Whether you've had a sports injury or just had an accident at home, a torn toenail can be a painful experience. A nail tear, or nail "avulsion," involves a tear in the nail away from the nail bed or losing the entire nail. Fortunately, many torn toenails can be treated by yourself with proper cleaning and aftercare. All you have to do is spot the signs that you should see a doctor.
Method 1 of 3: Treat your injury yourself
Step 1. Take care of the rest of the nail
Some nail avulsions are minor and leave most of the nail in place, while others can peel off an entire toenail. After your injury, take proper care of the portion of the nail that is left to get the right leg up as you heal. Let go of whatever is still stuck. If any part of the nail is peeled off, carefully cut it off as close to the nail bed or solid area as possible with clean nail scissors. Cut along the tear line.
- File any leftover part of the nail so it's smooth. This will help you avoid scratching your socks and bedding.
- If you are squeamish or have trouble with it, ask a friend or loved one for help. Children may need help from an adult handling a torn toenail.
- Be sure to remove a toe ring if you are wearing it before treating the torn toenail. You can use soap and water to lubricate your skin if the jewelry is difficult to remove. You can also see a doctor if you can't remove it.
Step 2. Stop any bleeding
Apply direct pressure on the bleeding area with a clean cloth or gauze pad. Keep the pressure on for ten minutes or until the bleeding stops. It also helps to slow down bleeding if you lie down with your foot on a pillow.
If the bleeding has not slowed after 15 minutes of pressure, see a doctor
Step 3. Thoroughly clean the wound
Wash your toe with warm, soapy water and a washcloth. If the wounded area is dirty, gently scrub the dirt off. Scrub off any dried blood or dirt from the injury. Don't be afraid to ask a friend or loved one to help you. Clean the area as best you can to prevent infection.
Gently pat the area dry with a clean towel or washcloth. Do not rub the area, which could cause more bleeding
Step 4. Apply antibiotic ointment
When your toe is clean and dry, dab a topical antibiotic ointment (such as Neosporin, Polysporin, or any of the "triple antibiotic" ointments) all over the injured area. You can get these at most pharmacies without a prescription.
- They are often also available in cream form. Be sure to get the ointment, which will better keep your bandage from sticking to the wound.
- If the skin is intact and there are no cuts or scratches, you can simply apply some petroleum jelly instead of the antibiotic ointment.
Step 5. Bandage your toe
Buy sterile gauze pads or non-stick bandages and adhesive plasters. Place a gauze pad or bandage over the injured toe (cut the pad to fit if necessary). Then, wrap the toe several times in gauze to hold the bandage in place. Leave enough extra gauze on the top of your toe to gently fold it over the nail. In this way you create a kind of bandage "cap" that you can easily pull off later. Put sticking plaster on top twice, crosswise (like an X). Use two pieces of adhesive tape to tape the bandage up to your toe on your foot to hold it in place.
- Either buy a non-stick bandage, or be sure to apply antibiotic ointment or petroleum jelly before bandaging your toe. Be careful not to pull on your toenail or the injured area when removing the bandage. Soak it in warm water for a few minutes to make it easier to remove if the bandage sticks to your toe.
- Don't wrap your toe so tightly that it turns red, purple, or loses the feel of it. The bandage should hold and be tight, but not uncomfortably tight.
Step 6. Change the bandage daily
Gently remove the bandage each day and wash your toe with warm, soapy water. Put your antibiotic ointment back on and apply a fresh bandage. Also, apply a fresh bandage if it gets wet or dirty. You should do this for seven to ten days until the nail bed, the soft, sensitive area under the nail, becomes hard.
Ideally, apply your new bandage to your toe every night before you go to bed. This will protect your injured nail from getting caught on bedding or bumping into something while you sleep
Method 2 of 3: minimize inconvenience
Step 1. Cool often on the first day
On the day of your toe injury, apply ice for 20 minutes every two hours to reduce pain and swelling. Fill a plastic bag with ice and wrap it in a towel before placing it on your toe so it isn't too cold.
