Nail plate injuries occur due to direct trauma to the toe typically from stubbing the toe onto furniture or dropping an object on the toe. Common injuries associated with nail plate injury are subungual hematoma, nail bed laceration, and nail avulsion.

Subungual Hematoma

A subungual hematoma occurs from injury to the toe and toe nail. The injury causes the nail bed to bleed trapping blood deep to the toe nail. Without treatment the trapped blood under the toe nail causes pressure, pain, or worse, infection. Treatment depends on how much of the toe nail is affected. If less than 50% of the toe nail is affected, a sterile needle is used to puncture through the toe nail thereby releasing the trapped blood. If greater than 50% of the toe nail is affected, the nail plate is removed along with repair of laceration is performed under local anesthesia. Depending on severity and possible infection, a short course of antibiotics may be prescribed.

Nail Bed Laceration

Lacerations to the nail bed typically occur either through an intact toe nail or when the hematoma is greater than 50%. Under local anesthesia the toe nail is removed and the laceration is repaired with suture. A short course of antibiotics may be prescribed.

Nail Avulsion

A nail avulsion occurs when the toe nail is lifted up either partially or completely after an injury. When the nail lifts up it can damage the nail bed and/or the nail root. Treatment depends on the severity of the injury. If the injury is severe with a laceration then treatment is the same as a nail bed laceration. If the toe nail is only partially lifted with no other injury such as a laceration, treatment typically involves pushing the lifted toe nail back down in contact with the nail bed. This may allow the toe nail to grow normally without incident or sometimes the toe nail will fall off on its own and a new toe nail will grow. Sometimes the damage may cause the new toe nail to grow thick or have a split. With these injuries, it is difficult to determine the damage to the nail root at the time of the injury.

If you or a family member injured their toe nail, call us today and make an appointment with our foot and ankle specialists!