Toenail Trauma: Black Nails, Lost Nails, and What to Do About Them

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

Toenail Trauma: Common, Usually Benign, but Not Always Simple

Toenail injuries — black discoloration from subungual hematoma, nail separation, and nail loss — are among the most common foot conditions in athletes and active people. They range from benign inconveniences that resolve without treatment to occasionally serious injuries requiring professional evaluation. Understanding which nail injuries need care and which can be managed at home avoids both unnecessary concern and missed conditions. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we see toenail trauma regularly and provide evidence-based guidance on management.

Subungual Hematoma: The Black Toenail

Blood under the toenail (subungual hematoma) produces the characteristic black discoloration familiar to runners and hikers. The blood collects between the nail plate and nail bed after direct impact (dropping something on the toe), repetitive impact (toe hitting the shoe box on long downhill runs), or crush injury. Small hematomas (under 25% of the nail) with manageable pain can be observed — the blood will gradually be incorporated as the nail grows out over 6-9 months. Large hematomas with significant pressure pain benefit from nail trephination — draining the hematoma through a small hole in the nail plate using a heated needle or electric cautery instrument. This immediately relieves pressure pain and is painless (the procedure is on the nail, not the skin). The underlying nail bed must be inspected if the nail is loose or if significant trauma occurred — nail bed lacerations require repair to prevent permanent nail deformity.

Nail Loss and Nail Avulsion

Complete nail loss — from trauma or from a black toenail growing out entirely — is alarming but not dangerous in otherwise healthy individuals. The nail bed underlying the lost nail is pink, sensitive, and requires protection from friction and direct pressure. Cover the exposed nail bed with a non-adherent sterile dressing changed daily until the new nail grows in far enough to protect the bed (typically 4-8 weeks). The new nail grows at approximately 1mm per month for the great toenail — full regrowth takes 9-12 months. The new nail may grow in with a ridge or slight abnormality from nail bed disruption during the injury — this often improves but may be permanent if the nail matrix was significantly damaged.

When Toenail Trauma Needs Professional Evaluation

Seek professional evaluation for: nail trauma with significant crush injury (fracture of the distal phalanx underlying the nail may be present), any nail injury in a diabetic patient (even minor nail bed injuries require professional wound care to prevent infection), nail bed lacerations visible beneath a partially detached nail (require repair to prevent permanent nail deformity), signs of infection (increasing redness, swelling, pus) developing after nail trauma, and completely avulsed nails in patients on blood thinners or with bleeding disorders. Contact Balance Foot & Ankle at (810) 206-1402 for toenail trauma evaluation and treatment, including nail trephination for painful hematomas and nail bed repair when needed.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Toenail Trauma

Toenail injuries from sports, dropped objects, or repetitive pressure can cause black nails, nail loss, and subungual hematomas. At Balance Foot & Ankle, Dr. Tom Biernacki provides nail trephination for painful blood under the nail, nail avulsion when needed, and guidance for healthy nail regrowth.

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Clinical References

1. Jellad A, Bouaziz MA, Boudokhane S, et al. Jogger toenail: prevalence and prevention. J Sports Med Phys Fitness. 2019;59(8):1375-1380.
2. Richert B, Andre J. Nail disorders in children: diagnosis and management. Am J Clin Dermatol. 2011;12(2):101-112.
3. Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg Am. 1999;24(6):1166-1170.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.