That title is way funnier in an English accent, and not just any accent, it has to be working class London ala Eliza Doolitle before she became a Fair Lady. The topic, however is not so funny: the so called subungual hematoma, or bruised toenail, commonly seen in runners, athletes, and those who are forced to walk defensively through the mean streets of Manhattan, New York. It is a rather common occurrence that comes stumbling into my NYC podiatry office and is the topic of this week’s action packed and mesmerizing blog post.
So what’s going on with these bruised toenails anyway?
The toenail is a unit of the skin, and serves to protect the tips of our toes, or perhaps they are a vestigial remainder of the talons that we all once used to crawl through the primordial muck. The skin under the toenail is both delicate and vascular, meaning there is a very good blood supply. These two factors, coupled with the fact that our nails are subject to trauma from external sources, including other peoples’ shoes, repetitive stress of running, or the blunt trauma of a heavy object, create a an ideal environment for a bruise to occur. A relatively minor trauma can lead to bleeding within the nail bed, and the blood collects under the nail. In fact, many of my patients who present with bruising under the nail are unable to recall any instance of recent trauma to their toe. Since the blood is external to the skin, it will remain sandwiched between the nail and the skin until the nail grows out, usually within 6-9 months.
Any treatment necessary, oh NYC Foot Doc?
Well, if the bruise encompasses a small area of the nail bed, no treatment is necessary. If there is significant trauma with a lot of bleeding and pain, the nail can be drained by inserting a small needle into the nail plate, which generally provides immediate relief. If that doesn’t work, it may indicate the presence of a cut within the nail bed itself, which would necessitate the removal of the nail and placement of a few dissolving sutures in the nail bed. And just as a parenthetical note, I’m not sure what it is about the idea of a nail plate that is detached from the skin that evokes a gross out reaction more than just about anything else witnessed in my NYC podiatry office, but the phenomenon is quite real.
So if you just finished a marathon and your toe pulses to the beating of your heart, you may need the expert care of your NYC podiatrist to “nail” your pain.
See you in the office.
Dr. Ernest L. Isaacson