Non-Traumatic Bruising of the Big Toe Nails

Bruising of the big toe nail without external trauma?

Last month, the toenails of both my big toes gradually turned dark.
After consulting a dermatologist, no cause was found; they only advised me to avoid friction and to monitor the situation.
Recently, the toenail on my right foot has turned completely dark, with the proximal end appearing white, while the skin temperature and color of my big toe are normal.
However, wearing sneakers or dress shoes causes pain.
The toenail on my left foot is also increasingly dark at the proximal end, showing a trend of spreading to the entire toe.
Should I see a dermatologist again? Are there any precautions I should take in my daily life or when seeking medical attention? Thank you for your guidance! Sincerely, Hsiao-Mei, who has been confused and troubled for a month.

Mei, 10~19 year old female. Ask Date: 2003/12/16

Dr. Zhong Yitun reply Dermatology

If the spot under your nail has been growing larger over the past few months, there is concern about melanoma.
However, since it occurred last month, based on your description, it is more likely to be due to "physical trauma" (such as ill-fitting shoes, especially if they are too small and you have been forcing yourself to wear them), which can cause subungual hematoma.
There are other possibilities as well, so to avoid any delays that could lead to regret, it is best to have it checked by a dermatologist.
If your shoes are uncomfortable, you should not force yourself to wear them; that is the best advice I can give you at this time.

Reply Date: 2003/12/16

More Info

Non-traumatic bruising of the big toe nails, as you've described, can be concerning and may indicate underlying issues that require further evaluation. The fact that both of your big toe nails are turning black and that you are experiencing pain when wearing shoes suggests that this is not a typical case of minor trauma or friction.
Firstly, it’s important to understand that bruising under the nails, known as subungual hematoma, typically occurs due to trauma. However, in cases of non-traumatic bruising, other factors may be at play. These can include:
1. Vascular Issues: Conditions that affect blood flow, such as peripheral vascular disease, can lead to changes in nail color. Poor circulation may cause the nails to appear darker.

2. Nail Fungus: Fungal infections can cause discoloration of the nails, often leading to a darkening appearance. This is usually accompanied by other symptoms such as thickening of the nail or crumbling.

3. Systemic Conditions: Certain systemic diseases, such as diabetes or autoimmune disorders, can lead to changes in nail appearance. For example, diabetes can cause poor circulation and nail changes.

4. Nutritional Deficiencies: Deficiencies in vitamins and minerals, particularly B vitamins and zinc, can affect nail health and appearance.

5. Medication Side Effects: Some medications can cause changes in nail color or texture, which may be worth discussing with your healthcare provider.

Given that you have already seen a dermatologist and were advised to avoid friction, it may be prudent to follow up with them, especially since the condition seems to be worsening. Here are some considerations for your next visit:
- Document Changes: Keep a record of any changes in your nails, including color, texture, and any associated symptoms like pain or swelling. This information can help your doctor make a more accurate diagnosis.

- Footwear: Since you are experiencing pain when wearing shoes, consider wearing open-toed shoes or sandals to alleviate pressure on your toes until you can get a more definitive diagnosis.

- Avoid Self-Treatment: While it may be tempting to try over-the-counter treatments for nail fungus or other conditions, it’s best to wait for a professional diagnosis to avoid exacerbating the issue.

- Consider a Podiatrist: If your symptoms persist or worsen, you might want to consult a podiatrist, a specialist in foot and ankle conditions. They can provide a more focused evaluation of your toe nails and any underlying issues.

- Blood Tests: If systemic issues are suspected, your doctor may recommend blood tests to check for conditions like diabetes or vitamin deficiencies.

In summary, while your initial visit to a dermatologist was a good step, the progression of your symptoms warrants further investigation. It’s essential to address any potential underlying causes to prevent further complications. Don't hesitate to seek a second opinion or ask for additional tests if you feel your concerns are not being fully addressed. Your health and comfort are paramount, and it’s important to advocate for yourself in the healthcare system.

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