Injuries to Your Toenails

What are some possible causes of toenail injury?

Everyday injuries can cause your toenail to fall off. Hitting your toe on a chair or bedpost, dropping something on your foot, or simply pulling your socks on too fast can damage your toenail.

Toenail Injury

Injuries to the nail may lead to a subungual hematoma, which causes blood to collect under your injured toenail. This can delay growth of the toenail and be painful for the first few days or weeks. If it can be tolerated, the best way to treat it is to soak the area in cold water for 15 minutes, clean the area with betadine or an alcohol swab, apply antibiotic cream, and trim straight across the toenail.

If the subungual hematoma extends to a little over a quarter or half of your toenail, then you must seek treatment at a doctor’s office. If you experience throbbing or severe pain near the hematoma, your doctor will determine if the hematoma needs to be drained to relieve the pressure.  X-rays may also be taken to make sure a fracture has not occurred. In diabetics, or immune-compromised patients, care is important so that infections do not occur.

Keep in mind, toenail growth will slow down significantly after the injury. It can take anywhere from six months to two years for the nail to completely grow back.

Pressure on the toenail can cause it to weaken and lift off the nail bed. Make sure other toenails are trimmed neatly and wear well-fitting shoes to prevent any future injuries. A half centimeter of room should always be present in the front of shoes to prevent pressure of toenails. A good shoe store can help fit your shoes and make sure you are not feeling extra pressure around your toenails.

It is also possible to develop a fungal infection of the nail after a toenail injury. The injury provides an invitation for fungus to grow between the nail bed and loose toenail. If this occurs, your doctor should take a sample of your toenail to confirm that it is fungus, and then treat accordingly. Your doctor will discuss when antifungal medications are necessary on a case by case basis, depending on the results of a nail biopsy. People who have athlete’s foot and diabetes are prone to fungal infections. Diabetic patients have a harder time fighting off a fungal infection and must take extra precaution.

Another cause of toenail detachment is psoriasis, an autoimmune condition. With psoriasis, the skin cells begin to build up at a faster rate and cause the toenail to lift off. Many cases of nail psoriasis are mild and don’t persist. Some of the symptoms may include thickening/pitting of nails, unusual nail shape, yellow-brown discoloration, or a chalky-like buildup. If the foregoing remains an issue, your doctor may prescribe topical steroids to rub into your toenail and cuticle.

 

What to do when your toenail is injured or falls off.

Step one: Don’t panic. If your toenail starts to fall off, you must follow a few basic tips to avoid worsening your prognosis.

  • First, clean the area with an antiseptic agent as tolerated.  
  • Second, apply an antibiotic ointment with a band-aid. If part of your toenail has fallen off or is detached, it is wise to let a doctor remove the remaining portion to avoid more pain or exposing your nail bed to infection.  
    • Do not lead the band-aid on all day and night– leave the band-aid on during the day, but leave your toe open at night to let the area get some air.
    • Change your band-aid regularly regularly– a dark, moist environment creates a way for infection and fungus to form.
  • Also, the doctor will determine how much of your toenail to remove, depending on how much of the toenail is detached.

Do not wait to seek treatment until your entire toenail falls off.

While these tips provide a basic understanding of toenail injuries and detachment, they are not substitutes for medical treatment, especially if the pain persists or you are unsure about how to proceed. In such cases, please contact your doctor.  

Foot and Ankle Surgeon Dr. Reema DuaDr. Reema Dua works in our Rockville, MD office.

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