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I can see a dark area beneath the second toenail, which may be a small subungual hematoma (blood trapped under the nail), often after bumping or pressure from footwear.
What would you like help with: whether it needs treatment, how to care for it, or whether it could be something else?
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subungual hematoma
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subungual hematoma management when to seek medical care authoritative
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https://www.healthwise.net/osumychart/Content/StdDocument.as…
Finding Sources
The dark patch under the second toenail most looks like a small subungual hematoma: a bruise or trapped blood beneath the nail, commonly from stubbing the toe, a dropped object, or repeated shoe pressure. In the photo it appears limited in size, and I do not see obvious pus, marked redness, or major swelling around the nail.
What to do now
- If it is not very painful and the nail is intact, it will usually heal without a procedure.
- Rest the foot, wear roomy shoes, elevate it when possible, and use a wrapped cold pack for 10 to 20 minutes at a time during the first day or two.
- For pain, use acetaminophen or ibuprofen only if you normally can take them safely and follow the product label.
- Keep the nail clean and dry. Do not try to pierce, burn, or drill the nail yourself. This can cause infection or nail-bed injury.
- The dark spot should gradually move forward as the nail grows. A toenail can take many months to fully grow out.
See urgent care soon, ideally within 24 to 48 hours, if
- Pain is severe, throbbing, or worsening.
- The dark blood covers about half or more of the nail.
- The nail is split, loose, lifted, bleeding around the edges, or there is a cut near the nail.
- You cannot walk normally, the toe looks crooked, or there was a heavy crush injury, since an X-ray may be needed to assess for fracture.
- You have diabetes, poor circulation, reduced sensation, or immune suppression.
A clinician can release pressure by making a small sterile opening in the nail when appropriate. It works best early, before the blood clots. Emergency-medicine guidance notes that acute, painful hematomas with intact nail folds can be treated this way, while a damaged or lifted nail may need assessment for nail-bed injury. Roberts and Hedges’ Clinical Procedures in Emergency, Subungual Hematoma section.
Get medical care promptly for infection signs
Increasing warmth, redness, swelling, pus, red streaks, fever, or pain that is increasing rather than settling should be assessed. Post-injury care guidance lists these as reasons to seek care.
When it may be something other than a bruise
Arrange a GP or dermatologist review if you do not recall any injury, the pigmentation does not move outward with nail growth over the next several weeks, it becomes a widening irregular brown-black band, pigment spreads onto the surrounding skin or nail fold, or the nail progressively lifts or deforms. Those features need evaluation to rule out uncommon causes such as nail-unit melanoma.
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