Treat a Torn Toenail

Whether you’ve had a sports injury or just an accident around the house, a torn toenail can be a painful experience. A torn nail injury, or nail avulsion, includes a tear in the nail away from the nail bed or losing the entire nail. Fortunately, many torn toenails can be treated at home with proper cleaning and aftercare, as long as you recognize signs that you should see a doctor.

Steps

Treating Your Injury at Home

1. Deal with the nail that’s left. Some nail avulsions are minor, leaving most of the nail attached, whereas others can take off an entire toenail. After your injury, properly care for the portion of the nail that’s left over to get your healing off on the right foot. Whatever is still attached, leave it attached. If a portion of the nail is unattached, gently clip it with clean nail clippers as close to the cuticle or to the attached area as possible. Cut along the line of the tear.
   • File any part of the nail left over so that it is smooth. This will help you avoid catching it on socks and bedding.
   • Ask a friend or loved one for help if you're squeamish or are having trouble. Children will probably need help from an adult when caring for a torn toenail.
   • If you are wearing a toe ring, make sure to take it off before you treat the torn nail. You can use soap and water to lubricate your skin if the jewelry is difficult to remove, or call a healthcare provider if you cannot remove it.
2. Stop any bleeding. Apply direct pressure to the bleeding area with a clean cloth or a gauze pad. Keep pressure on the area for 10 minutes, or until the bleeding stops. It will also help to slow bleeding if you lie down and elevate your foot by propping it up on pillows.
   • If the bleeding hasn’t slowed after 15 minutes of pressure, seek medical care.
3. Clean the wound thoroughly. Wash your toe with warm soapy water and a washcloth. If the wounded area is dirty, gently scrub the dirt away. Scrub off any dried blood or debris from the injury. Don't be afraid to ask a friend or loved one to help you. Clean the area as well as possible to prevent infection.
   • Gently pat the area dry with a clean towel or washcloth. Do not rub the area, which might cause more bleeding.
4. Apply antibiotic ointment. When your toe is clean and dry, dab a topical antibiotic ointment such as Neosporin, Polysporin, or any of the "triple antibiotic" ointments onto the entire injured area. You can get these at most drug stores, without a prescription.
   • These often come in cream form, as well. Be sure to get the ointment, which is better at preventing your bandage from sticking to the wound.
   • If the skin is intact and there are no cuts or scrapes, then you can just apply some petroleum jelly instead of antibiotic ointment.
5. Put a dressing on your toe. Purchase sterile gauze pads or non-stick dressing, and medical tape. Apply a gauze pad or bandage over the injured toe (cut the pad to fit, if needed), then wrap around the toe with gauze several times to keep the bandage in place. Leave enough extra gauze at the top of your toe to gently fold it over the nail, creating a sort of bandage “cap” that you can later pull off easily. Tape over the top twice in crisscross fashion (like an X). Use two pieces of medical tape to adhere the bandage to your toe up by your foot, to help keep it in place.
   • Either purchase non-stick dressing, or be sure to apply antibiotic ointment or petroleum jelly before bandaging your toe. Be careful when removing the bandage not to pull on your toenail or injured area; if the bandage is sticking to your toe, soak it in warm water for a few minutes so it’s easier to remove.
   • Don’t wrap your toe so tightly that it turns red or purple or loses feeling. The wrapping should stay in place and be snug, but not be uncomfortable tight.
6. Change the bandage daily. Every day, gently remove the bandage and wash your toe with warm, soapy water. Reapply your antibiotic ointment and put on a fresh bandage. If your bandage gets wet or dirty, put on a fresh one. You should do this for 7-10 days until the nail bed, the soft sensitive area underneath the nail, hardens.
   • Ideally, put your new bandage on your toe each night before you go to bed. This will protect your injured nail from snagging on bedding or hitting something while you sleep.

