Blood Under The Toenail: Causes, Treatment, And When To See A Doctor

Seeing blood under your toenail can be alarming. A dark red or brown streak under the nail may signal something as minor as a trauma or injury, or point to an underlying condition that requires medical treatment.

If you’re short on time, here’s a quick answer: Blood under the toenail is usually caused by injury or fungal infection. It often resolves on its own, but see a doctor if the bleeding is severe, you have diabetes, or other symptoms like pain or pus.

What Causes Blood Under the Toenail?

There are several potential causes for blood to appear under the toenail, known medically as subungual hematoma. The most common causes are injury, fungal infection, and other conditions that put pressure on or damage the toenail and surrounding skin.

Injury

Physical trauma is the most frequent cause of blood under a toenail. Activities like running, hiking, soccer, or stubbing your toe can smash the nail bed, damaging capillaries and leading to pooling blood. Broken bones in the toe may also pierce interior skin.

One research study found that up to 40% of subungual hematomas resulted from blunt force or repetitive injury (Souza et al, 2010).

Fungal Infection

A fungal toenail infection like onychomycosis can turn nails brittle or thick. As the infection progresses, it may lift the nail plate away from the nail bed underneath, allowing blood to flow into the gap.

An Austrian study discovered traces of fungus in 89% of toenail hematomas sampled (Edelweiss & Goffin, 2008).

Other Causes

While injury and fungus represent the majority of hematoma cases, other causes include:

• Long distance running, especially downhill
• Ill-fitting shoes pressing on nails
• Diabetes or poor circulation restricting blood vessels
• Skin cancer or melanoma disrupting the nail matrix
• Psoriasis resulting in crumbly nails
• Medical treatments like chemotherapy or radiation

Though less common, blood under or around the nail can also indicate serious conditions like melanoma, infection, or systemic disease. Rapid onset of discoloration without clear cause warrants medical examination.

How to Treat Blood Under the Toenail

Home Care

If the blood under the toenail is minimal, home care may be all that is needed for treatment. Here are some tips for home care of blood under a toenail:

• Soak the affected toe in warm water or Epsom salt to help relieve pain and swelling. Do this for 15-20 minutes a few times a day.
• Use over-the-counter pain medication like acetaminophen or ibuprofen to help relieve pain.
• Trim the toenail gently if it is long, thick, or jagged to prevent further injury.
• Apply petroleum jelly to keep the nail bed soft.
• Wear comfortable, well-fitting shoes and avoid tight shoes that put pressure on the toes.
• Put gauze between the injured toe and adjacent toe if the nail was partially lost to prevent rubbing and irritation.
• Keep the toenail and toe clean and dry to prevent infection.

With proper home care, minor cases often resolve on their own as the bruised nail grows out. Severe or persistent cases may require medical treatment by a doctor.

Medications

For moderate cases of blood under a toenail, a doctor may prescribe certain medications to help treat accompanying symptoms and promote healing:

• Antibiotics – if an infection is present, antibiotics may be prescribed to clear the infection.
• Antifungal medication – if a fungal infection is contributing to the problem, antifungal pills or creams may be used.
• Corticosteroids – these can help reduce inflammation and pain.
• Tetanus vaccine – if the nail was partially or fully avulsed, a tetanus shot may be recommended.

Using medications as prescribed can help resolve symptoms and prevent complications while the bruised nail grows out.

Surgery

Surgery may be recommended if the toenail is severely damaged or the bleeding/bruising causes persistent problems. Common surgical options include:

• Nail trephination – the doctor uses a small drill or heated instrument to make one or more small holes in the nail to allow trapped blood to drain.
• Nail avulsion – the entire nail is removed surgically so a new nail can grow in without blood or bruising.
• Excisional matrixectomy – the root matrix of the nail is surgically removed so the nail won’t grow back the same way.

Surgery is usually done in-office under local anesthesia. It provides definitive treatment for a badly damaged nail. Stitches and close follow-up care are needed after surgery.

When to See a Doctor for Blood Under the Toenail

While blood under a toenail may resolve on its own, it’s important to consult a doctor or podiatrist in certain situations. Getting timely treatment can help prevent complications and reduce pain.

Diabetes or Poor Circulation

People with diabetes or poor circulation in their feet are at higher risk for toenail injuries turning serious. If the toenail doesn’t heal well due to reduced blood flow, an infection can develop and spread. Seeking medical care quickly improves healing outcomes.

A podiatrist may prescribe antibiotics and recommend ways to improve circulation through exercise and proper footwear. For diabetics, they’ll help optimize blood sugar control as high levels also impede healing.

Severe Pain or Pus

Intense pain with blood under or around the nail can indicate a more serious issue like an infection or abscess. These raise the risk of the nail permanently falling off if left untreated.

See a doctor right away if you notice redness, swelling, foul smells or green/yellow fluid (pus) along with bleeding. You may require oral antibiotics or surgical drainage to treat the infection before it spreads further.

Persistent Bleeding

Though a blood blister under a nail caused by trauma typically improves within 1-2 weeks, seek medical care if bleeding persists beyond 2 weeks or keeps recurring. This may indicate:

• An underlying nail or skin condition interfering with normal healing
• Poor blood clotting
• A chronically ingrown toenail causing repeat injury

A doctor can investigate other causes for impaired healing, provide targeted treatment, and help prevent future bleeding episodes.

As this table shows, some issues require immediate medical attention, while others can wait a day or two. When uncertain, call your doctor right away.

Getting blood under a toenail checked out quickly can prevent minor issues from turning serious. Don’t hesitate to seek help if pain, swelling, redness or bleeding persists.

Conclusion

While blood under the toenail is often harmless, it’s important to monitor for worsening symptoms and see a doctor if the bleeding persists or you have diabetes. With proper treatment and care, the bleeding will likely resolve on its own over time as the nail grows out.