What causes redness around the nail after a toe injury?

Question

Hi doctor,

A suitcase was dropped on my big toe, causing the area under the nail to turn completely blue, while the skin around the nail was red. It is tender but not extremely painful. I am concerned that the redness might indicate an infection. Should I be worried, and what steps should I take to prevent or manage a potential infection?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is good that you saw a doctor and that they did not see signs of infection at the time. However, since you are noticing increasing redness around the nail, it is important to monitor it closely.

Possible explanations for the redness:

Normal healing response – Some redness and tenderness are common after trauma, especially within the first 24 to 48 hours.
1. Subungual hematoma (blood under the nail) – The blue color is likely trapped blood, which can put pressure on the nail and surrounding skin.
  1. Inflammation vs. Infection –
    1. Inflammation: Mild redness, warmth, and swelling that improves over time.
    2. Infection: Worsening redness, spreading warmth, pus, increasing pain, or fever.
      
      What you can do now
      1. Elevate and ice – Keep your foot elevated to reduce blood flow and swelling. Apply an ice pack (wrapped in a cloth) to the affected area for 15 to 20 minutes every few hours to minimize inflammation and discomfort.
      2. Keep it clean – Gently wash the area with warm water and mild soap to prevent infection. Pat it dry carefully, but avoid soaking your foot for now, as excessive moisture can slow healing.
      3. Apply antiseptic – Use an antiseptic solution like Betadine (Povidone-iodine) or an antibiotic ointment such as Neosporin (Bacitracin, Neomycin, and Polymyxin B) to prevent infection. Cover the area lightly with a clean, breathable bandage. Kindly consult your doctor and take medicines accordingly.
      4. Wear open-toe or loose shoes – Choose footwear that avoids pressure on the injured nail to reduce irritation and promote healing. Sandals or loose-fitting shoes are ideal until the nail feels better.
        
        Signs you should see a doctor again:
        
        Redness keeps spreading or becomes warm and swollen – This could indicate cellulitis (a bacterial skin infection) or worsening inflammation.
        
        Pus or drainage starts coming from around the nail – This is a sign of paronychia (infection of the tissue surrounding the nail).
        
        Severe throbbing pain or increasing tenderness – Persistent or worsening pain may suggest a deeper infection or damage.
        
        Fever or chills – Systemic symptoms could indicate that an infection has spread beyond the nail area.
        
        The nail starts lifting off or a dark area spreads under the nail – This could point to a subungual hematoma (blood trapped under the nail) or potential nail bed injury.
        
        If the blue area (blood under the nail) is large and very tight or painful – A doctor can perform trephination (draining blood by making a small hole in the nail) to relieve pressure and pain.
        
        Since it has only been a day, your symptoms could still be part of the normal healing process. However, keep a close watch on the redness and any signs of infection.
        
        I hope this helps.
        
        Kindly revert so I can assist you further.
        
        Thank you.