Subfoot hematoma on a finger and toe

Minor injuries at home and at work are considered an everyday occurrence. Sometimes we simply do not notice them, and are very surprised to find bruises and scratches on the body. But if it concerns the nail area on the fingers or toes, such injuries do not go unnoticed, because they are accompanied by severe pain and the appearance of a strange dark spot hidden under the nail plate and causing noticeable discomfort. This is a subungual hematoma, often accompanying severe mechanical injuries to the fingers. And today we will talk about how to treat such injuries.

Causes subfoot hematoma

No matter how frightening a dark spot under the nail may look, there is nothing unusual about its appearance. Damaging mechanical impact on soft tissues is accompanied by rupture of vessels inside them, and a bluish or brown spot is just a result of hemorrhage. In other words, a subungual hematoma is nothing more than an accumulation of blood in the space between the nail bed and the nail plate.

It is difficult to say where hematomas under the nails most often appear: on the hands or on the feet. In principle, both the lower and upper limbs are equally susceptible to injury. For example, a bruise under the nail of one of the fingers can be caused by a strong blow to it or pinching of the distal phalanx by a door.

Pinching of toes is unlikely. However, it is quite possible that a heavy object falls on the foot or a toe (usually a thumb) hits something hard.

It is quite easy to damage a toenail when walking barefoot, simply by hitting it hard on the ground or an object lying on the ground (for example, a stone). An identical situation is observed when playing football. Inappropriate footwear or its absence can become a very unexpected cause of a subungual hematoma on the big toe.

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Risk factors

Risk factors for the formation of a bruise under the nail can also include:

• wearing uncomfortable or tight shoes that squeeze the toes in the nail plate area,
• taking anticoagulants and other medications that reduce blood clotting and can cause minor hemorrhages,
• diseases characterized by low blood viscosity and a tendency to bleeding,
• increased fragility of blood vessels, as a result of which even minor trauma can be accompanied by rupture of blood vessels and hemorrhages.
• decreased sensitivity of the lower extremities, associated, for example, with the development of polyneuropathy against the background of diabetes mellitus (such patients may wear tight shoes and not feel pressure on the toes, leading to the development of hematomas under the nails),
• disproportionately long length of one of the toes, which leads to strong pressure on it from the shoe (for example, in Martynov's disease, the second toe on the foot is excessively long, so it is understandably more susceptible to injury than others).

You can get a nail injury both at home and at work. Such an injury is always accompanied by a certain discomfort, and sometimes can even have unpleasant consequences, so it is important to take the issue of its diagnosis and treatment carefully and seriously.

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Symptoms subfoot hematoma

As we have already said, if a bruise on the body can appear unnoticed even from a light blow or compression of soft tissues, then the appearance of a subungual hematoma is preceded by a strong mechanical impact on the nail plate and soft tissues of the fingers. It is simply impossible not to notice such an impact, another matter is how to react to it.

The first signs of injury accompanied by the appearance of a subungual hematoma are considered to be:

• sharp and severe pain at the site of the injury, which has a pulsating character and is often accompanied by a feeling of distension
• redness of the tissues under the nail plate,
• deterioration of finger function due to pain or bone damage.

The following may be observed:

• short-term loss of sensitivity in the finger (in case of severe injury, numbness may also persist for a long time),

• swelling of the tissues of the injured finger, as a result of which it increases somewhat in size,
• a change in the color of the spot under the nail from reddish to bluish, burgundy, dark brown and even purple-black (it all depends on the force of the blow and the amount of blood that flows under the nail plate),
• In some cases, complete or partial separation of the nail from the nail bed and its deformation are observed.

As for the pain, after a blow it is stronger than after wearing and removing tight shoes, but in the latter case the pain can be felt for a longer period of time, especially when putting pressure on the toe.

Complications and consequences

A careless attitude towards household injuries, which is observed everywhere, unfortunately, can have its unpleasant consequences. Well, you hurt your finger, a dark spot appeared on it, is this a reason to immediately run to the doctor if it will gradually disappear on its own as the nail grows? This is exactly what many of us think, not suspecting possible complications.

