However, our nails are commonly subjected to damage in the course of normal activity. Most often these injuries involve direct trauma, including a blow to the nail, tears/lacerations, or repetitive stress from tight-fitting shoes that subjects the nails to lifting or impact.
Some facts about nail injuries
- Nail wounds can be complex to repair
- Wounds can lead to permanent deformity
- When nails regrow, their shape may differ from original nail profile
- Nail injury can occur in any of the three different layers of the nail: the nail bed (provides growth and support), nail plate, and the eponychium (cuticle)
Types of Injuries
The classification of injuries is dependent on the nature and anatomic location of the damage. Injury types include simple or complex lacerations, and avulsion injuries.
Subungual Hematoma (Smashed Toenail)
This is a closed type of injury characterized by the collection of blood between the nail bed and the nail plate. A subungual hematoma can occur when there is a crushing of the toe, as when a heavy object is dropped on a toenail.
If the surface area of hematoma is less than 50% of the nail surface, and if x-rays don’t show any fracture, a hematoma can be managed conservatively. In instances where the hematoma is greater than 50% of the nail surface, the blood is drained by drilling a small hole through the overlying nail. Precaution is taken to prevent any chance of infection.
Nail Bed Loss
The nail bed is found beneath the nail plate. It is responsible for nail growth and support. The absence of the nail bed can result in non-adherence and deformity of the nail. Nail bed loss can be managed by replacing it with a nail bed graft which is harvested from the adjacent nail bed when the loss is small. Total nail bed loss will require vascularized nail bed grafts.
Nail bed avulsions
In some injuries, the nail bed is intact but avulsed from the germinal matrix. The germinal matrix is responsible for 90% of nail growth. A nail avulsion is a separation of the nail from the nail bed, leaving the nail bed exposed and vulnerable. It is naturally painful. Once a nail is removed from the nail bed, the body is unable to reattach it. The only option left is to remove the remaining portion of nail. A new nail will grow, though the process can take anywhere from 6-12 months.
Some nail injuries cut the nail all the way down to the cuticle and the nail bed/matrix is damaged in the process. A full laceration is often as a result of a severe blunt injury. It calls for immediate attention from a podiatrist.
Nail injuries are usually treated using basic wound care, based on the location and severity of the injury. If you’ve suffered a nail injury (or loss) that is painful, red or swollen, call Houston Foot and Ankle Care to schedule an appointment with Dr. Gabriel Maislos, DPM, FACFAS. We offer same-day and next-day appointments.
Call (713) 541-3199 if you experience:
- Blood under the nails
- Severely torn toenail
- Nail loss