Subungual Haematoma (Bleeding under nail)

What is a subungual haematoma?

A subungual haematoma is a bleed underneath the nail caused by a break in the skin of the nail bed, usually causing initial pain and discomfort which subsides in time.

Subungual = under the nail

Haematoma = bleeding out of the blood vessels

It is caused by either a major single trauma, or multiple minor trauma.

What causes subungual haematomas?

Subungual haematomas are caused by trauma/injury, this can either be a major single trauma, or multiple minor trauma. Examples of these are:

Major single

• Stubbing toe
• Someone standing on toe
• Dropping something on toe
• Kicking something

Multiple minor

• Running a marathon
• Hiking
• Wearing shoes that are too tight
• Wearing heels for periods of time

Who gets subungual haematomas?

Anyone can get a subungual haematoma (as long as there is a nail), although certain sporting activities and footwear will increase the chances of getting one.

What are the signs and symptoms of a subungual haematoma?

Usually pain is felt in the toe at the nail plate and surrounding areas, particularly upon pressure. This usually occurs after some form of trauma.

• The nail appear black or very dark red
• The skin surrounding the nail plate may be red, swollen and inflamed
• The nail and surrounding nail folds may be tender to touch
• It may be uncomfortable to wear closed-toe shoes

How is a subungual haematoma diagnosed?

A podiatrist can easily diagnose a subungual haematoma following a history taking and thorough visual examination of the feet.

Benefits of podiatry for a subungual haematoma?

Podiatry can be beneficial for subungual haematomas, as long as treatment it sought out as soon as possible after the initial injury, as,the blood beneath the nail can be drained in a sterile and controlled manner. Once the blood is drained from beneath the nail, this relieves the build up of pressure between the nail and nail bed and often an immediate reduction in pain is felt.

Having the blood drained from the nail also reduced the chances that it may fall off. If the blood is not drained, it eventually dries up on the nail bed, this scab gets in the way of the adherence of the nail to the nail bed meaning it is not attached anymore, as it grows out, usually a new nail grows underneath and the old one falls off.

What would podiatry for subungual haematomas involve?

Podiatry for a subungual haematoma would involve, a thorough medical and social examination of the foot and an account of the injury and what may have caused it. Once a subungual haematoma has been diagnosed, and it is within the time period where it is able to be drained, the podiatrist will attempt to drain the blood from beneath the nail.

The podiatrist will clean the nail, and then using a micro-drill will carefully drill a hole directly through the nail plate until it is fully punctured. Once the nail is punctured, this allows the blood to be drained from underneath it, the podiatrist will gently squeeze the nail and toe until they are satisfied it is adequately drained. Then a sterile dressing will be applied and you will be advised on how to take care of the toe following this.

The podiatrist will discuss how this may be prevented from occuring in the future if possible, but in some cases, such as dropping something on the toe, this is simply not preventable.

Summary

A subungual haematoma is bleeding under the nail usually caused by injury, shortly after the incident it is usually painful which settles down. If it is treated quickly enough, a podiatrist can drain the blood beneath the nail to relieve the pain and pressure, otherwise, if left, the blood dries up and is reabsorbed which usually causes the nail to fall off in time.

To arrange an assessment with one of our podiatrists please email office@chiropody.co.uk or call 0330 088 4222.

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