8 Causes Of A Black Toenail

A black toenail happens when blood builds up under the nail, usually due to an injury. This may occur when blood vessels beneath the toenail are damaged, causing bleeding that pools underneath.

The most common cause of a black toenail is direct trauma, like stubbing your toe or dropping something heavy on it. Athletes, especially runners and soccer players, might get black toenails because of the repeated stress and impact on their toes.

While a black toenail is usually not serious and may heal on its own, it could sometimes be a sign of a bigger problem, like a fungal infection, an ingrown toenail, or a health condition. In this article, we’ll look at 8 causes of a black toenail and what you should do if you have one.

What is Black Toenail?

A black toenail, often referred to as subungual hematoma, is characterized by the excess accumulation of blood beneath the nail surface due to trauma or injury. This condition could manifest as a dark discoloration, which can appear black, purplish, or brownish, depending on the extent of bleeding. The presence of blood pooling beneath the nail is the primary reason for the change in color, which can be accompanied by pain and swelling.

Black Toenail Symptoms

Symptom	Description
Discoloration	The toenail may turn black, red, purple, or brown due to blood under the nail.
Pain	Pain in the toenail, which can vary in intensity depending on the cause.
Nail Separation	The nail may begin to separate from the nail bed, causing discomfort and increasing the risk of infection.
Thickening or Splitting	The toenail may become thicker or split, complicating the condition.
Signs of Infection	Swelling, redness, odor, or discharge, which may indicate a serious infection.
Splinter Hemorrhages	Vertical lines or streaks are caused by bleeding from small blood vessels beneath the nail.
Persistent or Painful Discoloration	A doctor should check any discoloration that is painful or does not go away.

8 Causes of Black Toenail

1. Repetitive trauma

   Repetitive trauma may occur when your toes are exposed to constant pressure and friction, especially from shoes that are too tight or constricting. Tight footwear can pinch or jam your toenails, particularly your big toe, causing bleeding under the nail, which results in a black discoloration. The pressure damages the nail and causes blood to pool beneath it.

   Over time, this causes discomfort, swelling, and even the possibility of the nail coming loose. Athletes are more likely to experience this injury because of the repetitive movement and impact, which might worsen the effects of poorly fitting shoes.

2. Fungal Nail Infection

   Fungal nail infections may thrive in warm, moist environments, making sweaty feet a common cause. Once the fungi get into the nail bed, they might cause discoloration, thickening, and brittleness of the nail. The symptoms could be mild or severe and may often appear as darkened areas beneath the nail, which may look black, brown, or yellow.

   Some people may be more likely to get fungal infections. If you have diabetes, vascular diseases, or a weakened immune system, you could be at a higher risk because your body might have a harder time fighting off infections. These conditions may affect blood flow and immune response, allowing fungi to grow more easily. Poor foot hygiene and wearing shoes that don’t breathe well could also make the problem worse by creating the perfect conditions for fungi to grow.

3. Ingrown toenail

   Ingrown toenails may happen when the edge of the toenail grows into surrounding skin, causing pain, swelling, and redness. This condition usually affects the big toe, but it could happen on any toe. The main symptoms include pain, swelling, and redness around the toe. If left untreated, ingrown toenails might lead to complications like infections, which could cause more pain, pus, and further changes in the color of the nail.

   If you have an ingrown toenail, a doctor may examine your toe to see how severe the condition is and recommend treatment. At first, soaking your foot in warm water, applying antiseptic, and using pain relievers may help ease the discomfort.

4. Melanoma

   Black toenails may sometimes signal the presence of subungual melanoma, a rare but serious type of skin cancer. This condition might show up as a dark streak or patch under the toenail and could be mistaken for a bruise or hematoma. Subungual melanoma is concerning because it may spread if not diagnosed and treated quickly.

   You should be especially careful if the discoloration lasts for a while or if you notice other symptoms. Risk factors may include a history of skin cancer, too much sun exposure, and your skin type. Early detection is important because it can lead to better treatment and outcomes.

   Characteristic	Description
   Appearance	Dark streak or patch under the nail
   Symptoms	Persistent discoloration, possible pain
   Risk Factors	History of skin cancer, sun exposure
   Treatment Options	Surgical removal, chemotherapy, radiation

5. Certain medications

   Sometimes, taking specific medications may cause toenail discoloration due to their effects on the nail bed, blood flow to the nails, or increasing sensitivity to light.

   Cancer treatments, like tyrosine kinase inhibitors and taxanes, have been known to cause nail discoloration. These medications might affect blood flow to the nail area, leading to changes in color. Some antibiotics, like tetracycline and zidovudine, could also change the look of your nails, especially if you’re being treated for HIV.

   Retinoids, which are forms of vitamin A used in skin treatments, may also affect your nails. Psoralens, light-sensitive medications used for conditions like psoriasis, might make your nails more sensitive to UV light, leading to changes.

   Hydroxychloroquine (Plaquenil), a drug used to treat autoimmune conditions, has been linked to toenail discoloration. If you notice changes in your toenails while taking any of these medications, you might want to talk to your doctor.

6. Pigmentation Changes

   Medication may cause changes in the appearance of your toenails, which could be made more noticeable by natural differences in skin color. These changes in pigmentation may result from a variety of factors, like genetics or environmental influences.

