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Foot & Ankle

Common Toenail Injuries in Athletes

Also note this is using a needle, its often easier with electrocautery.

J
John Kiel
Sports Medicine Physician ยท February 27, 2022 ยท 3 min read

Overview

Demonstration of subungual hematoma trephination. Note the drop of blood after the procedure. Also note this is using a needle, its often easier with electrocautery.

Symptoms

Subungual Hematoma Subungual hematomas are painful hematomas that occur under the toenail following trauma. Typically this trauma is acute such as stubbing a toe, but can also occur in endurance events as well. Around 1/3 of subungual hematomas will have associated nailbed lacerations or fractures. The exam is typically pretty straight forward and will reveal red-purple discoloration under the nail. During the evaluation, the key is to identify any fractures or lacerations as that can change management.

Treatment Options

Uncomplicated cases can be managed with nailbed trephination alone. Nail removal for large hematomas (>50% of nail surface area) to evaluate for lacerations is discussed in the literature but is considered controversial. Most athletes do very well and can return to play quickly if the hematoma is uncomplicated. The most common complications are poor nailbed cosmesis and onycholysis (removal of the nail plate from the nail bed). Read More : https://wikism.org/Subungual_Hematoma Subungual Exostosis Clinical example of subungual exostosis.

When to See a Doctor

If you are experiencing symptoms that may be related to common toenail injuries in athletes, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.

*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*

Foot & Ankle
J
John Kiel
Sports Medicine Physician
Sports Medicine Review contributor

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