Article: Consider whether your toe was recently injured in some way. Injury to the nail bed can cause blood to accumulate under the nail, creating a black or dark brown discoloration. This is called a subungual hematoma. You may also experience symptoms such as a feeling of pain or pressure under the nail.  In some cases, it may be obvious that your black toenail was caused by an injury—for example, you may have dropped something on your foot or stubbed your toe. Black toenails can also develop gradually from repeated injury, such as pressure from overly tight shoes or trauma to the toes caused by frequent running, hiking, or sports. If your hematoma is minor and not causing you a lot of pain, you can likely manage it at home without medical help. Use Rest, Ice, Compression and Elevation (RICE) immediately after an injury to minimize swelling and pain and encourage your toenail to heal:  Rest: Rest the nail by minimizing the use of the injured foot as much as you can. For example, avoid running or hiking for a couple of weeks after the injury. Ice: Put an ice pack wrapped in cloth or plastic wrap on the injured toe to numb the pain and reduce swelling. You can safely use an ice pack up to once an hour, for 20-30 minutes at a time.  Compress: Apply gentle pressure by wrapping a bandage around the injured toe. This can help minimize the amount of blood that pools under your nail. Elevation: Reduce swelling by elevating your foot above the level of your heart as much as possible. For example, you might lie down on your couch with your foot resting on the arm rest or lie in bed with your foot propped on a pair of pillows. If your black toenail is painful, try an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin), naproxen (Aleve), or acetaminophen (Tylenol). This can relieve your pain and reduce swelling and inflammation. Ask your doctor before using aspirin or products containing aspirin, since these could make any bleeding under the nail worse. In some cases, home treatment for a subungual hematoma may not be enough. Make an appointment with your doctor if you have symptoms such as severe or unbearable pain, uncontrollable bleeding from the injured area, a deep cut to the toe or nail, or damage to the base of the nail.  The doctor may make a small puncture in your toenail with a laser or a needle to allow blood and other fluids to drain from under the nail. If the injury to the nail is severe or there are signs of infection, they may need to remove the nail altogether. If you are caring for a baby or small child with an injured toenail, take them to the doctor right away instead of trying to treat it yourself. Look for symptoms such as pus or other fluids seeping out from under the nail, increasing pain or swelling, redness around the injured nail, red streaks in your skin around the nail, or fever. The area around the nail may also feel hot to the touch. If you notice any of these symptoms, call your doctor or go to the emergency room immediately. Your nail may be more prone to infection if the toenail begins to come off, which is common with severe subungual hematomas. After the initial injury, your toenail will need time and TLC to recover completely. Wear closed-toed shoes with plenty of space around the toes to keep your injured toe from getting bumped or squeezed. You can also keep your toe safe and healthy by:  Keeping the nail clean, trimmed, and free of polish while it heals. Nail polish or false nails can slow down the healing process and make it harder to spot signs of infection or injury. Wearing comfortable, well-fitting shoes, especially while running. If you run, use shoes that are ½ a size larger than your regular shoes, and lace them tightly so they don’t slip around on your feet. Wearing thick, moisture-wicking socks to keep your feet dry and cushioned. Putting protective toe caps or tape on the affected toe(s) while running or hiking. The discoloration in your nail will not disappear until the old toenail has grown out all the way. For most people, this process takes around 6 to 9 months.  Even if your doctor does not end up surgically removing the nail, there’s a chance it will come off on its own. Typically, a new nail will grow in after several months. If your nail bed was severely damaged, there’s a chance that the nail will not grow back or that it will grow back incorrectly.
What is a summary of what this article is about?
Look for signs of toenail injury. Use the RICE protocol to treat your nail at home. Take over-the-counter pain relievers to manage pain. See your doctor if you have severe symptoms. Get immediate medical help if you see signs of infection. Protect your nail from further injury as it heals. Allow several months for the injury to heal completely.