Trauma resulting in subungual hematoma in specific toes is more common in certain sports than others. Sports that require frequent, abrupt stops and quick pivoting, such as basketball, tennis, squash, and racquetball, can lead to hemorrhage of the lateral nail bed because of jamming of the toe into the front of the shoe. Soccer and football players are more likely to develop hematoma in the nails of the second and third toes because of the way they kick the ball. Keeping the nails trimmed will help prevent trauma that can damage the nail bed. The treatment of a rapidly expanding subungual hematoma involves puncturing the nail plate with a hot, pointed instrument such as a thermal cautery unit, heated paperclip, or a drill designed for this purpose.
Observation is appropriate for less acute cases.
A significant percentage of patients who have a subungual melanoma have a history of trauma, so a history alone is insufficient for diagnosis. If the cause of the nail discoloration is in question, a biopsy is mandatory. Splinter hemorrhages, which look like what the name suggests, may also be a manifestation of acute trauma to toenails and fingernails, though they are more common in fingernails. They usually arise from a single blow but can also result from repeated minor stresses. Keeping the nails trimmed can help prevent these hemorrhages.