Toenail Trauma & Black Nail Michigan 2026

Quick answer:A black nail after toenail trauma is usually blood trapped under the nail, which grows out over months. Our Michigan podiatrists can relieve severe pressure, check for a fracture, and make sure a dark nail that appeared without injury is not something more serious. Book online, or call (810) 206-1402.

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.

A black toenail — medically a subungual hematoma — develops when blood accumulates under the toenail following trauma or repetitive pressure. It is one of the most common foot conditions seen in runners, hikers, and anyone who has stubbed a toe or dropped an object on the foot. While most subungual hematomas are painful but benign, certain presentations warrant professional evaluation to rule out underlying fracture, nail bed laceration, or — rarely — subungual melanoma (a dark pigmented lesion under the nail that requires biopsy). At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki evaluates nail trauma promptly and provides appropriate treatment ranging from simple trephination (pressure relief) to nail bed repair.

Causes

Acute subungual hematoma typically results from blunt trauma — a dropped object, a stubbed toe, or a crush injury. The nail bed bleeds beneath the nail plate, creating a painful, pressurized dark red to black discoloration. Runner’s toe (also called “jogger’s toe” or “tennis toe”) is a chronic form caused by repetitive microtrauma — the longest toe repeatedly striking the front of the shoe during downhill running or prolonged athletic activity. This typically affects the first or second toe, depending on which is longest. Tight or improperly fitted athletic footwear is a primary contributing factor. Unlike acute trauma, runner’s toe develops gradually and may not be painful.

When to See a Doctor

Seek evaluation for a black toenail when: the pain is severe and limiting weight-bearing; the injury involved significant force (possible underlying phalanx fracture); the dark pigmentation appears streaky or irregular (melanonychia striata — may indicate subungual melanoma rather than hematoma); the discoloration does not grow out with the nail over 2–3 months; you have diabetes or peripheral vascular disease (any nail trauma can become a wound complication in high-risk patients); or the nail is partially detached, contaminated with debris, or shows signs of infection. An X-ray at the time of injury is recommended to rule out distal phalanx fracture whenever significant trauma is the mechanism.

Treatment

For a painful acute subungual hematoma, trephination provides immediate relief — a small hole is made through the nail plate (using a heated electrocautery device or a needle rotated through the nail) to allow the pressurized blood to drain, instantly relieving the throbbing pain. This is a painless in-office procedure done within 24–48 hours of injury when the hematoma is still liquid. After trephination, the nail is protected with a dressing. The nail typically remains attached and grows out normally over 3–6 months. When the hematoma involves more than 50% of the nail plate or is associated with nail plate avulsion (the nail has been torn away), the nail bed may have a laceration requiring repair — the nail is removed, the nail bed sutured, and the nail replaced as a biological dressing. For runner’s toe, treatment focuses on footwear modification — ensuring adequate toe box depth (at least 12mm) and leaving a thumb’s width of space between the longest toe and the front of the shoe.

Frequently Asked Questions

Black toenail from running or injury? Get it evaluated to ensure there’s nothing more going on. Contact Balance Foot & Ankle for same-week evaluation with Dr. Biernacki in Southeast Michigan.

Visit Balance Foot & Ankle — Same-Day Appointments Available

Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Township. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.

Related Care at Balance Foot & Ankle

Clinical toenail services at our Howell and Bloomfield Township offices.

Ingrown Toenail TreatmentToenail MatrixectomyMedical Pedicure

When a nail injury is more than a nail injury. Crush injuries can fracture the bone underneath, and a nail bed laceration may need repair. If the toe is deformed, you cannot bear weight, or bleeding will not stop, see our guide to finding an emergency podiatrist — and which injuries belong in an emergency room.