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Subungual Hematoma

A subungual Hematoma, also called “runner’s toe,” is a buildup of blood in the nail bed that gives the appearance of a purple toenail. The injury is caused by damage to the blood vessels in the toe. It’s common among runners and other athletes

Subungual Hematoma Hero Image 2

A subungual Hematoma, also called “runner’s toe,” is a buildup of blood in the nail bed that gives the appearance of a purple toenail. The injury is caused by damage to the blood vessels in the toe. It’s common among runners and other athletes. Treatment is usually home-based but athletes should see a doctor if they see signs of infection or the condition doesn’t rapidly improve.

What causes Subungual Hematoma?

Runner’s toe is caused by broken blood vessels in the nail bed. Often this happens as a result of an acute trauma, like stubbing your toe or dropping a heavy object on it. This injury can also be caused by repetitive stress to the toe. Runners and dancers are at risk because of the down-striking forces involved in their sports. Shoes that are too tight can put pressure on the toes, contributing to this condition.

Subungual hematoma/runner’s toe is most common in these sports:

• Running
• Dancing
• Tennis
• Rock Climbing

Symptoms

The primary symptom of runner’s toe is pain in toenail area. The nail also becomes discolored due to blood pooling up in the nail bed, until the nail either falls off or grows out. Common symptoms also include:

• Reddish-purple color under the nail
• Nail gradually turning dark brown or black
• Pain that resolves in two to three days

When to see a doctor

If your symptoms aren’t the result of an acute injury, the bleeding under your toe doesn’t stop, or you have signs of an infection like a fever or pus, you should see a doctor. Usually, your doctor can make a diagnosis based on your medical history and a physical examination. Sometimes, x-rays are taken if there is concern you have fractured your toe or have some other condition causing your symptoms.

Non-operative treatment

Treatment for subungual hematoma/runner’s toe is usually minimal and home-based. Conservative treatments include:

• Rest from activities that could re-injure your toe.
• Applying ice or soaking your toe in cool water for 20 minutes, two or three times daily
• Elevating the leg
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, to help relieve pain and inflammation

If the pressure on your nail is too intense, your doctor may recommend draining the blood by making small holes in your nail.

You can also try these exercises at home:

Subungual Hematoma

Surgical Treatment

Surgery is not needed to treat runner’s toe.

Recovery

It may take several weeks for a new nail to fully grow back, but pain should resolve fairly quickly. To ensure a full recovery, once pain goes away athletes should ease back into play (e.g. shorter runs). To prevent re-injury, make sure you keep the toenails short and wear properly fitting shoes.

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