Perhaps the bruise itself does not pose a particular danger. But deformation of the nail plate (usually its splitting) or its detachment can cause frequent injury to the nail and discomfort when walking if the nail of the big toe is damaged.

We will not touch upon the topic of the cosmetic unsightliness of a nail defect, because such injuries can have more unpleasant consequences in the form of infection under the nail. Bacteria, having got under the nail plate, begin to actively multiply, causing inflammation and suppuration of tissues, and this already threatens, if not blood poisoning, then the loss of the nail and serious treatment with the use of local (and in the case of septic lesions and systemic) antibiotics.

By the way, there is also a risk of infection with an incorrect approach to treating a hematoma. Blood usually accumulates under the nail plate, and the more blood there is, the more unpleasant the sensations caused by the pressure of the blood on various tissues of the finger. If the blood is removed, the patient feels much better. But if the nail does not peel off, the blood can only be removed from under it by puncturing the nail plate. By making a puncture yourself with improvised means without proper treatment of the instrument and the surface of the nail, you can very easily introduce an infection inside, and instead of blood, pus will begin to accumulate under the nail.

Inaction after a finger injury also poses a certain danger. By ignoring the pain and the appearance of a bruise under the nail, a person can simply ignore a more serious problem - a fracture of the distal phalanx bone or damage to its joint. Such injuries, in turn, can lead to impaired finger mobility.

There is another important point. A more dangerous disease may be hidden under the guise of a hematoma – melanoma or skin cancer, the treatment of which should be started at the early stages of the process. And the sooner, the better, because melanoma has a tendency to rapid growth and spread of metastases.

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Diagnostics subfoot hematoma

Having dropped something heavy on our finger, crushed it with a door or simply hit it hard, we usually don’t rush to see a doctor. In some cases, this is even justified. For example, a small subungual hematoma that has arisen as a result of an injury and covers less than 25% of the nail surface is unlikely to require specialist intervention. Such bruises disappear on their own, moving upward as the nail grows.

In what cases should you consult a doctor for advice and first aid:

• if the dark spot under the nail (regardless of its size) did not appear as a result of injury and is not accompanied by pain,
• if severe pain after an injury does not go away after 24 hours,
• if the hematoma is large, that is, its area is larger than a quarter of the nail, which indicates a significant amount of blood accumulated under the nail plate,
• if the injury is accompanied by severe pain (sharp pain, increasing with the slightest load on the finger and when walking, may indicate a bone fracture), sometimes in this case even a slight crunching sound is observed when the bones touch.

A traumatologist diagnoses finger damage with the formation of a nail hematoma and, if necessary, refers the patient to other specialists, such as a surgeon, dermatologist or dermato-oncologist.

The examination begins with a physical examination and anamnesis. The doctor will ask the patient whether there was a recent episode of finger injury, the nature of the injury and its symptoms. If there is no acute pain and the finger is mobile, it is a common bruise with the development of a hematoma. Otherwise, there is a suspicion of a fracture of the bones of the distal phalanx or an intra-articular fracture.

If a finger fracture is suspected, the patient is sent for an X-ray examination.

Differential diagnosis

The cause of a dark spot under the nail is not always an injury. Some people have such spots from birth. The thing is that moles (nevi) can be localized anywhere on the skin, including the nail bed. A subungual nevus has a certain similarity to a hematoma that occurs as a result of a nail injury.

The danger of any moles is that under the influence of negative factors (for example, injury to a nevus) they can degenerate into a malignant neoplasm - melanoma. It turns out that an injury to the nail can cause pathological processes in the pigmented skin underneath it, resulting in malignancy of cells, and they will begin to divide uncontrollably, causing tumor growth and the spread of the process inside the body.

This is a very dangerous situation, requiring consultation with an oncologist and surgical treatment. The incidence of subungual melanoma is about 3-4% of all cancers.

