bruised the entire nail of my big toe badly

by jollie
(pretoria, gauteng, south africa)

Hi there,

Yesterday I dropped the couch on my toe while cleaning. Its entire surface of the nail on my big toe is blue, its very swollen and hurts terribly, its throbbing and stings every now and again. My wedding is in a weeks time and I don't want to limp down the isle. I don't want to loose the nail since winter is about to start, and wearing a closed shoe would be unbearable. I don't have a medical aid. Tomorrow is a public holiday and also I'm a model so my career depends on my feet. Please help me, dear dr. I am situated in Pretoria.

RESPONSE

Hi Jollie,

Unfortunately what you would like and what you are stuck with may be two different situations. The fact that the nail has turned color indicates that you did enough damage from the couch that there is bleeding underneath the nail.
The problem with the bleeding is three fold. One, obviously, it hurts and unless the blood is drained, the toe may continue to hurt.
The next problem is the fact that in trauma to the nail, if severe enough, the nail loosens up from the nail bed and the nail will eventually fall off.
You want this to happen under your terms not in a situation like quickly pulling off a sock quickly and ripping the nail with it. Talk about pain!
The third potential problem is the possibility of infection. Once the nail starts to bleed underneath, it lifts the nail off the nail bed. People experience this loosening in varying degrees.
The space that is created becomes a focal point of infection, which of course then makes the matter worse.
I do not know how much force came down on the toe, but you also have to be concerned about the possibility of actually fracturing the toe.
I understand you do not have health insurance, but the smart money would be on seeing a doctor who would be better able to evaluate your situation.
Regardless of whether winter is coming, removing the nail is not a big deal. If the nail happens to be excessively loose, I am usually able to remove them without anesthesia.
Removing the nail would eliminate your pain, it would allow all the excess blood to be cleaned away thereby dramatically reducing the chance of infection.
After the nail is removed, if you start soaking the toe in a salt solution, all the moistness is dried up and what happens is that the nail bed dries out and becomes no more or less sensitive to pressure than your toes that still have a nail on them.
Since your wedding is in a week, you really need to have something done otherwise you do run the risk of limping down the aisle.
If the nail were to be removed today or tomorrow, I would think, barring any complications, that you should be able to walk down the aisle pain free with just a bandaid on the toe.
As a side note, sometimes if the nail is not too loose, the blood can be drained by drilling a hole through the nail to allow for drainage, but this has to be done soon after the trauma, because otherwise the blood begins to coagulate and it will not drain out.
Good luck.

Marc Mitnick DPM
DISCLAIMER