What You Should Do If Your Toenail Rips Off In An Injury

toe injury

Lifting injuries to toe nails, especially to big toenails, are not uncommon.  However, this injury often does not receive the proper medical care it requires due to the perception that the injury is minor.  While true in many cases, there are times in which this injury can lead to significant complications, and in general many people treat this injury incorrectly from the start.

The toenail is a loosely attached piece of hard compressed tissue that grows from cells located behind the cuticle, under the skin.  The nail cannot stay ‘glued’ down onto the skin below it because it has to move forward as it slowly grows.  For this reason, any injury that catches under the edge of the nail, or smashes down on the nail causing bleeding under the nail can cause lifting of the nail itself, sometimes causing it to tear off completely (or at least close to it).  The natural response by most people is to try and reattach the nail back on the skin through tape, a dressing, or even glue.  Unfortunately, in certain circumstances, this can lead to various problems.  When an injury is strong enough to rip the nail off, it may be strong enough to cause damage to the bone at the tip of the toe, which is near where the nail grows from in the first place.  Toe fractures in and of themselves are generally not serious, but fractures associated with tearing or bleeding of the skin surface underneath the nail can be if the small pieces of bone are exposed to open air.  This can lead to bone infection, which is difficult to treat in the toes and can lead to a partial toe amputation.  This is especially true in diabetics or those with poorly functioning immune systems.

When one has experienced a toenail injury that has caused the nail to lift up or off, it is important to see a physician (preferably a podiatrist) for careful evaluation of the skin under the lifted nail, as well as possible x-rays if a fracture is suspected.  Sometimes the nail must be completely removed to drain blood, inspect the nail bed for bone fragments or tissue tears, or to prevent bacteria and fungus from growing underneath it and causing an infection that may be difficult to treat.  The nail will grow back, although it should be understood that any injury strong enough to lift the nail has likely also injured the nail root, and the nail growth that follows will likely be different forever.  The nail may now grow thick, malformed, or curved inward.  If bone fragments are noted, the area must be medically cleansed, antibiotics must be taken, and proper wound care must be performed under the direction of a physician in order for the area to heal properly and without infection.

One exception to this advice is when athletes like runners have toenails fall off due to bruising under the nail from running.  This is common, is related mainly due to continued toe pressure in shoes while running, and is rarely associated with more traumatic injuries like fractures.

Do Broken Toes Really Need Medical Attention?

toe fracture

One of the most common foot injuries is the toe fracture.  This seemingly minor injury can be the source of much pain and annoyance, and often hails from a midnight misadventure to the bathroom as a dresser suddenly lurches in the way of the unsuspecting sleepy victim.  The common assumption is that there is nothing that can be done for a toe fracture, so why bother to have it addressed?

My response to this is that if it were a finger, would one not seek medical attention?  Yes, I realize toes and fingers serve two very different purposes.  However, the anatomy of the injuries is generally the same, and the severity of not addressing these injuries in a timely manner could be equally problematic.

Toe fractures can run the gamut of simple clean breaks, all the way to displaced fractures that stick out away from the intact bone.  Clean breaks are simply treated with buddy splinting of the injured toe to the next toe, and the use of a stiff soled shoe.  However, there is no external indication as to whether a toe fracture is a clean break or if it is shifted out of position, and the level of pain or swelling associated with the injury does not offer a true clue either.  X-rays and medical attention are needed to determine this, as a decision has to be made as to what needs to be done to put the toe bone back into place and keep it there while it heals.  This may be as simple as manually distracting the toe to put the fracture in place with the use of splints to keep it there, or, in serious cases, treatment may require surgery to repair and secure the broken bone.  The danger of the bone not setting right comes in the form of future issues with the toe, which includes new areas of prominence from the displaced and malformed bone that may rub in shoes and cause sores (a particular danger for diabetics), long term pain from a non-healing fracture, or long term arthritis if one of the joint surfaces in the toe was disrupted by the separated fracture.

Ignoring a toe fracture could prove costly, as some non-healed fractures require additional surgery to remove the fractured bone end in an effort to end pain.  A simple visit to a physician, preferably a foot specialist (who by nature deals with toe fractures on a regular basis), can ensure that this nagging injury heals properly, quickly, and without long term consequence.