Toenail Bruising and Loss: Causes and Treatments

Q: Toenail Bruising and Loss: Causes and Treatments

Hello： After a toenail injury resulting in bruising, if it causes the nail bed to separate, it may take several months for a new toenail to grow back. <br>During this time, it is advisable to avoid further injury. <br>If the condition of the toenail does not improve or worsens, i

Nail bruising leading to the complete loss of the nail?

A few days after exercising, I noticed bruising under my big toenails.
At first, there were only a few spots, and I didn't pay much attention to it.
However, due to continued exercise, the bruising area has increased significantly and now covers the entire nail.
Both of my big toes are affected; the toenail on the right side has turned white in the middle, but the surrounding area remains black.
The toenail on the left side has already fallen off, and there is a dark area near the root that feels raised when touched.
I would like to know if this is caused by a blood clot, what to do about the toenail loss, and how to treat it.
Will it eventually grow back? Thank you.

Ezhen, 10~19 year old female. Ask Date: 2023/11/03

Dr. Li Yufen reply Dermatology

Hello: After a toenail injury resulting in bruising, if it causes the nail bed to separate, it may take several months for a new toenail to grow back.
During this time, it is advisable to avoid further injury.
If the condition of the toenail does not improve or worsens, it is recommended to consult a nearby dermatologist for diagnosis and treatment.
Thank you!

Reply Date: 2023/11/03

More Info

Toenail bruising and loss can be concerning, especially when it occurs after physical activity. The symptoms you describe, including the bruising (which appears as a dark discoloration) and the eventual loss of the toenail, are often caused by trauma to the nail bed. This trauma can occur from various activities, particularly those involving repetitive pressure or impact on the toes, such as running, jumping, or even wearing ill-fitting shoes.

Causes of Toenail Bruising and Loss
1. Trauma: The most common cause of toenail bruising is direct trauma. This can happen when you stub your toe, drop something heavy on it, or experience repetitive impact during sports. The bruising occurs due to bleeding under the nail, which is often referred to as a subungual hematoma.

2. Pressure: Continuous pressure on the toenails, especially during activities like running, can lead to bruising. This is particularly true if your shoes are too tight or if you are using footwear that does not provide adequate space for your toes.

3. Nail Bed Injury: If the injury is severe, it can damage the nail bed, leading to the nail becoming loose and eventually falling off. The white area you see in the middle of the nail may indicate that the nail is separating from the nail bed, which can happen due to trauma.

4. Underlying Conditions: In some cases, underlying health issues such as circulatory problems or blood disorders can contribute to bruising. However, this is less common in the context of physical activity.

Treatment Options
1. Rest and Ice: If you have bruising, it's essential to rest the affected toe and apply ice to reduce swelling and pain. Ice should be applied for 15-20 minutes every hour as needed.

2. Elevation: Keeping your foot elevated can help reduce swelling and promote healing.

3. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help alleviate discomfort.

4. Nail Care: If the toenail is loose but not completely detached, it’s essential to keep it clean and dry. Avoid pulling on the nail, as this can cause further injury. If the nail has completely fallen off, it’s crucial to protect the nail bed from infection. You can cover it with a sterile bandage.

5. Observation: In many cases, the toenail will eventually grow back. It typically takes several months for a toenail to fully regrow, as toenails grow at a rate of about 1 millimeter per month. The new nail may initially appear different in color or texture but should normalize over time.

6. Medical Attention: If you notice signs of infection (such as increased redness, swelling, warmth, or pus), or if the pain is severe and persistent, it’s essential to seek medical attention. A healthcare provider can assess the injury and may need to drain any accumulated blood if there is significant pressure under the nail.

Conclusion
In summary, the bruising and eventual loss of your toenail are likely due to trauma from your activities. While it can be concerning, following proper care and allowing time for healing is crucial. If you have any doubts about the severity of your injury or if complications arise, consulting a healthcare professional is always a good idea. They can provide personalized advice and treatment options based on your specific situation. Remember, taking care of your feet and ensuring proper footwear can help prevent future injuries.

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