   If you have darker skin, you might notice dark patches appearing beneath your toenails. This is fairly common, but it could cause worry about your nail health. These changes may show up as discoloration on the nail bed, which could be mistaken for more serious issues like subungual hematomas or fungal infections.

   Dark patches could also appear on your fingernails, showing that these pigmentation changes aren’t limited to toenails. While these changes are often harmless, it’s still a good idea to have them checked by a doctor, especially if the discoloration is new or comes with other symptoms, like pain or swelling.

7. Improper Footwear

   Improper footwear, like shoes that could be too tight or don’t fit properly, may put pressure on your toenails. This pressure can cause the toenails to press against the inside of the shoe, leading to bruising underneath the nail.

   When blood vessels under the toenail are damaged from the pressure, blood can collect beneath the nail, causing it to turn black.

   Tight shoes can also rub against the toenail, which might cause friction and irritation, increasing the risk of injury and discoloration.

8. Blunt force

   Blunt force trauma to your toenail is a common cause of pain and discoloration, often happening when something heavy is dropped on your foot. This injury can damage the blood vessels in the nail bed, causing blood to collect beneath the nail, which is called a subungual hematoma. Right after the injury, you might notice swelling and pain in your toe.

   The injured area could turn dark red, purple, or black, depending on how much blood has pooled under the nail. The pressure from the blood may cause intense pain, and in some cases, you might need to see a doctor. If the hematoma is large and the pain is severe, your healthcare provider might use a needle to drain the blood, relieving the pressure and pain.

   If the pain doesn’t go away, the discoloration gets worse, or you suspect signs of infection, you should seek medical attention.

Black Toenails Diagnoses

• Your doctor will examine the toenail for signs of injury, infection, or other possible causes of discoloration. They will check for swelling, pain, or damage to the nail.
• The doctor may ask if you’ve had any recent injuries, if you play sports, or if your shoes are too tight. They may also ask about any health conditions like diabetes or circulation problems.
• If your doctor thinks there might be a bone injury, they may suggest an X-ray to rule out fractures or other damage.
• If a fungal infection is noticed, the doctor could take a sample from your toenail to check for a fungal infection.
• In rare cases, if your doctor thinks the discoloration might be caused by something serious like cancer, they may recommend a biopsy, where a small tissue sample is taken from the nail for testing.
• If the discoloration is due to injury, your doctor may suggest watching the nail as it grows out to see if the color improves over time.

Treatment Options to Treat a Black Toenail

• Drainage of Blood: If a blunt force injury causes a black toenail and blood is trapped beneath the nail (subungual hematoma), a doctor may create a small hole in nail to allow the blood to drain out. This may relieve pressure and pain.
• Topical and Oral Medications: If a fungal infection causes the black toenail, over-the-counter antifungal creams or ointments might help treat it. If the infection doesn’t improve, your doctor could prescribe stronger oral medications to clear the infection.
• Treating Underlying Conditions: If health conditions like diabetes are causing nail discoloration, it’s important to address those underlying issues. Your doctor may need to adjust your treatment plan to help with healing and prevent further problems.

Prevention Tips for Black Toenails

• Wear properly fitting shoes that may provide adequate space for the toes.
• Maintaining good foot hygiene is also crucial; keeping the toes clean and dry can prevent fungal infections that may cause discoloration.
• It is advisable to avoid open-toed sandals in environments where stubbing or crushing injuries could occur, such as workplaces or crowded areas.
• Exposure to the sun may cause excess skin damage and potential complications.
• During nail care, trimming toenails straight across prevents ingrown nails, which can contribute to discoloration and infection.
• Regular self-examinations of the feet and toenails are recommended. Any changes in color, texture, or pain should prompt consultation with a doctor.

When To Consult a Healthcare Provider?

• Severe discomfort may suggest significant injury or infection.
• Continuous bleeding that does not cease may require urgent care to prevent further complications.
• Symptoms such as swelling, redness, or discharge should be evaluated promptly.
• Bluish or pale nails, which may indicate issues with oxygenation and potentially serious conditions affecting heart or lung health.

Frequently Asked Questions

• Can Black Toenails Heal on Their Own Without Treatment?
  Black toenails might heal on their own, especially if the injury is minor. However, it’s important to monitor for any signs of infection or worsening symptoms. If these occur, you may need medical treatment.
• Are Black Toenails Contagious or Spreadable?
  Black toenails are not contagious or spreadable. Trauma, infections, or underlying health conditions usually cause them. While the discoloration itself isn’t transmissible, good hygiene might help prevent secondary infections.
• What Home Remedies Can Help With Black Toenails?
  Home remedies for black toenails may include applying tea tree oil or vinegar to combat fungal infections and using cold compresses to reduce swelling. Ensuring proper nail hygiene and wearing breathable footwear also promotes healing and prevention.

Conclusion

Black toenails can happen for many reasons, from simple injuries to more serious issues like infections or health problems.

While some cases may heal on their own, you need to watch for signs of infection or worsening pain and seek medical help if needed.

You can prevent further problems and keep your nails healthy by understanding the causes of black toenails and taking care of your feet.