Bleeding under the nail bed can be caused either by direct trauma (smashing finger, dropping bowling ball on toe) or can occur over time from pressure over time (wearing shoes that are too small while practicing or competing). Bleeding from a direct trauma injury can be treated immediately to reduce pain. Bruising from pressure over time can be prevented by wearing the correct size of shoe.
Direct trauma to the nail can cause bleeding under the nail bed. The accumulating blood under the nail has nowhere to go creating increased pressure directly under the nail. This bleeding results in a painful throbbing of the nail. As the nail bed swells, the pain increases.
Once a fracture has been ruled out, treatment can focus on relieving the pressure under the nail (Foundations of Athletic Training: Prevention, Assessment, and Management, 4th Edition, 2009). First, soak the finger or toe in ice water for 10 – 15 minutes to reduce the bleeding and numb the area.
Clean the injured area thoroughly with antibacterial or antiseptic soap. Wash hands in the same manner and apply latex gloves.
Draining the Nail Bed
There are different tools that can be used to make a hole through the nail. A physician will use either a surgical blade or a rotary drill. However, a heated paper clip can also do the job. Heat the end of a paper clip until it turns bright red. The heat will enable the paper clip to melt through the nail bed.
Apply the heated end of the paper clip to the base of the nail bed until a hole has been made through the nail bed. Because the skin under the nail bed is sensitive, take care in the amount of pressure applied so as not to damage the skin under the nail when the paper clip breaks through the nail bed.
Once the hole has been made in the nail bed, apply light pressure on the end of the finger to push the excess blood through the hole. Once the blood has been drained, the individual will feel immediate relief from the pain.
Because a hole has been created in the tissue, care must be taken to prevent infection in the injured area. After the nail has been drained, soak the finger or toe in iodine solution for ten minutes. Cover the area with a sterile dressing and apply a protective splint for 24-48 hours.
Check carefully for signs of infection. These include redness, pain, heat, and drainage from the wound. If signs of infection are present, contact a physician for further treatment.
Reducing Swelling
Because new injuries can continue to bleed for up to 48 hours, the individual should elevate the area above heart level if possible to reduce the amount of swelling. Soaking the finger or toe in ice water every 2 hours for the first few days will also help in reducing swelling.
Throbbing is an indication of increased bleeding to an area. If a “throbbing” pain reoccurs, there may be additional accumulation of blood under the nail bed. The nail bed can be drained again using the method stated above.
Preventing Loss of Toenails
Toenails can also be bruised from constant pressure during activity when wearing shoes that are too small. Pressure from the toe pushing up against the end of the shoe can damage the nail. If enough pressure is applied to the nail bed, the growth plate of the nail can be damaged. Once the growth plate is damaged, the nail will eventually loosen and fall off. A new nail will grow back in four to six months.
This can be prevented by paying close attention to toe pain during activity, especially with new shoes. If toenail pain is felt, stop the activity and change the shoes. This simple act can save the individual from unnecessary pain and loss of a toenail.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
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