Toenail Issues After Hiking: Pain, Swelling, and Care

Nail problems

A few days ago, I went hiking, and while descending, my big toe kept hitting my shoe, resulting in pain.
After taking off my shoes, I noticed that my big toe was red, swollen, and bruised.
I experienced pain while walking even without shoes.
Later, I applied an anti-swelling ointment on my own.
Today, I found that the pain has decreased.
However, there is a raised white area at the base of the nail, with bruising underneath.
It is not very painful to touch, but when I press down, the nail feels soft.
What could this be? I originally read that if it doesn't hurt, the nail will gradually detach and can be trimmed off.
Now, when I press on the nail bed, it feels soft.

Xianzi, 40~49 year old female. Ask Date: 2023/01/30

Dr. Peng Xianwen reply Surgery

It is recommended to seek on-site consultation for appropriate medical treatment, as it is difficult to draw conclusions based on your description.
Dr.
Hsien-Wen Peng, Department of General Surgery, Nantou Hospital.

Reply Date: 2023/01/30

More Info

It sounds like you’ve experienced a common issue known as a subungual hematoma, which occurs when blood collects under the toenail due to trauma. This can happen during activities like hiking, especially if your toes are repeatedly hitting the front of your shoes. The symptoms you describe—pain, swelling, and discoloration (red, swollen, and bruised)—are typical following such an injury.

When you mentioned that the area around the nail bed is white and the nail feels soft, it suggests that there may be some damage to the nail matrix or the underlying tissue. The white appearance can indicate that fluid is accumulating beneath the nail, which can happen after trauma. The black and blue coloration is due to bruising from the blood vessels breaking under the nail.

Here are some steps you can take to care for your toenail and ensure proper healing:
1. Rest and Elevation: Avoid putting pressure on the affected toe as much as possible. Elevating your foot can help reduce swelling.

2. Ice Therapy: Applying ice wrapped in a cloth to the toe for 15-20 minutes every hour can help reduce swelling and numb the pain. Make sure not to apply ice directly to the skin to avoid frostbite.

3. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and reduce inflammation. Follow the dosage instructions on the package.

4. Monitor for Infection: Keep an eye on the toe for signs of infection, such as increased redness, warmth, swelling, or pus. If you notice any of these symptoms, it’s important to seek medical attention.

5. Nail Care: If the toenail is not too damaged and the pain is manageable, you can allow it to grow out naturally. However, if the nail becomes very painful or if you notice significant changes in its appearance, it may be necessary to see a healthcare provider. They might need to drain any accumulated blood if the pressure becomes too great.

6. Footwear: Ensure that you wear well-fitting shoes that provide adequate space for your toes. Tight shoes can exacerbate the problem and lead to further injury.

7. Follow-Up: If the pain persists or worsens, or if you notice any changes in the nail (such as it becoming loose or falling off), it’s advisable to consult a podiatrist or a healthcare professional. They can assess the injury more thoroughly and provide appropriate treatment.

In most cases, a subungual hematoma will resolve on its own, and the nail will eventually grow out. However, if the nail matrix was significantly damaged, it may lead to permanent changes in the nail's appearance or growth.
In conclusion, while it seems like your condition is improving, it’s essential to monitor the situation closely. If you have any concerns or if the symptoms do not improve, don’t hesitate to seek professional medical advice. Taking care of your feet is crucial, especially after activities like hiking that can put them under stress.

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