What causes toenails to become injured?
A toenail can be injured by dropping something on your toe, stubbing your toe, repetitive trauma (e.g. wearing shoes that are too tight or through sports, such as running), surgery, disease or by peeling or picking the nail.
In some cases, blood under the toenail will accumulate, a condition called subungual hematoma. It is similar to forming a blood blister elsewhere and is in response to moderate or more severe trauma – dropping a heavy item on your toe, stubbing the toe with force, or often seen in marathon runners.
Repeated trauma to toenails, caused by ill-fitting shoes, can lead to long-lasting deformities in the toenails. The deformities may resemble a fungal infection; nails can be thickened or discoloured, ridged or layered, and can lift away from the nail bed, which causes cosmetic concerns.
Some patients require toenail surgery due to infection or pain or genetics, but a nail surgery can also result in long-term cosmetic changes in the toenail as seen in other types of toenail injury– such as nail discolouration, ridges, or thickness. These changes occur because of damage to the nail root (matrix) that is permanent.
Habits such as nail biting and cuticle peeling also can cause trauma to the nails. Nail biting, picking or improperly trimming toenails can be a cause of infected ingrown toenails, which is usually accompanied by swelling and irritation. In extreme cases, the nail can split.
Lastly, some conditions such as psoriasis can cause nail changes and although you may notice the toenail changes at the time of injury, it may actually have been present longer as a result of the systemic disease. Your family doctor or nurse practitioner can provide more insight here.
Treatment & prevention
If you observe a blood blister under your toenail, it is best to seek immediate draining. This is a fairly painless procedure but if discomfort is felt, a numbing agent can be used. If you do not seek immediate draining (within 24 hours of injury), then you should seek to have the toenail removed if at least half of it is red, black or blue within the first 7 days. However, when a heavy item is dropped on the toe, or it is stubbed with force, a first step would be an x-ray to determine if the toe is broken, before proceeding with nail care. BioPed Chiropodists are credentialed to drain or remove toenails related to injury.
Footwear should be evaluated if the reason for toenail damage is not known as this could be the culprit for toenail changes or a subungual hematoma without a known traumatic event.
Finally, where there is a habit of nail biting, pulling, peeling, or splitting, efforts should be made to discontinue these practices. Any infection or ingrown toenails should be evaluated by a Chiropodist. Where there are nail changes such as discolouration or thickening, our Footcare Nurses or Chiropodists can assess and provide treatment solutions and care.
Once the cause of injury is identified, your footcare clinician will work with you to develop a long-term plan to prevent recurrence, provide maintenance and/or avoid further nail damage.
To speak with a Footcare Nurse or Chiropodist at BioPed regarding your toenails, request an appointment today at a location near you.
