Yes, a bruised toenail may fall off, and this is often a natural part of the healing process after a significant injury. The discoloration is a collection of blood under the nail plate, medically known as a subungual hematoma. This pooling blood results from trauma that ruptures small blood vessels in the nail bed. While the sight of a dark, bruised nail can be alarming, it is a common response to an impact injury like stubbing a toe or dropping a heavy object.
Understanding Nail Bruising and Detachment
The separation of the nail from the nail bed is a mechanical consequence of the trauma. Blood leaks from damaged vessels and becomes trapped in the confined space between the nail plate and the sensitive tissue underneath. This trapped blood forms a hematoma that exerts significant upward pressure on the nail plate. This internal pressure physically pushes the nail away from the underlying nail bed, leading to a separation called onycholysis. If the hematoma is large or the trauma was severe, the separation progresses until the entire nail plate loosens and eventually detaches completely.
Immediate Care and Self-Treatment
For a minor bruised toenail, you can manage the initial injury at home using the RICE protocol. Rest the injured toe to prevent further trauma. Applying a wrapped ice pack helps reduce swelling and numb the pain. You can also gently elevate your foot above heart level to encourage fluid drainage and decrease swelling. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can effectively manage discomfort.
Do not attempt to drain the blood yourself by poking a hole in the nail. This non-sterile procedure carries a high risk of introducing bacteria and causing a severe infection.
When Professional Medical Help Is Needed
Certain symptoms indicate that a bruised toenail requires immediate evaluation by a healthcare provider. Seek urgent care if you experience extreme, throbbing pain not relieved by ice and pain medication. This intense pain suggests a large hematoma that needs professional drainage, a procedure called trephination, to relieve the internal pressure. Medical attention is also required for signs of infection, such as increasing redness, warmth, swelling, or pus draining from under the nail. A doctor should assess the toe if the discoloration covers more than half of the nail plate, or if the injury suggests a deeper issue like a toe bone fracture.
If you have underlying conditions like diabetes or poor circulation, any toenail injury should be examined quickly due to the increased risk of complications.
The Long-Term Healing and Regrowth Process
If the bruised nail detaches, the old nail plate often acts as a natural protective cover for the sensitive nail bed underneath. The new nail begins to form at the nail matrix and slowly pushes the damaged nail forward and off the toe. The timeline for complete toenail regrowth is long, typically ranging from 12 to 18 months. You will usually see the first signs of new, healthy nail growth emerging from the base of the toe within two to three months. During this time, keeping the nail bed clean and protected is important to encourage the development of a healthy, fully attached replacement nail.