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What Is A Subungual Haematoma?

subung haem

A subungual haematoma is a collection of blood (haematoma) underneath a toenail or fingernail (black toenail). It can often be extremely painful despite its relatively small size. However, it is not considered a serious medical condition. It is sometimes known as runner’s toe, tennis toe, or skier’s toe.

Subungual haematomas are common nail bed injuries caused by blunt or sharp trauma to the fingers or toes. Bleeding from the rich vascular nail bed results in increased pressure under the nail and can cause significant discomfort. Subungual haematoma drainage, also known as nail bed trephination, can be performed to relieve this discomfort should it be required. This can be performed in a consultation room and generally does not require the use of anaesthesia.

Ouch! So how does this happen?

The condition results from a traumatic injury, such as slamming a finger in a door, blunt force trauma from a dropped heavy object or from sports activities, such as climbing or hiking rugged terrain.

The bleeding comes from the (vascular) nail bed underlying the (avascular) nail plate. A laceration of the nail bed causes bleeding into the constricted area underneath the hard nail plate. Throbbing pain is common. The nail develops a black discoloration overlying the nail bed but under the nail plate.

Subungual haematomas are also very common in runners and are caused by downward pressure or horizontal separation of nail plate from the nail bed. This repetitive trauma leads to bleeding and pooling of blood beneath the nail plate.

Symptoms of a Subungual Haematoma

The most common symptom of a subungual haematoma 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 toe.

Diagnosis of a Subungual Haematoma

If a subungual hematoma was caused by a severe blow to a finger or toe, you should either seek medical attention from your Podiatrist or hospital emergency room. In addition to the hematoma, you may have broken bones or serious damage to the nail bed and/or surrounding tissues.

Depending on the mechanism of injury, you may have a broken bone or suffered serious damage to the nail bed and surrounding soft tissues and structure. Your Podiatrist will examine your nail and may require you to undergo an X-ray to either confirm or rule out a bone fracture or other injury.

Clinically, it is characterized by reddish-black discoloration of the toe nail. The nail plate may also become thicker and more brittle as a result of the injury (onychochauxis). Infrequently, the toe may become painful and require surgical drainage

Runner’s toe is often associated with poor or tight-fitting shoes. The key to prevention of runner’s toe is to purchase properly fitted shoes!

Treatment of an Uncomplicated Subungual Haematoma

A painless and small subungual hematoma usually requires no treatment. However, the pressure caused by the pooled blood under the nail can be extremely painful and limit the function of your walking. To relieve the pain, your Podiatrist may perform a decompression (also called trephination) procedure to allow the underlying blood to drain, relieving pressure and pain to the area.

After numbing the affected finger or toe with a nerve block, your Podiatrist may use one of the decompression methods to drain the subungual hematoma:

  • Cautery. A heated wire (electrocautery device) or carbon laser is used to burn the hole or holes. This is a quick and painless procedure.

During the cautery procedure, the heated tip is cooled by contact with the hematoma, which prevents injury to the nail bed.

Resolution of a Subungual Haematoma

Unless a subungual hematoma is very small, an affected nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed. A new fingernail can regrow in as little as eight weeks while a new toenail may not fully regrow until about six months. If there has been injury to the nail bed and/or surrounding tissues, regrowth may be delayed.

Even with the best repair, there is still a possibility that the new nail may grow back with an abnormal appearance. See your Podiatrist if you notice any problems with the nail as it heals and regrows.

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