Understanding and Addressing Blue and Black Toenails (2023)


Discovering blue or black discoloration on your toenails can be alarming, but fear not – it may be a subungual hematoma, a condition resulting from trauma or injury to the nail bed. In this comprehensive guide, we'll delve into the signs, causes, progression, and consequences of blue toenails. We'll explore effective at-home relief methods, diagnostic procedures, podiatrist interventions, prevention tips, and debunk common myths associated with black toenails.

Signs and Symptoms

  • Blue, purplish, or black discoloration of the toenail.
  • Discoloration may cover the entire nail or be limited to one area.
  • Spontaneous appearance.
  • Loose or detached toenail.
  • Sharp or dull pain.
  • Redness and swelling around the nail.
  • Occasional bleeding or pus drainage.


Understanding the origins of blue toenails is crucial:

  • Direct trauma to the toenail, such as heavy object impact or falls.
  • Repeated minor stress from ill-fitting shoes or sports activities.
  • Micro-injuries that weaken the nail bed over time.
  • Rarely, fractures of the phalanx bones beneath the nail.

Progression and Consequences

While often cosmetic, complications may arise:

  • Slow nail growth, taking up to 12 months for discoloration to disappear.
  • Potential toenail loosening or complete loss.
  • Increased vulnerability to bacterial and fungal infections.
  • Irregular nail shape post-injury.
  • Risk of ingrown nails after partial or full loss.

How to Relieve at Home

When symptoms arise, consider these initial steps:

  1. Wash feet with a saline solution (3 tablespoons of salt in 2 liters of water) for 10 minutes, 1-2 times daily.
  2. Apply antibiotic ointment like Polysporin 2-3 times daily; cover with a Band-Aid during the day.
  3. Avoid tight, narrow shoes.
  4. If symptoms persist, consult a podiatrist.

Diagnostic Procedures

Diagnosing a subungual hematoma involves:

  • Visual observation of the toenail.
  • Possible toenail sample collection or biopsy.
  • X-rays in trauma cases.

Podiatrist Intervention

Your podiatrist can recommend tailored treatments:

  1. Piercing the nail and cleansing the bed for proper regrowth.
  2. Complete nail removal under local anesthetic for severe cases.
  3. X-rays for suspected fractures.
  4. Prescription of antibiotic ointment for infections.
  5. Monitoring new nail growth.

Prevention Tips

Proactive steps to avoid blue toenails:

  1. Keep toenails short.
  2. Wear appropriately sized shoes with room for toes.
  3. Secure shoelaces tightly to prevent unnecessary foot movement.
  4. Choose proper footwear for heavy chores.
  5. Stay vigilant to prevent accidents.

Myth Busting

Contrary to popular belief, a black nail doesn't signify death:

  • Coagulated blood causes the color, but the nail matrix remains alive.
  • Dried blood under the nail can lead to persistent discoloration.
  • Injured nails may fall off as new, healthy ones grow.

Exploring Alternatives

Consider other potential causes if blue toenails don't align with your symptoms:

  • Onychomycosis (fungal infection).
  • Warts or calluses under the toenail.
  • Ingrown toenail.
  • Granuloma.
  • Osteochondroma.
  • Skin cancer.
  • Diabetic foot ulcer.


In summary, understanding and addressing blue or black toenails involves recognizing symptoms, identifying causes, and implementing appropriate care. Whether pursuing at-home remedies, consulting a podiatrist, or considering preventative measures, this guide aims to equip you with comprehensive insights into managing and preventing blue toenails. For personalized advice, reach out to our expert podiatrists at Anjou Clinic, Lachine Clinic, or Bromont Clinic.


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