Nail Trauma

Overview

Nail trauma refers to any injury affecting a fingernail or toenail and the soft tissue around and beneath it. It is very common and ranges from minor to significant. A mild injury might cause a small bruise under the nail, while a more severe one can split the nail, tear it partly off, or injure the nail bed underneath and the surrounding skin.

Most nail injuries are not serious and heal on their own with simple care. However, some injuries, especially crush injuries from doors or heavy objects, can damage the nail bed or the bone of the fingertip or toe and may need medical attention to heal properly and to avoid lasting nail deformity. Knowing how to care for a nail injury and when to seek help supports good healing.

Symptoms

Symptoms depend on the type and severity of the injury. They may include:

• Pain and throbbing, which can be intense with bleeding trapped under the nail.
• Bruising under the nail (a dark red, purple, or black area) from collected blood, called a subungual hematoma.
• A split, cracked, or torn nail.
• The nail partly or fully lifting or detaching.
• Bleeding from around or under the nail.
• Swelling of the fingertip or toe.
• Later, the nail may loosen and fall off, with a new nail growing in over time.

Causes

Nail trauma results from physical force to the nail or surrounding tissue. Common causes include:

• Crush injuries, such as catching a finger in a door or dropping a heavy object on a toe.
• Stubbing a toe.
• Sharp blows or hitting the nail with a tool such as a hammer.
• Repeated pressure or friction, for example from running or ill-fitting shoes, which can cause bruising under toenails.
• Cuts or tears from sharp objects.
• Aggressive manicures or biting and picking at nails.

Risk Factors

Factors that make nail injuries more likely or more problematic include:

• Sports and activities with repeated foot impact, such as running and hiking.
• Manual work involving tools and heavy objects.
• Poorly fitting footwear.
• Conditions that slow healing, such as diabetes or poor circulation.
• Habits such as nail biting or picking.

Diagnosis

Most nail injuries are diagnosed by simple examination, but more serious injuries may need imaging:

• Examination of the nail, nail bed, and surrounding skin to assess the type and extent of injury.
• X-ray if a crush injury is severe or a broken bone in the fingertip or toe is suspected.
• Assessment of the nail bed when the nail is torn or detached, since damage to the bed affects how the new nail grows.
• Checking for signs of infection if the injury is older or the skin is broken.

Treatment

Treatment depends on the injury. Many minor injuries can be cared for at home, while others need medical care:

• Home care for minor injuries includes cleaning the area, applying ice wrapped in a cloth, elevating the hand or foot, and taking over-the-counter pain relievers as directed.
• Draining blood under the nail, a procedure a clinician may perform for a painful subungual hematoma to relieve pressure; this should not be attempted by untrained people.
• Repair of a torn nail bed with stitches in some cases, to help the new nail grow smoothly.
• Protecting a loose or detached nail and keeping the area clean while a new nail grows, which can take months.
• Treatment of fractures if a bone in the fingertip or toe is broken.
• Antibiotics if infection develops.

Prevention

Some nail injuries can be prevented with simple precautions:

• Wear properly fitting shoes, especially for running and hiking, and keep toenails trimmed.
• Use protective footwear and gloves for work involving heavy objects or tools.
• Be careful with doors and drawers around fingers.
• Avoid biting or picking at nails.
• Take extra care of the feet and hands if you have diabetes or poor circulation.

When to See a Doctor

See a doctor for a nail injury with severe pain, a large area of blood under the nail, a deep cut, a nail that is torn off or has a damaged nail bed, or if you cannot move the fingertip or toe normally, as these may need professional care or an X-ray.

Seek prompt care for signs of infection, such as increasing redness, warmth, swelling, pus, or fever, and for any crush injury that is very painful or deformed. People with diabetes or poor circulation should be especially cautious and seek care early for foot and nail injuries.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine.
2. American Academy of Dermatology.
3. Mayo Clinic.