Excruciating pain in toe and then it turned blue

by Maria
(New York )

About 6 months ago one of my toenails turned blue. I assumed I had stubbed my toe. It was the summer and I wore flip flops a lot but I don't remember injuring it. My dermatologist said it was a hematoma and would take a while to heal. Last night I felt excruciating pain in that toe and it immediately turned blue. It is still blue today. I was at rest when it happened, sitting and watching television. My toe nail is still dark and now my toe is black and blue. Any explanation would be greatly appreciated.

RESPONSE

Hi Maria,

Most times when a nail turns black and blue, it is from bleeding underneath the nail. That is usually the result of trauma. Trauma to a toe comes in many forms, ranging from stubbing your toe all the way to dropping something on the toe.

Trauma also comes in the form of micro trauma. Simple walking in a dress shoe that might be slightly too small could cause bleeding underneath the nail. Walking downhill a lot, running , playing golf and similar activities can also cause bleeding underneath.

So you need to think about these other possibilities. If you cannot come up with these other possibilities as the source of the discoloration then you need to think about other potential problems.

In the course of my career I have seen hundreds if not thousands of discolored nails, the vast majority of them is due to bleeding underneath, however, most of them are not associated with pain.

What concerns me even more is the fact that last night the toe began to hurt a great deal for no apparent reason and on top of that turned blue. That does not happen from bleeding under the nail.

Additionally, if the discoloration is from bleeding underneath the nail, typically the discoloration grows out over the course of six months or so. Yours has not.

I wish I knew how old you are and if there are any other medical issues that you suffer from that may impact your problem.

If you came walking into my office, based on your narrative, the first thing I would do is to remove the nail. It can be done in the office under local anesthesia and is not a debilitating procedure. I would remove the nail so that I could inspect the nail bed, which is the skin underneath the nail. Sometimes there can be a growth of some sort that may be causing the bleeding to occur on a regular basis. In that scenario the discoloration never resolves and can actually worsen.

When there is a growth on the nail bed in most cases it is a benign growth but you have to look to make sure there is nothing more serious going on.

If the nail bed ends up being clear, the next thing I would do is take an x-ray. You can have a condition known as a subungual exostosis which is a bone spur underneath the nail pointing up to the nail. This too, can create pain underneath the nail which may not resolve itself over time.

If it turns out that you do have a subungual exostosis, this can be removed surgically and is not a large involved procedure.

On the more remote side, there is a possibility that you have what is known as as A-V fistula which in simple terms is a conglomeration of small blood vessels that are "clogged up" so to speak at the end of the toe. This could cause pain, and discoloration at the end of the toe.

In reality since I do not have the luxury of actually examining you, I have no idea what is going on with your toe, but you have mentioned symptoms that are not typical of most people with bleeding underneath their nail and for that reason I suggest you see a local doctor for further evaluation.

Marc Mitnick DPM
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