The nail bed is the skin underneath the nail. Injuries to this area are common, and they often occur when a heavy object crushes or hits the fingers or toes or when a person sustains a cut from a sharp object.
Prompt treatment can help the nail bed and underlying structures heal and ensure that the broken nail grows back smoothly.
In this article, we explore different types of nail bed injury. We also describe how to care for these injuries at home and when to seek professional attention, as well as the various treatments and procedures that can help.
There are several types of injury to the nail bed, including:
A subungual hematoma looks like a bruise. It forms when small blood vessels under the nail bed leak, and blood pools between the nail and the nail bed.
This leakage usually occurs when the tips of the fingers or toes have been crushed or subjected to a heavy impact. Also, very tight-fitting shoes can put pressure on the blood vessels and cause leakage.
As the blood clots, the color of a hematoma can change from red or purple to brown or black.
These injuries are often increasingly painful; as the blood accumulates in the small space beneath the nail, it puts pressure on the tender skin of the nail bed.
Sometimes, the nail lifts away from the nail bed.
Another type of nail bed injury is a cut, or laceration, that pierces the nail and nail bed beneath.
Injuries that involve these lacerations can also cause larger subungual hematomas.
A nail bed avulsion involves the nail and part of the nail bed pulling away from the rest of nail bed, either partly or entirely.
This typically results from the nail being crushed or sustaining a high impact injury.
Avulsions can cause significant pain.
Home remedies can help, as can medical treatments.
Self-care for minor injuries
A person can often treat a minor nail bed injury at home by:
- removing all jewelry
- washing the injured area gently with fragrance-free soap
- bandaging the injury gently, if there is an open wound
- applying an ice pack for about 20 minutes at a time
- elevating the injured hand or foot
- applying gentle compression to reduce any throbbing
- taking over-the-counter pain relief medication, according to the instructions
Minor nail bed injuries, including subungual hematomas, often heal on their own, especially when no other injuries are present.
Receiving professional treatment can help ensure that the nail bed heals appropriately, forming a smooth surface on which the new nail can grow.
A doctor may treat a more severe subungual hematoma by making a small hole in the nail and draining the pooling blood. This is known as trephination. However, a doctor will not use this method if the nail is damaged.
If the collected blood covers more than half of the nail bed, the doctor may remove the nail and repair the nail bed and matrix — the area at the base that produces new nails.
If the nail is damaged or torn, the doctor may remove it and repair the nail bed. They may also do so if the finger or toe is fractured.
The doctors may likewise remove part or all of the nail if the nail bed matrix is damaged.
A doctor uses stitches to repair any laceration to the nail bed and reattaches the nail, if possible, to provide protection and support while the new nail grows.
Doctors treat avulsions in a similar way, but the nail is sometimes too badly damaged to be reused. The doctor may attach a synthetic nail, which is gradually pushed forward as the new nail grows.
When an avulsion is more severe, a surgeon may use reconstructive techniques, such as grafting.
People with nail bed injuries may need a course of antibiotics to prevent infection. Also, the doctor may check on the status of their tetanus injections and request an X-ray to check for any bone fractures.
Depending on the severity of the injury, it may take 6–9 months to fully recover.
A person should see a doctor if:
- any jewelry is difficult to remove from the injured finger or toe
- pooling blood covers more than half of the nail bed
- pain from the injury is severe
- bleeding does not easily stop
- any cut is deep
- the nail is cut, torn, or detached from the nail bed
- the finger or toe has an usual shape
Anyone who is uncertain whether a nail bed injury requires treatment should speak to a doctor.
Many nail bed injuries are minor, and a person can treat them at home.
Others require prompt medical attention to ensure that the area heals and the nail grows back smoothly. Depending on the severity of the injury, the nail may still grow back with small ridges or bumps.
Injuries affect the rate at which the nails grow, but with proper treatment, the rate eventually returns to normal.
Full recovery may take 6–9 months, depending on the type and severity of the injury.