- Nail Trauma
Torn or Detached Nail Facts
- Fingernails and toenails, like hair, are composed of protein and fat and are not live tissue.
- Nails grow a bit more than one-tenth of an inch per month and require three to six months to completely regrow. (Toenails grow more slowly than fingernails.)
- Nails are produced by the nail matrix cells that reside in the moon shaped whitish area (lunula) at the base of the nail.
- If the nail matrix is not damaged, the nail is typically capable of regrowth.
- The nail protects the nail bed, the skin at the upper tip of the finger or toe.
- A well-rounded diet and good general health help to produce strong nails.
Why Is My Toenail Falling Off?
Since the nails are on the back of our fingertips and toes, they are prone to damage.
- Anyone who works or plays or runs or walks has injured a fingernail or toenail.
- Longer nails are more likely to become damaged because they can be levered off the nail bed or run into the end of an athletic shoe.
- Poorly fitting shoes are likely to injure nails through repeated trauma.
What Are Symptoms and Signs of a Torn or Detached Nail?
- Torn or damaged nails are quite apparent on simple examination. After a traumatic event, a portion of the nail or even the entire nail is no longer adherent to the nail bed. This is most often associated with a minimal amount of bleeding and a moderate amount of pain.
When to See a Doctor for a Torn or Detached Nail
Once a nail has been torn or detached, there is little that can be done to replace or repair it. The major concern is damage to adjacent structures. If there seems to be significant damage to areas around the nail, then a visit to a physician may be necessary.
- If there are any signs of infection, swelling, increasing pain, or pus that develop a few days after the injury, then a visit to a physician is mandatory.
- Occasionally, after blunt trauma to a nail, there may be bleeding between the nail and the nail bed resulting in a subungual hematoma. This can produce a very painful problem that can be quickly relieved when a doctor drills a tiny hole in the nail plate to immediately relieve the pressure of the accumulated blood.
How Is a Torn or Detached Nail Assessed?
- Generally, a visual inspection of the nail and adjacent structures is all that is necessary. Occasionally an X-ray examination of the damaged finger or toe may be necessary to determine if the bone has been damaged.
What Is the Treatment for a Torn or Detached Nail?
If the entire nail is detached from the finger or toe, there is nothing that can be done to repair, reattach, or replace it.
- If there is any damage to adjacent tissues, the nail bed, nail matrix, or the proximal nail fold that could result in scarring, this should be assessed by a physician and repaired if appropriate.
- If a portion of the nail is still adherent to the nail bed, it can be left intact. The non-adhering portion of the nail should be removed. The usual local precautions to prevent infection should be taken.
- The damaged skin should be covered with an appropriate dressing. If the nail bed and nail matrix are not damaged, the nail should regrow normally.
Are There Any Home Remedies for a Torn or Detached Nail?
- Most damaged nails do not require a visit to the physician or emergency room. If there is no evidence of tears or lacerations to the matrix or the nail bed, then simply removing any unattached remnants of the nail with a nail clipper and cleaning the nail bed with a soapy washcloth and water to remove foreign material and blood is all that is necessary.
- Any remaining sharp ends should be filed smooth so that they will not catch clothing or socks. The uncovered nail bed can be covered with petroleum jelly or neomycin ointment and dressed with a clean bandage.
How Long Does It Take for a Torn or Detached Nail to Regrow?
Fingernails grow at rate of .13 inches per month. Toenails grow more slowly, usually close to half the rate of fingernails. Fingernails can regrow entirely in three to six months. Fingers or toes that have sustained injuries that affect the nail bed and the matrix grow more slowly than unaffected nails for about three months.
What Are Complications of a Torn or Detached Nail?
If there is damage to the nail matrix, the growing nail plate will contain a defect.
- Minor damage will produce minor defects in the nail. More significant defects can result in a permanently deformed nail.
- Damage and scarring of the nail bed can produce whitish changes in the nail. This is most likely due to a lifting of the nail plate away from the nail bed (onycholysis). Sometimes a minor surgical procedure to the nail bed can improve the nail's appearance.
- If the trauma that produced the damaged nail involves adjacent structures and an infection occurs, this will require treatment with appropriate antibiotics and possibly surgical debridement.
How to Prevent a Nail Tear or Detachment
- Wearing well-fitting, roomy shoes can reduce damage to the nails.
- Limit time going barefoot, and avoid running into furniture.
- Keeping nails short can be beneficial.
- Be careful to avoid dangerous situations while the toe is healing.
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Wang, Quincy C., and Brett A. Johnson. "Fingertip Injuries." American Family Physician 63.10 May 15, 2001: 1961-1966.