Foot Care Library | Nail Injuries

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Nail Injuries

The nail can be injured in many different combinations of ways. The most common injury is a bruise beneath the nail called a subungual hematoma. The bruise (hematoma) forms beneath the nail (subungual) when the nail is avulsed (pulled away) from the underlying nail bed. More aggressive and destructive injuries include lacerations to the nail bed and crush injuries to the soft tissue and bone. Let's take a look at what to do with a nail injury.

Treatment of nail injuries
First, injuries to the nail can have a tendency to bleed for a while. Be sure to wrap the injured toe with a clean (preferably sterile) bandage for 30-60 minutes. During this period of time, elevate the foot and allow the bleeding to stop.

The next step is to evaluate the status of the nail plate. In most cases we recommend trying to keep the nail plate in place. There's several pro's and con's to this decision but most importantly, the nail will act as a guide for the new nail as it grows in. When the old nail is removed, the soft tissue on the tip of the finger or toe will contract making it difficult for the new nail to reattach to the nail bed. There is one significant problem with leaving the nail in place. If there is dead tissue under the nail it will create a source of infection. We recommend that you follow these directions:

Soak the injured nail twice daily in Epsom Salts following the directions on the box.
Use a band aid to hold the damaged nail in place.
Monitor the injured nail for redness or swelling. If this does occur, please call you doctor for an antibiotic and possible removal of a portion of the damaged nail.

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	Long term management of the nail requires a little patience and a lot of compliance. The most important consideration is to protect against fungal infections of the nail. Following any nail injury, the door of susceptibility swings open allowing the fungus to infiltrate the nail. Prior to injury, the nail is fairly well protected and able to fend off fungal infections. It's important to apply an antifungal medication to the nail for the entire length of time it takes to grow out. This length of time can vary but is typically 3-4 months for fingernails and up to 10 months for toenails. Proper application of an antifungal medication requires consistency. The fungus doesn't take a day off and neither should you. All it takes is a very small amount of topical antifungal applied twice daily. For more information regarding nail fungus, please review our article on onychomycosis. Nails will change over the period of our lives becoming rough and irregular. These changes are due to repetitive low grade trauma such as the shoe hitting the nail or the nail being placed in a position (such as a hammer toe) where it continually hits the floor. Take care to prevent fungal infections in these cases by using a daily application of antifungal. Biotin, a keratin precursor, is also helpful in the battle against rough ridges called Beau's line

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