A toenail can be injured by a blow to the nail or by closing the toe in a door. This kind of trauma commonly results in blood under the nail, a condition called subungual hematoma. Nails also can be accidentally torn or split, or a splinter can get under the nail.
In most cases when a patient loses a toenail due to an injury, the toenail does grow back and discomfort is temporary; however, it can take several months for the toenail to grow back in its entirety. During that time, you will want to protect the top of your toe while wearing shoes to prevent further irritation.
Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails. The deformities may resemble a fungal infection; nails can be thickened or discolored and can lift away from the nail bed, which causes cosmetic concerns. Bleeding under the toenail usually occurs from the toenail repeatedly making contact with the shoe. This causes bleeding under the toenail from a shearing force that can separate the toenail from the nail bed (skin holding the nail to the toe). This often happens because shoes are too tight or because toenails are too long. It can also happen if a heavy object strikes the toenail. Torn nails usually occur when the nail catches on something and is pulled off.
Toenail bed injuries can occur due to the mere friction of one's shoe. Runners often lose their toenails from the repetitive motion of the nail rubbing against the end of the running shoe. The friction and pressure cause a blister to form beneath the nail, resulting in the loss of the toenail.
Accidentally kicking an object while walking is another common cause of toenail bed injury. Sandal and soft shoe wearers are more prone to injury.
Treatment for a subungual hematoma is aimed at relieving pressure by draining the blood trapped under the nail. For a small hematoma, your physician can provide the treatment in his or her office using a sterile blade or needle. If blood takes up more than half of the area under your nail, a physician should evaluate the nail. Occasionally, the nail may need to be removed so a deep tear can be repaired with stitches. If your nail lifts completely off the nail bed, it may be most comfortable initially to replace the nail and hold it in place with a bandage. Nails will not reattach themselves to the nail bed after they have separated from it, but in most cases a new nail will slowly re-grow. The wound should heal within a few weeks. Toenails may take 12 to 18 months to grow back. Injured nails may look different when they grow back.
To help prevent nail trauma:
• Wear properly sized shoes. Many people wear shoes that are too small, which can lead to many foot problems, including toenail trauma.
• Keep your fingernails trimmed and do not bite your nails or cuticles.