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. If your shoes are slightly too small, you can stretch them at home to make them more comfortable. A black toenail is common in runners, ballerinas, and soccer players.
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 (if you don’t have an ice pack on hand, you can make one at home. You can safely use an ice pack up to once an hour, for 20 to 30 minutes at a time. [3] X Research source 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.
Ask your doctor before using aspirin or products containing aspirin, since these could make any bleeding under the nail worse.
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.
Your nail may be more prone to infection if the toenail begins to come off, which is common with severe subungual hematomas.
Keeping the nail clean, trimming your toenails regularly, and avoiding nail polish while your toe 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 choosing running shoes. Wearing 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. To use toe caps, slide the cap onto the affected nail before putting on a sock. To use toe tape, wrap your affected toe with tape securely before putting on your socks.
Thickening or warping of the nail Whitish or yellowish-brown discoloration Crumbling or brittleness of the nail An unpleasant odor
Your doctor may take some clippings from the nail or collect debris from under the nail with a scraper for lab testing. Tell your doctor about any symptoms you are having, as well as medications you are using or other health issues you may be dealing with.
These treatments may be more effective if you thin and soften the nail before applying the medication. Trim the affected nail and gently file down any thickened spots, taking care not to file through the nail. You can also help the medication penetrate deeper by applying a urea-based cream to the nail first, such as Urea 40+.
Commonly prescribed topical medications include amorolfine, ciclopirox, Efinaconazole, and Tavaborole. Some antifungal ointments may need to be applied daily, while others are only applied once a week. You will probably need several weeks of treatment for the medication to be effective. Some antifungal medications take the form of a medicated nail polish (Penlac) that is applied daily to the affected nail. [12] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source
You may need to take these medications for 6 to 12 weeks before the infection is eliminated. It can also take several months for the damaged nail to grow out completely, so don’t be discouraged if you don’t see an obvious improvement right away. Oral antifungal medications may cause serious side effects, like liver or kidney problems. Check in with your doctor frequently to make sure you are tolerating the medication well and that your labs all look good. Tell them about other medications you are taking or other health concerns you may have.
In most cases, the nail will eventually grow back after treatment. This may take several months or up to a year. If the fungal infection keeps returning and does not respond to treatment, your doctor or dermatologist may need to do a surgical procedure to permanently remove the nail.
Brown or black streaks under the nail that may grow over time—particularly streaks that extend from the tip of the nail to the base of the nail bed A bruise or dark spot under the nail that does not move up or disappear as the nail grows Separation between the nail and nail bed Darkening of the skin around the nail Cracking, thinning, or warping of the nail Bleeding from under the nail
Your doctor will likely order a biopsy, in which a small amount of tissue is taken from the nail bed and examined for cancerous cells. If the tissue tests positive for melanoma and your doctor suspects that the cancer has begun to spread, they may also perform a biopsy on some of the nearby lymph nodes. [17] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source
If the melanoma has spread to the surrounding tissues or lymph nodes, it may be necessary to supplement surgery with chemotherapy or radiation therapy. Even if the extent of the melanoma is relatively limited, your doctor may still recommend additional therapies to prevent the melanoma from returning or to kill any remaining cancerous cells. Follow up regularly with your doctor after treatment and do routine self-checks in case the melanoma recurs.