If melanoma of the nail is suspected, the patient is sent for dermatoscopy - an examination that allows one to examine the condition of the tissues under the nail. To confirm the diagnosis of skin cancer, a tissue biopsy in the affected area is additionally prescribed. Histological examination of the material taken during the biopsy is considered the most accurate analysis, on the basis of which the final diagnosis is made.

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Treatment subfoot hematoma

If there was a minor injury to the nail, as a result of which a small hemorrhage occurred under it, the treatment will consist only of reducing the intensity of the pain syndrome. For this purpose, you can use ice cubes or frozen products in a package. The cold is applied to the site of the injury, thereby relieving pain and swelling. It is advisable to apply ice every half hour for 3-5 minutes until the pain subsides.

If the pain is strong enough, you can take painkillers: analgesics or non-steroidal anti-inflammatory drugs that are in your home medicine cabinet. This could be "Analgin", "Tempalgin", "Ibuprofen", "Nimid", and for severe pain "Ketorolac" or "Ketanov".

Additionally, as an absolutely safe painkiller and anti-inflammatory agent, you can take a decoction made from the herb and flowers of St. John's wort. It is recommended to drink the medicinal composition several times a day, little by little, at intervals of 3 hours. You should not expect a quick result from a natural medicine, but after a couple of days you can observe a noticeable reduction in pain.

As an option, they suggest applying a fresh leaf or gruel of white cabbage to the sore finger. It must be said that the effectiveness of this recipe remains in doubt. Although an uncomplicated subungual hematoma is an excellent reason to test it.

The same can be said about softening the nail plate in order to remove dried blood using a hot solution of potassium permanganate, which should have a rich cherry color. It is assumed that the desired effect can be achieved by dipping the injured finger in hot (as hot as you can stand it without getting burned) water for a quarter of an hour.

This recipe is recommended only if the injury was earlier, the pain has passed, leaving only a bruise under the nail.

Usually, first aid is enough to make the pain and inflammation subside. If the unpleasant sensations do not go away within 24 hours, there is pressure and discomfort in the nail area, indicating a strong bruise, you should definitely seek help from a specialist doctor. The help of a specialist may also be needed if the nail plate has separated from the skin as a result of injury or if it has broken. The doctor will examine the wound and prescribe the appropriate treatment.

If blood accumulation is observed under an intact nail plate, the doctor will perform a drainage operation to remove it. The essence of the operation is to puncture the nail and extract the accumulated blood from under it, which brings patients noticeable relief and prevents the nail from peeling off.

Puncture of a subungual hematoma is not a painful procedure, because the nail plate itself has no nerve endings, and blood removal does not require damage to the integrity of soft tissues. However, some people psychologically prepare themselves for pain, begin to worry, and make sudden movements. To avoid this, the doctor may suggest local anesthesia with lidocaine. In other cases, the puncture site is irrigated with an anesthetic solution.

After preliminary treatment of the nail plate with an antiseptic, drainage begins. The procedure for extracting blood from under the nail can be carried out in two ways:

• the puncture is made using a fairly thick medical needle, screwing it into the nail plate as in the case of a drill,
• The nail plate at the site of the hematoma is burned with a special device - a thermal cautery.

Blood begins to flow out through the hole that has formed. To speed up this process a little, lightly press on the nail plate. Next, a napkin soaked in antiseptic is applied to the finger, which is fixed with a bandage. Since blood can ooze from the hole in the nail for a day or more, the bandage should be changed periodically (at least once a day).

A prerequisite for the success of this procedure is sterility, because infection at the puncture site will provoke the development of a purulent process under the nail plate, the treatment of which may require its removal. A solution of hydrogen peroxide is usually used as an antiseptic. If it is not available, you can use other excellent antiseptics: an alcohol solution of iodine, an aqueous solution of potassium permanganate or furacilin. The use of the drug "Chlorhexidine" with a pronounced antibacterial effect is indicative. It is customary to treat not only wounds, but also hands and surgical instruments before and after surgery.

