Do You Need to Remove a Nail After Trauma and Discoloration?

Does a nail injury require nail removal?

I have experienced trauma to my toenail, which resulted in bruising.
However, the nail hasn't been growing properly since then.
Eventually, the bruised area of the nail lifted, and I trimmed that part off.
After cutting it, I noticed that the underlying nail appears black.
Should I consider having the nail removed? The trimmed nail is also fragmented.

Miss Huang, 20~29 year old female. Ask Date: 2016/03/06

Dr. Li Zhonghuai reply Surgery

Hello! To assess how much of the remaining nail and nail bed are still attached, sometimes it's better not to forcefully keep the nail if it's not growing well.
In that case, it might be better to remove it entirely, as it will grow back evenly in about a month.
Changhua Hospital cares about you!

Reply Date: 2016/03/06

More Info

When dealing with trauma to a toenail, especially when there is discoloration and the nail appears to be growing poorly, it is essential to assess the situation carefully. Based on your description, it seems that you experienced a significant impact to your toenail, leading to bruising (hematoma) and subsequent changes in the nail's appearance. The fact that the underlying nail appears black and that the nail has not been growing properly raises some concerns.

Firstly, it is important to understand that a black appearance under the nail can indicate a few things. It could be a result of blood pooling under the nail (subungual hematoma), which is common after trauma. If the hematoma is large, it can cause pressure and pain, and in some cases, it may lead to the nail separating from the nail bed. If the nail has been damaged significantly, it may not grow back normally, and the appearance of the new nail may be altered.

In your case, since you mentioned that the part of the nail that was bruised has lifted and you have trimmed it, it is crucial to monitor the area for signs of infection. Look for increased redness, swelling, warmth, or pus, as these could indicate an infection that may require medical attention. If the nail is still attached but is damaged, it may be best to leave it in place as long as it is not causing pain or discomfort. The nail may eventually fall off on its own as the new nail grows in.

Regarding whether you need to have the nail removed, this decision typically depends on a few factors:
1. Pain and Discomfort: If the nail is causing significant pain or discomfort, it may be advisable to consult a healthcare professional to evaluate whether removal is necessary.

2. Infection Risk: If there are signs of infection or if the nail is completely detached, a healthcare provider may recommend removal to prevent further complications.

3. Nail Growth: If the underlying nail bed appears healthy and the nail is just slow to grow back, it may not be necessary to remove it. However, if the black discoloration persists and you notice no improvement over time, it would be wise to seek medical advice.

4. Professional Evaluation: Ultimately, if you are uncertain or if the condition of your nail worsens, it is best to consult a podiatrist or a healthcare professional. They can perform a thorough examination, possibly including imaging if needed, to determine the best course of action.

In summary, while it may not be immediately necessary to remove the nail, monitoring the situation closely is essential. If you experience worsening symptoms or have concerns about the appearance and growth of your toenail, seeking professional medical advice is the best approach. They can provide tailored recommendations based on a physical examination and your specific situation.

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