Subungual hematoma

The subungual hematoma is bleeding that occurs under your fingernails . It is about the exit of blood from the blood vessels and its accumulation in the space between the nail plate and the bed on which it rests.

The subungual hematoma is common in athletes from different specialties, especially athletes, football players, runners, etc. In short, all those activities that cause a continuous friction of the nail of the toes against the toe of the shoe.

Despite being a banal condition, it is necessary to differentiate it from other diseases that can settle in the same area and present with a similar appearance. This cause makes the opinion of a specialist necessary to make a good diagnosis and guide the patient about the appropriate treatment for each moment.

Purple Nails by Hematoma

The nails rest on the nail bed, located at the fingertips. This area is highly vascular and this circumstance means that any blow or friction, no matter how small, can cause bleeding. The inability for blood to escape to the outside causes it to accumulate under the nail and form a hematoma in this area, coloring the nail black or bluish.

The accumulated blood increases the pressure to this level , which causes tension in the tissues and therefore pain. In this way, the nail appears in an intense black or blue color and is very sensitive to friction or pressure, which makes it difficult to withstand the friction of footwear on this area.

Causes of subungual hematoma

The cause is usually a recent blow received on the nail, repeated microtrauma caused by the practice of a sport or by the use of poorly fitting footwear , and on more particular occasions it appears associated with pathological conditions or the ingestion of certain medications.

Certain athletes who perform sports in which quick stops are made or people who wear narrow shoes can develop this pathology. The effect will finally be the same and it translates into a tapping or excessive friction between the nail and the toe of the shoe.

Diseases that cause a bruise on the nail

• Subacute bacterial endocarditis .
• Severe trichinosis
• Vasculitis
• Purple.
• Hemophilia.
• Deficiency vitamin C .
• Systemic lupus erythematosus.
• Leukemia.
• Tetanus.
• Sepsis .
• Etc.

It has also been found associated with the intake of certain medications such as tetracycline , griseofulvin or cytostatic drugs .

Why do subungual hematomas appear?

The friction continued on the nail of the finger of the foot or repeated or accidental blow this area will cause a rupture of blood vessels at this level. The area under the nail is a highly vascular area where we find a large number of blood vessels. This condition causes a rosy skin to be seen through the nail due to the accumulation of blood in the vascular bed formed by capillaries and small-caliber veins.

The rupture of these small blood vessels causes the blood to escape from them and therefore its escape to the outside. However, unlike other parts of the body, in this case the blood does not flow visibly , but rather accumulates in the space between the nail and the bed on which it rests.

Collection of blood under the nail

The accumulation of blood in the subungual area causes a hematoma consequent with the coagulation of the extravasated blood, which makes a blackish or bluish spot visible through the nail plate , which corresponds to coagulated blood, that is, with the hematoma formed at this level.

The accumulation of blood under the nail causes increased pressure on nearby tissues. This increase in pressure will cause pain by excitation of the superficial nerve endings found in the skin. This circumstance causes the subungual hematoma to cause a very intense pain that makes the slightest friction at this level unbearable.

The greater the trauma received on the area, the greater the bruise produced.

What symptoms appear?

With regard to its symptoms, severe and throbbing pain usually appears, especially at the time of trauma.

The finger appears swollen or edematous and with the nail red or blue. The color of the nail changes to a dark black due to resorption of the hematoma.

In the initial stages, a more reddish coloration is seen through the nail that agrees with the color of the blood. Later, the blood coagulates and the stain that is observed under the nail changes towards bluish tones until it reaches a dark black. In this way, it is possible to find out if the trauma that caused the hematoma has occurred recently or if it is an old injury.

Subungual bruising pain

Obviously, the intense pain caused by the bruise makes it difficult to put on shoes, especially with a shoe that rubs on the front of the toes and that presses the nails on the toe.

As the hematoma is reabsorbed, the pain progressively diminishes.

If the trauma that caused the hematoma is very large, the hemorrhage produced can lift the nail from the bed and cause it to detach. This circumstance can cause the loss of the nail.

However, in a study carried out by Farrington it was observed that the loss of the nail occurred in 81% of the cases of subungual hematoma, which suggests that the fact of suffering a hematoma under the nail can cause the loss of the nail with relative ease.

Diagnosis of subungual hematoma

It is important to make a good differential diagnosis with other diseases that can cause the same symptoms as subungual hematoma, but which, on the contrary, are much more serious diseases and in which an early diagnosis is necessary, such as malignant melanoma. pigmented.

In the case of hematoma, it develops rapidly and has a uniformity in color with well-defined margins. It is always important to inquire about blows or trauma to the fingers . It is also important to associate it with the practice of certain sports or the use of narrow shoes that press on the tip of the foot.

In cases of doubt, it is best to curettage the lesion and biopsy it . It involves collecting a portion of the tissue that is under the nail and sending it to its study by an expert anatomo-pathologist, who will be in charge of analyzing the lesion to rule out any other larger problem.

Subungual hematoma treatment

The treatment consists of the evacuation of the accumulated blood under the nail.

This process can be performed with a needle, a lancet, the blade of a scalpel, or a micromotor with a fine point bur. In emergencies an office clip can be used to evacuate the blood accumulated under the nail, although it is an unprofessional action and should only be reserved for exceptional cases.

The evacuation process consists of making a hole in the nail plate until the blood accumulated under the nail is released. When the retained blood is removed, the patient feels an immediate relief of the symptoms, since the pressure exerted by the sequestered blood under the nail disappears and the problem of pressure on the nerve endings is solved.

If the hematoma has caused the lifting of the nail, the action of a Podiatrist is necessary to evaluate it and proceed to the appropriate treatment that will consist of removing the portion of the detached nail, evacuation of the hematoma and disinfection of the area to avoid the appearance of infections at this level.

How can I avoid these bruises?

The prevention of subungual hematoma should be aimed at the prevention of those activities or circumstances that favor the rubbing of the toes with the toe of the shoe. In this way we must:

Go to a professional who guides us about the footwear that we should use for the practice of certain sports, such as long-distance runners, footballers, tennis players, etc. It is necessary to know the exact measurement of the foot , to wear a sports shoe long enough to allow the blows that the tip of the foot receives, especially in braking movements.

If sports such as soccer are practiced, it is mandatory to use special boots for this sport that have a reinforcement on the toe that prevents injury to the finger when hitting the ball. It is important to wear a shoe of our size, which does not fit excessively to the forefoot, and which allows at least a half-centimeter space between the longest toe and the toe of the shoe.

Wear safety footwear at work

It is important to use safety footwear in the performance of those jobs that have the risk of falls from blunt objects or blows to the feet. There are safety boots that have a metal toe cap to prevent these accidents .

Avoid wearing pointed toe shoes, especially if you suffer from blood clotting diseases or take blood-thinning medications.

Go to the podiatrist if:

• Observe that a toenail has turned blue or black to find out the origin of that coloration. If I have received a blow to the finger, and the nail has changed color.
• If the nail has changed color and I have severe pain that does not allow me to put on shoes.
• If I have received a blow to the toe and the nail has come off .
• When it is necessary to evacuate the blood retained under the nail.
• If I have any problem with the appearance or growth of my nails .
• If I am going to do a sports practice on a regular basis so that I can be guided about the sports shoes that I should use.
• If I am taking anticoagulants or suffer from a clotting disease, to prescribe the safest footwear for my problem.