What Really is Subungal Hematoma?

Last Wednesday at the Clinic, I caught up in ole talk with a dear friend who finally came in for a long overdue pedicure. We got into a banter regarding his toes…the reasons for his condition, and the worst case scenario. He exclaimed loudly that his toenails would NEVER look like the ones in my article done recently on Black Toes – to which I said it could. He exclaimed again, this time saying “In the name of Jesus…NEVER!”

He’s the prototype of the metro male: generally quite concerned about his appearance; in the barber shop at least twice per week; slim fitting trousers; and extremely pointed shoes. A lot of ladies take a second look; however, he’s in denial about his feet. Subungual Hematoma is occurring, along with hammering of his toes. But who am I to suggest such a thing! He’s not stopping his football, or reviewing his shoes…

It seemed to be a time for it, cause a few days prior to that, a business associate called me and came in for me to see what he described on the telephone as a blood clot; again Subungual Hematoma. His came from one of his hiking trips.

What Really is it?

I have mentioned the term Subungual Hematoma, and I’m sure the question on many minds is – what is it really? A subungual A fully clotted nailhematoma is a collection of blood, usually partially clotted, that tends to result from the breakage of a vein or blood vessel. It can happen through blunt trauma, or repetitive pressure. This blood then collects below the surface of the nail, causing it to appear bluish-black. It is sometimes accompanied by pain and swelling which will subside in a few days leaving only the discolouration behind.

Causes of Hematomas


Many of you would have developed such a mere month ago, with the trauma occurring during the Carnival season.

With hiking, the mountainous/hilly region can contribute; your foot can get hurt with a rock, or simply the impact from the pressure of climbing uphill then downhill. Sometimes, it’s because of inappropriate footwear or the sneakers/hiking boots being too tight, too big, or worn. This can lead to the blue-black colour under the nail, or a reddish hue. Basically the same occurs for Carnival; one other action that contributes in this scenario is persons mashing/jumping on your toes.

Other examples of blunt trauma would include hitting the finger with a hammer, slamming a finger in the car door, or dropping a heavy object on the toe.

Repetitive Pressure

Swollen toe with a HematomaThis is often the result of regular activities, such as running, hiking, tennis, or soccer. It is common in athletes who run excessively. As you step forward for walking or running, the front part of the toes gets rubbed against the inner surface of the shoes. If you are wearing tight fitting shoes, then compression of the toe damages the nail bed. Consequently, a blister is formed under the toenail, and blood and fluid accumulate there. You may also get bruises under the nail if the size of the nail is so big that it is pushed at the front end of the shoe again and again.

What to do by way of treatment?

Initial treatment is with cold compresses and pain killers.The coloured spots will fade in about a fortnight; as each day passes, the colour can change as the blood pigment gets broken down.

Doctors may drain out the blood with the help of a surgical blade or rotary drill. They would then prescribe oral pain relieving medicines, along with antiseptic cream for topical application. In some cases, where the toenail turns black, they may recommend its complete removal.

Once the accumulated blood under the toenail is released, the pain and swelling will subside on its own. After a few days, you may lose the nail. However, it will grow back in a matter of 4-6 months. Then onwards you must try to prevent any kind of injury to the toes. This is possible by wearing of properly fitted shoes and regular trimming of the nails, so that the toes do not strike against the shoe recurrently.

A bruised nail is not a pretty sight and some nail techs may be tempted to use their skills to beautify the nail with false nails … don’t do it! Check a doctor, podiatrist, chiropodist, or foot health practitioner instead.

Your feet mirror your general health . . . cherish them!

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