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Black Toenails

Definition: A black toenail (subungual hematoma) in a build up of blood beneath the nail plate. If may be acute, due to stubbing the toe or dropping a heavy object on the toe or chronic, due to repeated friction of the nail.

Cause:

  • Acute or chronic injury to the nail.
  • Improper fitting shoes (too short, not enough room in the toe box)
  • Repeated jamming of toes in boots, especially going downhill grades

Symptoms:

  • Acute pain in the toenail
  • Minimal pain but discoloration of the nail
  • Occasional bleeding and drainage from beneath the nail

Treatment:

  • If pain is acute, the hemorrhage beneath the toenail must be drained.
  • In the field this can be done by heating a paperclip or sharp instrument and applying it to the nail plate until drainage occurs.
  • If you have access to a physician or clinic, they can decompress the nail with a high-speed drill or electrocautery.
  • Chronic non-painful cases can be left alone. The nail will often grow out and eventually fall off leaving a new nail beneath it.

Prevention:

  • Careful fitting of shoes and socks.
  • Avoidance of acute injuries to the toes

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Hospital Affiliations

midwest orthopadic speciality hospital wheaton franciscan healthcare wheaton franciscan healthcare columbia st mary's childrens hospitel of wisconsin surgicenter of greater milwaukee wisconsin health center aurora health care

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