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Subungual Hematoma

Subungual Hematoma

A Subungual Hematoma is a transient condition where blood and fluids collect underneath the toenail or fingernail. This is usually caused by a traumatic injury as in hitting your thumb with a hammer or stubbing a toe. It can also occur by wearing tight fitting shoes which traps blood between the toes, leading to blood pressure within the blood vessels of the toe. In either case the injury leads to the breakage of small blood vessels underneath the nail. The nail may feel sore or tender to touch. As blood pools under the nail, the pressure from the blood can cause severe pain. The colour under the nail will change over time, initially red to purple and later to dark brown and black as the blood clots. The pain usually resolves days after the injury and the nail looks worse than it feels.

Causes of Subungual Hematoma:

Most often, a Subungual Hematoma is an immediate consequence of a crush-type injury involving the tip of the finger or toe. Common example include:
-Slamming your finger e.g. in a car door or house door etc.
-Hitting your finger with a heavy object such as a hammer.
-Dropping a heavy object such as a dumbbell on your toe.
-Stubbing your toe on a hard surface.
-Side effect of insulin shots, blood thinners, aspirin, NSAIDs etc.
-From a surgery that went wrong
-People with bleeding disorders, low platelet count, blood cancer, chronic liver disease
-Wearing tight – fitting shoes, that place a lot of pressure on the toenail.

If you have a darkened area under a nail, and no history of trauma to the nail, you should have it evaluated by your podiatrist. The spot will grow with the nail if it’s a Subungual Hematoma.


The most common symptom of a subungual hematoma is severe, throbbing pain generated by the pressure of blood collecting between the nail and the nail bed. Other symptoms include:
-A dark-coloured discoloration (red, maroon, or purple-black) under all or part of the affected nail.
-Tenderness and swelling of the tip of the affected finger or toe.
The pain may also be caused by other injuries such as a fracture (break) to the underlying bone, a cut in the nail bed, or bruising to the finger or toe itself.

Treatment for Subungual Hematoma

A painless and small subungual hematoma usually does not require any medical treatment, however the pressure generated by the pooled of blood under the nail can be extremely painful. To relieve the pain your podiatrist may perform decompression also called trephination, which allows the underlying blood to drain.

If a large area of the nail is damaged, it may be removed by your podiatrist. If the nail was not removed, it may separate and fall off in the next two weeks. In almost all cases, the nail will grow back from under the cuticle. This takes a few weeks to start and is complete in about 4-6 months for a fingernail and 12 months for a toenail. If the nail bed was damaged, the nail may grow back with a rough or irregular shape. Sometimes the nail may not regrow at all.

Prevention of Subungual Hematoma:

-Being careful so as not to drop heavy objects and tools on your toes or getting your fingers rammed by doors
-Wearing steel-toed shoes while engaging in certain high-risk professions, such as construction and engineering.
-Being watchful of children’s hands so not to accidentally slam your car door on to their hands
-Be fully attentive towards the task that you are involved into finger injuries frequently occur when an individual is distracted while using a tool, such as a hammer.
-Avoid lifting something is too heavy for you to handle. Always ask for assistance while carrying heavy objects so that you do not drop them on the toes.

If you think you have a subungual hematoma on any of your toes or if have any other concerns regarding your feet contact Mint Foot Care today to organise your consultation with our podiatrist on 1300 975 980.

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