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 Background Subungual hematoma refers to a painful condition caused by a buildup of blood (hematoma) or “blood blister” underneath the fingernail or toenail. It may occur after trauma to the nail, either acute or repetitive. Runners and dancers are commonly affected due to repetitive down-striking forces to the toes, but the injury is seen in tennis players and rock climbers as well. Symptoms The main symptoms are pain underneath the nail as well as a dark or black coloration. The pain is caused by the pressure from the blood, whereas the color is due to the breakdown of the pigments in the collecting blood and will resolve over time (usually several months) as the toes grow out. Sports Medicine Evaluation & Treatment The diagnosis is made by the nail’s appearance and x-rays are usually not obtained unless a fracture is suspected. It is important to provide an accurate history to your physician, as a melanoma (type of skin cancer) of the nail unit can appear very similar and requires urgent attention. Although the condition is not considered serious and will resolve with time, the pain can prevent continued activity and may not be able to be treated with ice and over-the-counter pain medications alone. For these cases, a physician or medical professional will need to create holes through the top of the nail (a procedure known as trephining), commonly with a heated needle or similar tool, in order to relieve the pressure and prevent the nail from falling off. Anesthesia (such as numbing medication) is not usually required for this procedure as it is quick and well-tolerated by most individuals. Injury Prevention Using proper fitting footwear decreases the chance of occurrence. The most common footwear changes are to have a less constrictive toe box in the shoe or to pad the toes. Return to Play Return to sport or activity can be immediate if symptoms permit. AMSSM Member Authors References Category: Dermatology (Skin) Issues, Foot and Ankle, [Back] |
