Footnotes / Blog

When a toenail is crushed by injury, it may start bleeding underneath the toenail. This is referred to as a subungual hematoma.

This can cause intense pain and throbbing as blood collects underneath the nail. Often this happens when something is dropped on the foot, or if the toe gets forceably stuck between two objects.

Diagnosis

If you go to the visit a doctor for this issue, you are likely experiencing pain. The doctor will examine, and possibly take an xray to make sure you didn’t break and bones in your toe. Your doctor will also evaluate the percentage of the nail that has blood underneath it, as this may dictate the treatment.

Treatment

To relieve the pain, your doctor may perform decompression, also called trephination. This allows the underlying blood to drain, relieving pressure and pain to the area.

Your doctor may numb the affected finger or toe with a nerve block and use one of the following decompression methods:

• Cautery. The doctor uses a heated wire to burn a hole or holes. The heated tip of the wire is cooled by contact with the hematoma, which prevents injury to the nail bed. This is a quick and painless procedure.
• Needle. The doctor uses a needle to make a hole in the nail.

After the procedure, your doctor will bandage your nail. You will need to keep the finger or toe bandaged and elevated — and may also need to use cold compresses — during the first 12 hours after decompression. In some cases, your doctor may recommend you use a splint for as long as 3 days until the tenderness subsides.

The main complication associated with decompression is a small risk of infection in the residual hematoma.

If you have bleeding under a large area of the nail surface, the nail bed may be injured. In this case, your doctor may need to remove the entire nail and use stitches to repair the nail bed.

If you are suffering from a painful subungual hematoma, visit one of our offices. We are located throughout northern New Jersey with 6 physicians on staff who can all evaluate and treat your foot and ankle problems.