Think back to the last time you got a bruise. It could have been on your arm, your thigh, or anywhere else. Wherever it was, you probably recognized that black and blue patch right away. Most people are very familiar with this kind of darkened, tender skin. Black toenails, however, are less familiar—so they can concern people when they appear. In most cases, thankfully, the causes of black toenails are simple and not serious.

Bruising Your Nails

In most cases, black toenails are bruises under the hard keratin. When you jam your toe, drop something heavy on it, or otherwise injure the ends of your digits, you can sometimes damage the area under the protective hard keratin. This causes the nail bed to bleed. That blood leaks out and stains the underside of your toenail, creating the discolored, black patch you see. This may or may not be painful, depending on how much blood builds up under the nail.

Blood that pools under the nail puts uncomfortable pressure on your toe. This can make it hard for you to wear normal shoes or even participate in activities in some cases. Although it’s rare, an extremely painful black nail may have serious damage to the nail bed or even the bone below. Large lacerations or fractures hidden by your blackened nail are painful and put you at risk for serious infections.

Generally, any injury to the ends of your digits can be one of the causes of black toenails, like tripping or stubbing your toe. The problem doesn’t have to be a sudden accident, though. Repetitive small injuries or pounding against the front of shoes are some of the most common culprits. This is especially true for runners and other athletes. Even footwear that is just too tight can bruise your nails.

When It’s Not a Bruise

Black Toenails: Bumps and Bruises

Occasionally, bruising is not the source of your discolored nails. There are a few other potential underlying issues, though they are far less common. Certain kinds of mold or fungal infections under your toenail can turn the keratin black. A spot of melanoma cancer can also cause the problem. Even though these are rare, it’s generally important to have your black toenails examined so these unlikely but more serious conditions can be either diagnosed or ruled out.

Taking Care of Black Nails

In many cases, black toenails are actually harmless. The discoloration eventually grows out and your toes remain healthy. Painful nails, however, will need treatment to alleviate the pressure on your digit. Dr. Darren Silvester and our team at Next Step Foot & Ankle Clinic will carefully examine your lower limbs for signs of complications, infections, or serious damage to the nail bed or bone. Then we can help you treat the problem.

For blackened nails that don’t cause pain and have no complications, you may not need care. Your nail will eventually grow out the darkened areas. Sometimes the nail separates from the toe and falls off. In those cases, you’ll need to carefully protect the end of your digit from additional damage.

If the blood under your nail has pooled painfully, however, it will need to be drained. Our staff will use a sterile needle to poke a small hold in your toenail and allow the collected fluid to leak out. The hole will be cleaned and treated to help prevent infection as well. Although rare, sometimes the whole toenail needs to be removed. This allows our team to check for and treat lacerations and injuries to the toe bone.

Black toenails are unsightly and sometimes uncomfortable, but in most cases they are not a dangerous injury. With the right care, any pain can be easily eliminated. Let Dr. Darren Silvester and our experts at Next Step Foot & Ankle Clinic help you keep your nails healthy and beautiful. Don’t wait until you have an infection to get help. Contact our office for an appointment at 210.375.3318 for an appointment.