Subungual Hematoma Treatment Guide 2026 | DPM

Quick answer: Treatment for subungual hematoma treatment follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

A subungual hematoma — pooled blood under the toenail — is one of the most painful and dramatic-looking nail injuries, but also one of the most straightforward to treat. Here’s everything you need to know. What it looks like: Dark red, maroon, purple, or black discoloration under part or all of the nail plate. The discoloration typically appears within minutes to hours of injury. It may be associated with significant throbbing pain from the pressure of blood beneath the rigid nail plate. The nail itself is intact — the blood is under it, not through it. When to drain it (trephination): Small, painless hematomas (under 25-50% of the nail area) don’t need drainage — they’ll resorb over weeks as the nail grows. Large, painful hematomas — especially those causing throbbing pain that makes sleep or normal activity difficult — benefit significantly from trephination (draining through the nail). The procedure: a heated wire or small drill creates a tiny hole in the nail directly over the hematoma. The blood drains immediately, and pain relief is rapid and dramatic. This is a minor in-office procedure done under topical anesthetic — takes less than 5 minutes. Will the nail fall off? Large hematomas often cause the nail to separate from the nail bed (onycholysis) and eventually fall off over 2-4 months as new nail grows. This is normal and expected — the new nail is growing underneath. Don’t pull the nail off forcibly — let it detach naturally. Is it always from trauma? Black discoloration that appeared without injury, a dark stripe running from the base of the nail, or pigment spreading to the surrounding skin should be evaluated for subungual melanoma. When in doubt, see a podiatrist. See our black toenail guide for the full differential. Home care: Ice and elevation for first 24 hours. OTC pain relievers (ibuprofen or naproxen). Protect the nail with a bandage. Monitor for signs of infection (increasing pain after 24 hours, redness spreading to surrounding skin, pus) — rare but possible if the nail bed was lacerated. Same-day appointments. (810) 206-1402 | Book online

When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics

About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your subungual hematoma treatment, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.