Is Your Toenail Turning Black After Injury? What You Need to Know

Nail lifting issues?

Hello, Doctor.
A month ago, I injured my big toe, causing the nail to lift.
I went to the emergency room nearby, and the doctor there said that the flesh was not lifted with the nail, so they pressed the nail back down and bandaged it, advising me to change the dressing myself.
Now, a month later, there has been no pain, but the area under the nail is getting darker.
I don't mind the appearance, but I'm concerned if there might be an issue inside.
Should I just leave it as is? Thank you.

Ms. Chen, 20~29 year old female. Ask Date: 2021/12/21

Dr. Li Zhonghuai reply Surgery

Hello! There is a concern that the nail bed may be damaged and require suturing.
It is recommended to consult a general surgeon for removal.
In about two weeks, a thin membrane will form, and you will be able to come into contact with tap water.
Take care! Changhua Hospital cares about you!

Reply Date: 2021/12/21

More Info

When a toenail turns black after an injury, it can be concerning, and it's important to understand the potential implications. In your case, it sounds like you experienced a traumatic injury to your toenail, which resulted in the nail being lifted but not the underlying skin. The fact that you have not experienced pain is a positive sign, but the darkening of the nail can indicate several things.

Firstly, the black color you are observing is likely due to a collection of blood under the nail, known as a subungual hematoma. This occurs when blood vessels are damaged during the injury, causing blood to pool beneath the nail. Over time, as the nail grows out, this discoloration may become more pronounced. In many cases, a subungual hematoma will resolve on its own, and the nail will eventually grow out, revealing a new, healthy nail underneath.

However, there are a few important considerations to keep in mind. If the hematoma is large (typically more than 25% of the nail bed), it may cause pressure and discomfort, which could necessitate medical intervention. In some cases, a healthcare provider may need to relieve the pressure by creating a small hole in the nail to allow the blood to drain. This procedure is usually quick and can provide significant relief.

Additionally, while you mentioned that you are not experiencing pain, it's essential to monitor the area for any signs of infection. Symptoms of infection can include increased redness, swelling, warmth, or discharge from the nail bed. If you notice any of these symptoms, it would be wise to seek medical attention.

As for the appearance of the nail, it is common for the nail to change color as it grows out. The black area may eventually be replaced by a new nail, but this process can take several months, depending on the rate of nail growth. In some cases, the nail may become discolored or deformed as it grows out, especially if the injury was severe.

In summary, while it is often safe to monitor a blackened toenail after an injury, you should keep an eye on it for any changes that might indicate complications. If you experience any pain, pressure, or signs of infection, or if you have concerns about the appearance of the nail, it is advisable to consult a healthcare professional. They can provide a thorough examination and determine if any treatment is necessary. In the meantime, keeping the area clean and protected can help prevent further issues.

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