Dr Phil Kieran: Is there anything we can do to save my son's injured toenail?

Trauma can lead to bruising or injury to the nail bed, which may be visible on the surface or located under the fold of skin at the base of the nail.

My teenage son plays a lot of sports and recently injured his big toe in a football match. He has recovered, but a black bruise is growing from the base of the nail. 

Does this mean he could lose the nail? And, if so, is there anything he can do to save it?

Toenail injuries are very common for people who play a kicking sport or who run long distances.

Nails are composed of keratin, a hard substance that is also found in hair.

This material is mostly laid down in an area approximately 5-7mm above the cuticle, or where the skin on the fingertip meets the nail.

As the nail is generated, the skin underneath (the nail bed) moves towards the tip of the finger or toe, and the nail moves with it. This is what causes nail growth.

Trauma can lead to bruising or injury to the nail bed, which may be visible on the surface or located under the fold of skin at the base of the nail.

The trauma can happen with a single, significant impact, like someone standing on your toe or catching your finger in a door, or through multiple minor impacts, such as the ones long-distance runners get, particularly in shoes that are too small.

If a bruise happens in the visible part of the nail, you will typically see it immediately.

If it’s large and causing a lot of discomfort, we sometimes create a small hole in the nail to allow the blood to drain and relieve pressure (this works best within the first 24-48 hours after the injury).

If the bruise is under the nail fold, you won’t see it straight away. This type of bruising can occur if the impact is on the tip of the nail, causing it to be pushed back into the skin. 

You will see the bruise emerging from the base of the nail and appearing to get bigger as it moves towards the tip of the digit.

If your son’s bruise is large enough, it can cause the nail to separate from the underlying nail bed. This is what causes the nail to fall off. 

However, if this does happen, the nail usually grows back without any issues.

I would recommend being careful not to injure the exposed nail bed while the nail is growing back, as this can cause the nail to regrow abnormally.

I usually suggest to sportspeople that they cover the toe with some cotton wool if they want to continue playing.

Keep in mind that there is nothing you can do to prevent a nail from falling off, as the injury has already happened.

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