You’re ready to slip into some summer sandals when you look down and realize that long hike you did over the weekend left you with a new accessory: a bruised toenail. It might throb to the touch or just offer a subtle ache, but you can’t ignore the bluish-purplish tint on your toe. Even worse, you know there’s a possibility that the nail might soon fall off altogether.
While bruised toenails typically resolve on their own, it’s important to know how to identify them, as well as how to treat them. Not only can it help you avoid a painful situation in the present, you might be able to potentially prevent one in the future, too. After all, not all discolored toenails are a sign of bruising.
Why do toenails bruise?
According to nail-focused board-certified dermatologist Dana Stern, MD, toenail trauma can occur from repetitive pressure between your toe and the front of your shoe (which is common in activities like tennis, hiking, and running—especially downhill). It can also occur from a sudden, single-instance injury, like stubbing your toe or dropping something on your foot.
“Any trauma to the nail can crush these small vessels and cause bleeding under the nail.” —Dana Stern, MD
“The nail bed is loaded with small blood vessels and any trauma to the nail can crush these small vessels and cause bleeding under the nail,” Dr. Stern says. “This type of ‘bruise’ is called a subungual hemorrhage. Since the nail is firmly adherent to the nail bed, there is not a lot of space for the blood to collect and so if there is significant bleeding, the increased volume of fluid under the nail will cause the nail to lift and separate and will be potentially painful.”
If you’ feel like you’re particularly prone to bruised toenails, you might be wearing shoes that are too small for your foot shape. Get fit by a professional in-store to see if sizing up might help solve your problem.
How do you know if your toenail is bruised?
While bruised toenails are more common during the summer months due to people being more active and wearing open-toe shoes, nail hemorrhages can occur year-round—as can skin cancer. Because of this, it’s helpful to know what signs indicate a bruise, as well as which suggest something more serious.
“If a bruise does not seem to be resolving or growing out, see a board-certified dermatologist,” Dr. Stern says, noting that toenails typically take four months to grow out. “We can look at the pigment with a special magnifier to help decipher blood (hemorrhage) from pigment (potential melanoma).” Fungal infections and ingrowns are other possible reasons for discolored nails.
How to care for a bruised toenail
Bruised toenails can be painful, but there’s not much you can do to treat them apart from being patient and waiting for them to grow out. That said, if more than half the nail is bruised, Dr. Stern suggests making a doctor’s appointment.
“The nail can be trephinated, in which a small hole is created to allow for the blood that is collecting to escape,” she explains. “This will relieve the pressure and thus pain, and will potentially prevent the nail from falling off.” While it’s safest to let a doctor perform this small procedure, if you don’t have access to a healthcare provider, Dr. Stern says that, if you’re brave and careful, you can DIY with a hot paper clip—just make sure not to press too hard, since that can cause more pain.
If you still find that your bruised toenail falls off—immediately or down the line during grow-out—Dr. Stern says to keep the nail bed clean. “Wash it with antibacterial soap and water,” she instructs. “If the area is tender, you can cover it with a BandAid for extra cushioning.” Most importantly, she says you’ll want to avoid re-injuring it while it’s in a more vulnerable state: Wear socks and comfortable sneakers while it heals to keep it protected.
Meanwhile, if you’ve bruised your toenail and your only concern is the unsightliness of it, consider it the perfect excuse to get a fresh pedi. “If the bruise is older and there is no pain, it’s fine to cover it with polish, but never mask a potential medical issue with polish,” Dr. Stern says.
One more thing…
While discussing toenails, Dr. Stern points out that it’s important to get yearly skin checks sans nail polish. “Always remove polish on all 20 nails prior to your annual skin check with a board-certified derm because your nails are an important part of your exam,” she says. Cancer can develop underneath the nails, so you want to make sure nothing is hidden.