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Subungual Hematoma (Tennis Toe)

■ ■ ■ Description

Subungual hematoma, also known as tennis toe or black toe, is bleeding under the toenail due to separation of the nail plate from the nail bed. The bleeding causes the nail bed to look dark blue or black.

■ ■ ■ Common Signs and Symptoms
  • Pain under the toenail after exercise, occasionally very painful

  • Black or dark blue discoloration several days after the activity; when the discoloration appears, generally there is no pain

  • Toenail may separate and fall off eventually

■ ■ ■ Causes

Bleeding between the nail plate and the nail bed due to separation of these two structures after repeated contact of the shoe against the nail

■ ■ ■ Risk Increases With
  • Shoes that fit poorly (particularly too tight)

  • Sports that allow for repeated pressure of the shoe against the toenail, such as tennis (hard courts more often), jogging, snow skiing, and hiking

■ ■ ■ Preventive Measures
  • Wear properly fitting shoes (with lots of toe room) and equipment.

  • Avoid activities that create constant pressure on specific skin areas.

  • Relieve shoe pressure by stretching the areas of the shoe that cause the pressure, and use ointments to soften leather shoes.

  • Keep toenails trimmed.

■ ■ ■ Expected Outcome
  • This condition is usually curable with rest, usually 1 to 2 weeks for recovery. Recurrence is likely even with treatment if the caused is not removed. The discoloration disappears as the nail grows.

■ ■ ■ Possible Complications
  • Pain elsewhere from altered mechanics (walking or throwing) due to compensation to avoid the pain of continued irritation

  • Loss of toenail

■ ■ ■ General Treatment Considerations

Initial treatment consists of removal of the source of pres- sure if possible. Wearing shoes with a large toe box to prevent further pressure against the toenail, trimming of the toenails, and, occasionally, anti-inflammatory medications are all that is necessary. Having a shoe repair person modify the shoe by pushing out areas of pressure may help. Infrequently, the pain is severe and acute; this can be relieved with decompression (removing the blood) by drilling a needle through the toe nail. This is not a painful procedure.

■ ■ ■ Medication
  • Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

  • Pain relievers may be prescribed as necessary by your physician. Use only as directed and only as much as you need.

■ ■ ■ Notify Our Office If

  • Symptoms get worse or do not improve in 2 weeks despite treatment

  • Any signs of infection develop, including redness, swelling, increasing pain or tenderness, or increased warmth around the corn or callus

  • The black discoloration does not disappear as the nail grows back

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects)

Tennis Toe

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