What to do if your toenail falls off

What to do if your toenail goes black?

Both a bane to runners and – in a strange way – a badge of honour, the black toenail, or subungual haematoma, is blood collecting under your nail.

It can occur from acute or chronic injury, says Jordan Metzl, a sports medicine doctor at the Hospital for Special Surgery in New York City. The chronic repetitive trauma can range from mild (a small, painless, black-and-blue discoloration beneath the nail) to severe (large, bloody blisters between nail and nail plate), adds podiatric surgeon Jacqueline Sutera. Here’s what you need to know.

How can you prevent black toenails?

A common culprit is repetitive trauma, caused by the motion of running and exacerbated by ill-fitting footwear, eg if the top of your shoe rubs against your nail or your toe slams into the end of your shoe. So keep your toenails short and make sure there’s a thumb-width distance from the tip of your longest toe to the end of your shoe, says Quinton Yeldell, founder of footcare company Southern Hospitality. Then look for shoes that are wide enough that your forefoot rests comfortably in the shoe without hitting either side. Going up a half size in running shoes or wearing a thinner sock can help ease the pressure and protect toenails, says Metzl.

How do you treat black toenails?

In mild cases, no treatment is needed, and the black nail will simply grow out. But in some cases, the subungual haematoma can cause pain – the more blood under your nail, the more it will hurt, says Metzl. If this is the case, head to your doctor. He or she can poke a few holes into the nail to drain the blood, which relieves the pressure and will also help save the nail. Prompt action is crucial here, however: the procedure must be done within the first few days of the injury. So if you feel pain, don’t play the waiting game. This is a procedure that needs to be done at the doctor’s. Despite what you may hear about it being a DIY trick, attempting this yourself can leave you at risk of infection.

You may be tempted to hide the discolored toenail with nail polish, but nail polish does not allow the nail to breathe and you could risk losing it altogether, says sports doctor William Roberts. Reserve that move for special occasions, not everyday wear.

How do you heal black toenails?

In cases of repeated microtrauma – hitting your nails against the shoes when you run – the nail can simply fall off without any bleeding or open wounds. If that’s the case, you should still use an antibiotic ointment and a bandage to guard against infection. By the time the nail comes off, your nail bed is usually less sensitive and the pain should be minor, says Metzl. Sometimes there is already a new nail growing beneath it. ‘As long as it doesn’t hurt too much, you should be fine to run,’ he says. A new nail should take between six and eight weeks to grow in.

What to do if you lose your toenail

So you lost a toenail. It happens.

Blame both ill-fitting shoes and training for full or half-marathons, says podiatrist Brian Fullem, the author of The Runner's Guide to Healthy Feet and Ankles: Simple Steps to Prevent Injury and Run Stronger.

Why? A constant battle between your toes and the end of a shoe can injure your nail and even cause blood blisters, forcing the nail away from the skin, he says. (Short-as-possible nails pre-long runs can help sidestep this.)

But if it’s already a lost cause (read: buh-bye toenail)? Consider this your plan:

What to do if your nail comes off in a bloody mess:

Your first step is to apply pressure to the area until the bleeding subsides, says Dr Meredith Leigh Ward, a podiatrist at Moore Foot and Ankle Specialists in Asheville, North Carolina. Follow this with an antiseptic treatment and a plaster - or visit your GP who will prescribe antibiotic cream if they see fit. You can reapply daily after a shower until the skin opening has closed (about one to two weeks, she says).

Super sore? Once a bandage and your treatment are on, soak your foot for 10 minutes in warm water and Epsom salts, suggests Fullem. “This will help draw out some of the soreness.”

What to do if the toenail has completely come off:

“Often, after repeated micro-trauma, the nail may fall off without any bleeding or open skin lesion underneath, which can be left alone,” says Ward. Plasters and antiseptic or antibiotic treatments are good options here, too, for an added layer of protection against infection.

If you’ve got a blister, to boot? Fullem suggests sterilising a needle with alcohol and draining it.

Whilst we're on the subject, here's the lowdown on fungal toenail infections

What to do if the nail is kind of falling off, but not all the way:

Repeat after us: Don’t. Pull. It. Off. Doing so can cause avoidable pain as well as unnecessary additional trauma.

Instead, trim the loose nail as short as you can so that it doesn’t snag on a sock or shoe (ow!), says Ward. Also: don’t tape it back down. As Fullem puts it: “It will not re-attach.”

Unfortunately, you’ll just have to practice your patience for this one. “Each nail is a separate entity which takes six to nine months to grow,” he says. You’ll start to see a new nail growing in in about six weeks.

When to see a doctor about your toenail

If you notice an increase in pain, red streaking up your toe, swelling or any smelly drainage, it’s time to make an appointment with a podiatrist, as those are all signs of infection.

Fullem says “The nail sits very close to the bones of our toes, and if an infection starts in the skin surrounding the nail it can easily travel to the underlying bone and cause a severe infection if left untreated.”