If you’ve ever dropped something heavy on your toe or slammed it into furniture, you may have noticed a dark spot forming under the nail. What starts as a dull ache can quickly become throbbing, painful pressure—often mistaken for a simple bruise. In reality, you may have a subungual hematoma, a common but painful nail injury that requires proper treatment to avoid complications.
At Foot & Ankle Care of Colorado, we treat subungual hematomas regularly, helping patients relieve pain, protect the nail, and avoid long-term damage to the nail bed or toe.
What Is a Subungual Hematoma?
A subungual hematoma is a collection of blood trapped under the toenail, usually caused by direct trauma—like dropping an object on the toe, stubbing it hard, or repetitive pressure from poorly fitting shoes. It often affects the big toe, but can occur on any toe (or even fingernails).
The injury causes small blood vessels under the nail to rupture, leading to bleeding between the nail plate and the nail bed. Because the blood has nowhere to escape, pressure builds, causing pain and visible discoloration.
Common Symptoms
Symptoms can vary depending on the severity, but typically include:
- Dark red, purple, or black discoloration under the nail
- Throbbing pain that worsens when walking or wearing shoes
- Swelling or tenderness around the nail
- Nail separation or loosening over time
- In severe cases, the nail may lift or fall off entirely
The discoloration is usually very distinct and does not move with the nail as it grows—unlike fungal infections or nail polish stains.
When Should You See a Podiatrist?
Not every subungual hematoma requires medical intervention. Small injuries that cause minor discomfort often resolve on their own. However, you should schedule an appointment if:
- The pain is severe or worsening
- The discoloration covers more than 25–50% of the nail
- The nail is lifting or appears loose
- There’s visible swelling, redness, or pus (possible infection)
- You have diabetes, poor circulation, or immune compromise
- You’re unsure whether it’s trauma, fungus, or something else
Prompt treatment can reduce pain dramatically and protect the nail matrix—the part of the toe responsible for future nail growth.
Subungual Hematoma Treatment at Foot & Ankle Care of Colorado
We offer in-office treatments tailored to the severity of your hematoma and your long-term foot health needs. Common treatments include:
1. Nail Trephination (Pressure Release)
For moderate to severe hematomas causing pressure, we use a sterile tool to create a tiny hole in the nail, allowing trapped blood to drain. This procedure, known as trephination, provides immediate pain relief and prevents further nail damage. It’s quick, low-risk, and typically performed under local anesthesia if needed.
2. Nail Removal
If the nail is significantly lifted, infected, or already partially detached, we may recommend removing all or part of the nail. This allows us to assess the nail bed for injury and promote clean healing.
3. Wound and Infection Care
If there are open wounds or signs of infection, we’ll clean and dress the area, and may prescribe oral or topical antibiotics. Keeping the area sterile is especially important for patients with diabetes or circulation issues.
4. Follow-Up and Nail Regrowth Monitoring
It can take 6–12 months for a toenail to fully regrow. During follow-up visits, we monitor healing and look for signs of permanent nail bed damage, nail thickening, or deformity.
How to Prevent Future Injuries
While accidents happen, you can reduce the risk of subungual hematomas by:
- Wearing shoes with adequate toe box space
- Using steel-toed boots if working in hazardous environments
- Trimming toenails properly (not too short or uneven)
- Avoiding repetitive trauma from poorly fitting shoes or sports activity
- Keeping nails dry and clean to prevent fungal infection after trauma
Don’t Wait—Relieve The Pressure Today
A subungual hematoma may seem minor, but if ignored, it can lead to infection, nail loss, or permanent damage to the nail bed. If you’re experiencing pain, discoloration, or pressure under your toenail, let the specialists at Foot & Ankle Care of Colorado evaluate and treat it quickly and safely.
Relief is only one visit away. Call today to schedule your appointment.