After the first day, cool for 20 minutes three to four times a day
Step 2. Put your foot up
Lie down and use pillows to prop your foot higher than your heart in case your toe is throbbing. That should reduce the swelling significantly. Do this for the first 48 hours after getting injured.
Step 3. Take over-the-counter pain relievers
Ibuprofen and naproxen reduce swelling and your pain. Paracetamol does not help against swelling, but it does help against pain. You can get this at the pharmacy without a prescription. Only take them according to the instructions in the package insert.
Talk to your doctor before taking these medications if you have heart disease, kidney problems, high blood pressure, or have ever had stomach ulcers
Step 4. Wear open or wide shoes for several weeks
Tight shoes put uncomfortable pressure on your injured nail. Wear open-fronted or loose-fitting shoes to relieve pressure and improve healing. Wear them for as long as you need to be comfortable.
Method 3 of 3: See a doctor if necessary
Step 1. See a doctor if you have any signs of infection
No matter how well you take care of your injury, you could still get an infection. If your toe is infected, you may see red streaks running up your foot or leg. You may have a fever of 38ºC or higher. Pus - thick, white, or colored discharge from the injury - is another sign of infection. See a doctor if any of these signs occur because infections can be serious.
Your doctor will prescribe antibiotics for you if you have an infection. Take these as prescribed until they are used up
Step 2. See your doctor if you experience worsening pain, redness, or swelling
If your pain is so severe that it interferes with your sleep or daily activities (or two hours after taking pain medication, it hasn't improved, or has gotten worse over time), see your doctor. Get help if you have swelling that gets worse or no better after taking medication, using ice, and putting your foot up.
Ask questions like, "My toe hurts more today than it did yesterday, and ibuprofen is not helping. Is that okay?" or "How much swelling is normal?"
Step 3. Get examined if your nail turns blue
Sometimes an impact injury to a toenail (such as dropping a heavy object on it) can cause a "subungual hematoma" - bleeding below the nail. This creates a small blood bag under the nail, which can be uncomfortable because of the pressure. It looks like a dark blue, black, or purple stain under your nail. If the bruise is smaller than a quarter of the nail, it will likely resolve on its own. Otherwise, see a doctor as you may need to drain the fluid to prevent further pain and injury. Do not try this yourself or on someone else. Go to the doctor.
Your doctor will drill a very small hole in your toenail to allow the blood to drain out. This procedure shouldn't hurt. The drainage of the blood makes your toe feel better because it relieves the pressure
Step 4. See a doctor if there is any damage around the torn nail
Whether your toenail grows back normally depends on whether the nail bed has been damaged. Talk to your doctor about the possibility of minor nail bed surgery if you are concerned about how your nail will look when it grows back. See your doctor if you can see any damage to the tissue around your nail, such as any cracks. If the nail bed (or nail matrix) is badly damaged, your nail may not grow back or may look different - but some problems can be fixed.
It could take six to twelve months for a toenail to completely grow back
Step 5. If you cannot get the wound clean, ask for help
Get medical attention if you've spent 15 minutes (or more) trying to scrub your injury and still see dirt in it. It's really important to clean the wound thoroughly to prevent infection. So if you can't do it yourself, you need someone who can.
Depending on how you injured your toe, you may also need a tetanus shot or a tetanus booster. If the cut is dirty and it's been five years or more since you last freshened up, you'll need a tetanus shot. But if the cut is clean and it was more than ten years ago your last refresh, you will need one too
Step 6. If you can't move your toe or if it looks strange, get an X-ray
Many injuries that cause nail avulsion can also cause broken bones. Examine your injured toe to see if it flexes and extends all the way. If not, or if it is sticking out at an odd angle, it may be broken. Go to the emergency room for an X-ray and proper treatment.