Conditions / Nail Conditions
Subungual Haematoma (Bruised Toenail)
A collection of blood beneath the toenail, usually from injury or repetitive pressure, that can be uncomfortable and, in some cases, benefits from draining to relieve pressure.
A subungual haematoma is a collection of blood that builds up beneath the toenail, typically following an injury to the nail bed. It appears as a dark red, purple or black discolouration under the nail and can range from a small, painless mark to a large, throbbing collection under significant pressure.
The nail bed is richly supplied with small blood vessels, so even relatively minor trauma — stubbing a toe, dropping something on it, or repetitive impact from running or tight footwear — can cause enough bleeding beneath the nail to create noticeable pressure and discomfort.
Acute Trauma
Stubbing the toe, dropping something on it, or crushing injuries are the most common cause of a sudden, painful subungual haematoma.
Repetitive Impact ("Runner's Toe")
Repeated micro-trauma from running, particularly downhill or in poorly fitted footwear, can cause a gradual build-up of bleeding under the nail.
Tight or Poorly Fitted Footwear
Footwear that presses the toe repeatedly against the front of the shoe increases the risk, particularly for the longest toe.
Blood-Thinning Medication
Anticoagulant medication can increase both the likelihood and the extent of bleeding beneath the nail following minor trauma.
Dark red, purple or black discolouration beneath the nail
Throbbing pain, particularly in the first 24–48 hours after injury
A sensation of pressure or tightness under the nail
Swelling of the surrounding toe
In more significant cases, the nail may eventually loosen or be shed
Assessment includes examining the extent of the haematoma and the surrounding nail and toe, and confirming there's no associated fracture of the underlying bone — a possibility with more significant crush injuries, which may need an X-ray to exclude if clinically suspected. We'll also check the nail bed itself hasn't been significantly lacerated, which can affect how the nail grows back.
Small, low-pressure haematomas often don't need active treatment and resolve as the nail grows out. Larger, painful collections under significant pressure can benefit from a simple in-clinic procedure to relieve the pressure and pain.
If the toenail is significantly painful or throbbing, covers more than around a quarter of the nail, or followed a crush injury, an assessment is worthwhile — both for pain relief and to check there's no underlying fracture or significant nail bed injury. Prompt drainage of a large, painful haematoma typically brings fast relief.
Does draining the haematoma hurt?
The procedure itself is generally well tolerated — a small hole is made through the nail, which has no sensation, to release the pressure. Most patients feel immediate relief once the pressure is released.
Will I lose my toenail?
It depends on the extent of the injury. Small haematomas often don't affect the nail long-term. Larger ones, or those involving significant nail bed injury, sometimes result in the nail loosening and being shed over subsequent weeks — a new nail then grows in its place over several months.
Should I try to drain it myself?
We'd advise against this — it's easy to introduce infection without sterile technique, and it's worth having the toe properly assessed first to check for any underlying fracture or significant nail bed injury before draining.
Is this covered by insurance?
Yes — podiatry consultations and minor procedures are typically covered by most major insurers. We work with Bupa, Aviva, WPA and others. See our
insurance page for full details.
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