Minimizing Discomfort

1. Ice often on the first day. The day of your toe injury, apply ice every 2 hours for 20 minutes at a time to reduce pain and swelling. Fill a plastic baggie with ice and wrap it in a towel before putting it on your toe, so that it’s not too cold.
   • After the first day, ice for 20 minutes three to four times a day.
2. Elevate the foot. If your toe is throbbing, lie down and elevate your foot with pillows to above the level of your heart. This should greatly reduce swelling. Do this for the first 48 hours after being injured.
3. Take OTC pain relievers. Ibuprofen and naproxen will reduce swelling and improve your pain. Acetaminophen will not help with swelling, but it will help with pain. You can get these at your pharmacy without a prescription. Only take them as instructed on the package.
   • If you have heart disease, kidney problems, high blood pressure, or have ever had stomach ulcers, talk to your doctor before using these medications.
4. Wear open or loose shoes for several weeks. Tight shoes will put uncomfortable pressure on your injured nail. Wear open-toed or loose fitting shoes to relieve pressure and improve healing. Do this as long as you need to in order to be comfortable.

Visiting Your Doctor When Necessary

1. Seek medical care if you have signs of infection. No matter how well you take care of your injury, you might still get an infection. If your toe is infected you might see red streaks running up your toe, foot, or leg. You might get a fever of 100.4ºF (38ºC) or higher. Pus – thick, white or colored drainage from the injury – is another sign of infection. See your doctor if any of these signs occur, because infections can be serious.
   • Your doctor will prescribe you antibiotics if an infection is present. Take these as prescribed and until they’re gone.
2. Visit your doctor if you have worsening pain, redness, or swelling. See your doctor if your pain is severe enough to interfere with sleep or daily activities, does not improve 2 hours after taking pain medicine, or gets worse over time. If you have swelling that gets worse or does not improve after medicine, ice, and elevating your foot, get help.
   • Ask questions like, "My toe hurts more today than it did yesterday and Tylenol isn't helping, is that okay?" or "How much swelling is normal?"
3. Get checked out if your nail turns black and blue. Sometimes, a crushing injury to a toenail (like having a heavy object dropped on your toenail) can cause a subungual hematoma – bleeding underneath the nail. This creates a little pocket of blood under the nail, which can be uncomfortable because of the pressure. It looks like a dark blue, black, or purple bruise like splotch beneath your nail. If the bruise is less than ¼ the size of the nail, it will probably resolve on its own. Otherwise, see your doctor because you may need to have the fluid drained from under the nail to prevent further pain and injury. Don’t attempt to do this on your own or for someone else. See a doctor.
   • Your doctor will drill a very small hole in your toenail to let the blood drain out. This procedure shouldn’t hurt, and draining the blood will make your toe feel better because it relieves the pressure.
4. See your doctor if there’s visible damage surrounding the torn nail. Whether your toenail will regrow normally depends on whether or not the nail bed was damaged. If you’re worried about how your nail might look when it grows back, speak to your doctor about the possibility of a small surgery on your nail bed. If you can see visible damage to your tissue around your nail, like any tears, see your doctor. If the nail bed or nail matrix are very damaged, your nail might not grow back or might look different – but some problems are fixable.
   • It may take 6-12 months for a toenail to completely regrow.
5. Ask for help if you can’t get the wound clean. If you spend 15 minute or more trying to scrub your injury clean, and you still see dirt or debris in it, get medical help. It’s really important to thoroughly clean the wound to prevent infection, so if you can’t do it on your own you need someone who can.
   • Depending on how you hurt your toe, you might also need a tetanus shot or tetanus booster. If the cut is dirty and it has been 5 years or more since your last booster, then you will need a tetanus shot. If the cut is clean and it has been more than 10 years since your last tetanus booster, then you will need a tetanus shot.
6. Go for an x-ray if your toe is immobile or looks odd. Many injuries that cause nail avulsion can also cause broken bones. Check your injured toe to see if it bends and straightens all the way. If not, or if it’s sticking out at an odd angle, it may be broken. Get emergency care for an x-ray and proper treatment.

Video

Template:Video:Treat a Torn Toenail

Tips

• If your nail is severely damaged, it may completely fall of in about 1-2 weeks. This is normal. Let it fall off naturally rather than forcefully removing it.

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Sources and Citations

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• Clean Under Your Fingernails
• Heal Cuticles
• Heal Damaged Nails
• Get Rid of Ingrown Toenails
• Make Your Fingernails Look Good
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• Buff Your Nails
• Clean Your Fingernails
• Grow Long, Strong Nails
• Care for Your Feet and Toenails

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