
While discussing toenails, Dr. Stern points out that it’s important to get annual skin checks without nail polish. “Always remove polish from all 20 nails before your annual skin exam with a board-certified dermatologist because your nails are an important part of your exam,” she says. Cancer can develop under the nails, so she has to make sure nothing is hidden.