Traumatic Nails– Trauma can occur to the toenail as a result of chronic trauma or from acute injuries. Chronic or low grade trauma can be caused by tight shoes that place pressure on the toenail or from running with improper shoes. This can injure the toenail and may cause the nail to form a blister under the nail plate which can lead to a paronychia. This can be a painful condition and may necessitate the need to have the toenail taken off.
Acute trauma often is the result of dropping an object onto the toe or stubbing the toe against something that forces the nail plate to become separated from the nail bed. Blunt trauma can cause a subungual hematoma which is a collection of blood from under the nail plate. This can cause pain and also can lead to infection. If a subungual hematoma develops, the collection of blood will need to be drained by either creating a hole in the nail plate by using a needle, cautery or a laser or by removing the toenail. If it is not drained, the pressure will continue to build up and cause pain to the toe.
Blunt trauma can also lead to laceration of the nail bed that would warrant repair. In addition, blunt trauma can cause a fracture to the underlying bone (distal phalanx) that would also require treatment. If the nail bed is traumatized along with a fracture to the distal phalanx, it is classified as an open fracture.
Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.
He has offices located at both McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Have you ever been cooking in the kitchen and dropped a can of vegetables on your toenail? Have you ever ran for a long time and developed blood under a toenail. I am guessing at some point you have had blood under the nail plate whether due to direct trauma or repetitive microtrauma. The scientific name for blood under the nail plate is subungual hematoma.
Subungual hemoatomas develop because the arteries in the nailbed (the tissue between the nail plate and the bone) get damaged. There is a potential dead space or vacant space that can form between the nail plate and the nail bed, which can fill with blood.
The pressure from the blood under the nail can cause severe pain.
Most patients present with a swollen toe and complaints of throbbing pain following the injury. The 2 most common mechanisms are repetitive microtrauma from sports such as running and tennis or direct trauma from a crush-type injury.
When looking at the nail plate, if the blood takes up more than 25% of the nail plate, then a fracture of the bone underneath usually occurs.
Treatment involves draining of the blood to relieve the pressure. Hematomas involving less than 25% of the nail plate are usually drained by poking a hole through the nail plate with a heated paperclip, a needle, or a hand-held cautery tool. Once the nail plate is penetrated, the blood under the nail is expressed using slight pressure. The area should then be cleansed a dressed with a sterile dressing.
When the blood collection involves more than 25% of the nail plate, there is increased risk of nail bed laceration. Therefore, complete removal of the nail is required in order to properly evaluate the entire nailbed.
Decompression of a subungual hematoma is quick, easy and painless. Patients feel immediate relief and generally have no complications following prompt drainage. Usually the nail will come off on its own in approximately 6 weeks after the trauma, and a new nail is regrown by 6-9 months without being disfigured.