Chiropody

The medical name for a bruised or blackened toenail is a subungal haematoma.  It is easiest to think of it as bleeding from the nail bed which then becomes trapped under the nail itself (not unlike a bruise under the skin). They are caused by trauma – either one large individual episode (e.g. someone else stamping on the toe) or a lower level trauma which happens again and again and again (the toe hitting the roof of a running shoe every single step).

Appearance and healing times will be dependant upon the cause of the problem and its severity. Often a very small amount of bleeding beneath a nail will often resolve without any complications, and the discolouration will grow out with the nail. However a more severe problem will bring with it the risk of becoming infected (often identified by a malodorous weeping from beneath the nail) and may result in the nail having separated itself from the nail bed beneath.

Should this occur salt water foot baths on a daily basis are encouraged, and if there is no improvement within a few days of this then a visit to the GP for some antibiotics may be required. A nail should never be pulled off, but be aware that once it has detached from the nail bed it will not reattach. It is best left to fall off when it is ready, or grow out if it is only the top portion which feels loose. It may be advisable to gently tape down the nail in the interim so it is not caught on hosiery or bed linen to ensure no further unnecessary trauma is caused.

Historically it was often advised to drill a hole in the nail to release any pressure, but this is not as common practice now with more emphasis being placed on infection control and conservative non invasive management.

Bruised toenails can be prevented in most cases with simply obtaining footwear which is slightly larger, or which has a more accommodative toe box.  There are also various toe protectors available from high street chemists which may provide some relief.