On the Internet, you can find a description of nail drainage at home using a paper clip, which needs to be heated over a fire, and then pierced with it to extract blood. Before the procedure, it is recommended to lubricate the surface of the nail with iodine, and after removing the drainage and blood - with hydrogen peroxide and apply a bandage soaked in the same solution.

In theory, if the operation is performed under conditions of good disinfection of the paper clip and the nail, infection should not occur. However, such self-treatment often has sad results. Patients have to see a doctor because the nail is already suppurating.

In the case of very large hematomas covering a large part of the nail, as well as when spontaneous detachment of the nail plate is observed, doctors often resort to surgical treatment - removal of the nail followed by treatment of the tissues underneath it.

Treatment involves removing accumulated blood, treating the cavity with an antiseptic, and applying an aseptic dressing to prevent infection from entering the open wound.

In some cases, not the entire nail is excised, but only the deformed, exfoliated part, which may subsequently be subject to repeated injury.

Surgical removal of the nail may also be necessary if a purulent-inflammatory process has begun under the nail plate. In this case, the wound is washed, treated with an antiseptic, and then one of the antibacterial ointments effective for such injuries is applied on top (tetracycline, syntomycin, erythromycin, etc.). An aseptic bandage must be applied on top. The wound must be treated and bandaged daily.

In case of severe injuries, if the nail has peeled off on its own and had to be removed, doctors can apply sutures at the site of tissue damage using self-absorbable materials. A follow-up appointment with an examination of the sutures can be scheduled for 3-4 days after the injury.

At the doctor's request, the stitches will have to be washed with soap and water at home and antibiotic ointments will have to be applied to them, after all, any wound is the path of least resistance for the penetration of pathogenic microorganisms that cause purulent-inflammatory processes.

Prevention

You can avoid the appearance of subungual hematoma due to regular compression of the toes by choosing shoes that are appropriate in size and shape. During training and playing football, it is recommended to use special sports shoes with a sufficient degree of protection of the toes from impact. Special shoes should also be worn by workers in construction professions, because they usually have a higher risk of foot injury.

When lifting excessively heavy loads, do not forget about the danger of dropping them on your foot. You need to learn to correctly calculate your strength.

Let's not forget about our fingers, which, due to our inattention and carelessness, so often end up in the sharply narrowing doorway. Small children, who do not yet understand the full danger of the doorway, are especially often affected. Parents are often to blame for children's injuries, as they close the door to their apartment or car, not paying attention to the location of the hands of children who are nearby. Attention and caution will help prevent such injuries.

If the injury could not be avoided, urgent application of ice to the site of injury will help reduce the severity of its symptoms and possibly avoid the appearance of a subungual hematoma. This five-minute treatment is recommended to be carried out every half hour, observing the sensations and changes in the injured limb. The absence of symptom relief within 24 hours is in any case a sure reason to visit a medical facility.

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Forecast

Subungual hematoma is a rather unpleasant phenomenon, but its prognosis is considered favorable in most cases. If the treatment is carried out competently, complications do not arise and in a short time the person forgets about the finger injury that took place. Although the hematoma itself in the form of a dark spot will remind about the incident for a long time until the nail grows enough and is cut in the dark area.

The prognosis worsens if the injury damaged bones and soft tissues or if a purulent process developed at the site of the hematoma. In this case, the growing nail may have an irregular shape and various defects. An untreated fracture can negatively affect the functionality of the finger. Pain and displacement of bones can impair mobility and change the shape of the damaged phalanx or joint.

A dual prognosis can also be given to melanoma disguised as a hematoma. If the malignant process is detected in time at the early stages, the chances of forgetting about the disease for a long time are about 70-100% percent, depending on the size of the neoplasm. Detection of skin cancer at late stages reduces the percentage of survival after treatment to 30-50%.

But let's return to our hematoma, received as a result of trauma. If its cause is precisely traumatic damage to the nail and tissues under it, prevention of this condition can be considered the prevention of domestic and industrial injuries. First of all, this is caution and accuracy.

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