Discolored, bleeding, or loose toenails resulting from an injury are painful problems, and must be treated immediately. If you are a diabetic, have poor circulation, a compromised immune system, are taking blood thinners, or have other systemic diseases, see a doctor immediately, to prevent possible serious consequences. Or, if there is profuse bleeding, the toe is pale or blue, or it is cool to the touch, you should also see a doctor immediately. If you do not fall into one of the above categories, then you can try the following suggestions.
Self-treatment must begin immediately after the injury, in order to reduce pain and prevent infection.
Toenail injuries should not be confused with toenail fungus conditions. Sometimes a fungus toenail that is badly infected may become painful as well as loose and even some bleeding can occur under the nail secondary to the thickness of the nail. This is best taken care of by a Podiatrist who will assist in the diagnosis and the treatment of this condition.
- If there is bleeding: apply gentle pressure to the toe, not the nail. Just behind the nail, towards the foot, gently squeeze the toe from top to bottom. Apply this pressure for 5 minutes. If the bleeding does not stop, try again for 5 minutes. If bleeding continues, there may be a deep laceration present, and a doctor must treat this; go to the emergency room immediately (wrap the toe with a clean bandage first). If the bleeding has stopped, or there is just a drop or two, gently wash the nail area, and tip of the toe with cool water and mild soap.
- Examine the nail:
- If it is completely torn off, remove it from the nail bed, and wash the nail bed with hydrogen peroxide. Allow the peroxide to bubble for a minute, and then wipe it off with a tissue. Examine the nail bed and make sure that there are no bone or bone chips protruding from the nail bed. If there are, then this is serious and you must go to the emergency room immediately for treatment.
- If it is partially torn off, gently trim off the loose portion without cutting the attached nail or skin. Wash with hydrogen peroxide, and following the instructions given in #1.
- If the nail is completely attached, but there is a red or blue discoloration under the nail, it means that there is trapped blood under the nail. This trapped blood can cause a great deal of pain unless it is released. In order to release it, a hole must be drilled into the nail. This is difficult and dangerous to do without the proper knowledge and equipment. To save yourself a lot of aggravation and pain, go to the emergency room or your doctor, and have it done properly.
- Infections are the most serious consequences of nail injuries, and everything must be done to prevent them. After washing with hydrogen peroxide, apply an antibiotic cream to the nail and nail bed. Cover the area with a sterile gauze pad and tape. Apply with mild compression to prevent bleeding. Check the color and temperature of the toe, especially the tip, to make sure it is normal, and not white, blue, or cool to the touch (do not apply so much pressure that you reduce the circulation in the toe). If the dressing is too tight, remove it immediately, and make sure the toe returns to normal. If it does not, go to the emergency room immediately. If comfortable, leave this dressing on for 6 hours.
- Apply an ice pack to the top of the foot. Do not put ice on the toe, as this may stop the blood flow into the toe. Make sure the ice is wrapped in a cloth, and that it does not cause discomfort. Leave the ice on 20 minutes, and re-apply it every hour. This will reduce the pain and swelling. Continue using ice for as long as it makes the wound feel better. Do not use heat.
- After 6 hours remove the original dressing. If it sticks to the wound do not pull it off, as this will cause it to bleed. Soak the dressing with hydrogen peroxide, and this will separate the dressing from the wound. Check the toe and nail bed. If it is pale, blue, or cool see a doctor immediately. Or, if you see red streaks running from the toe to the foot, this means you may have an infection, and should see a doctor immediately. If at any time you see the following, see a doctor immediately: increased redness in the toe, red streaks, pus, abnormal discolorations, continued bleeding, or you feel abnormal temperatures in the toe.
- To prevent infection, reduce pain, and aid healing, the nail or nail bed must be soaked. In a clean container with one quart of lukewarm water, add 2 tablespoons of Epsom Salt. Soak the foot, or just the toe, for 15 minutes. Carefully dry the toe with a clean cloth. Allow it to air dry for 15 minutes, and then apply antibiotic cream and gauze, as directed above (#3). Use minimal tape to keep the gauze on, as the wound needs to "breathe." Keep the dressing looser now, as the bleeding should have subsided (if it has not, there is a problem, and you should see a doctor). This should be done twice a day, until the wound has a nice scab on it. This can take 5 to 14 days, depending on the severity of the injury. Once the scab has formed, continue to soak the toe to keep it clean; and, continue the antibiotic cream and gauze. Do not pull off the scab, as this is nature's "band-aid!" Allow it to fall off on its own. Complete healing may take 2 to 4 weeks; and during this time the toe may be painful and swollen, but these symptoms should gradually lessen.
- During these 2 to 4 weeks, all pressure, especially shoe pressure must be kept off of the toe. This will reduce pain, swelling, and healing time. Podiatrists have found that the best way to do this is with an Injury Shoe. This shoe is designed to allow you to walk with minimal bending and movement of the toes, thus reducing pain. It can reduce healing time by 50%. We will ship this shoe to you by Priority Mail at no extra charge.
- Some final comments:
- Do not get the toe wet in a shower or bath while it is healing. This may cause it to become infected.
- When the new nail begins to grow out, it may appear to be ingrown or deformed and possibly painful. If this occurs, see a podiatrist for treatment.
- If at any time during the healing process you notice the following, see a podiatrist immediately: increased pain, swelling, or redness; pus, or continued bleeding; unusual discolorations or temperature changes; or if you think that you may have an infection.