ZocdocAnswersMy toenail is purple and bruised, should I go to an ER?

Question

My toenail is purple and bruised, should I go to an ER?

Monday my great toe was smashed by a wheelchair lift on a school bus when I was unloading my patient. First appearance was purple half way up my toe nail and around the cuticle. I did nothing for it until I got home. I used a sterilized needle and poked a hole in the nail to relieve pressure because it was throbbing pain. Next day the whole toe nail was purple and there was bruising at the tip of the toe and some swelling. Today the right side of the toe is swelled so much the the nail is lifting out of the nail bed. It's still purple, very red around the swelled area. When I apply pressure to the swelled area I can feel that there's a lot of fluid behind it. Still a good amount of pain present. The toe nail is intact to the nail bed.

Answer

Based on your description, it sounds like you may have a subungual hematoma, which means a 'blood blister' underneath your nail. This can represent an underlying break of the bone or, at the very least, an injury to the underlying nail bed. In either case, you should be evaluated by a physician to treat the underlying nail bed injury and potentially treat the underlying fracture. While your injury may not require surgery, it may at the very least require removal of the nail with stitches to the nail bed. The hematoma (or blood blister) occurs due to the injury, and can continue to expand, causing pain and discomfort. another key point here to note is that you should never try to decompress these on your own. No matter how sterile you think you are doing this, the chance and likelihood of infection is high, which would obviously complicate matters. I think that you had the right idea, which is that a blood blister under the toenail needs to be decompressed. However, this should always be done in sterile fashion by a trained clinician. My recommendation to you would be to consult your physician for possible nail removal with repair of your nail bed injury. You will also need formal x-rays of the foot to evaluate for any underlying fracture.

This answer is for general informational purposes only and is not a substitute for professional medical advice.

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