What to do if a toenail suddenly breaks and bleeds?

Immediate Management of a Broken and Bleeding Toenail

Apply direct, firm pressure to the bleeding nail bed with clean gauze or cloth until bleeding stops, which is the most effective method to control this type of bleeding. 1

Initial Bleeding Control

• Apply continuous direct manual pressure over the bleeding site using gauze or a clean cloth until bleeding completely stops 1
• The pressure must be firm and maintained for an extended period—do not remove the initial gauze if bleeding continues; instead, add more gauze on top and apply additional pressure 1
• If continuous manual pressure is not feasible, wrap an elastic bandage firmly over the gauze to maintain pressure 1

Important: Elevation of the foot and pressure points are NOT recommended for bleeding control, as these methods are unproven and may compromise the effectiveness of direct pressure 1

After Bleeding is Controlled

Wound Care

• Cover the wound with a clean dressing once bleeding has stopped to reduce contamination risk 1
• Keep the area clean and protected from further injury 2

Cold Therapy

• Apply local cold therapy (such as an ice pack wrapped in cloth—never directly on skin) for 10-20 minutes to reduce pain and swelling 1
• Limit cold application to 20-30 minutes at a time, 3-4 times daily 1
• Ice should never be placed directly on the skin to prevent cold injury 1

When to Seek Medical Care

Seek immediate medical attention if:

• Bleeding does not stop with sustained direct pressure after 15-20 minutes 1
• The nail bed shows signs of severe damage or complete avulsion (tearing away) 2
• Signs of infection develop (increasing redness, warmth, swelling, pus, or red streaks extending from the wound) 3
• The injury involves deep tissue damage or bone exposure 2
• There is significant pain that doesn't improve with basic measures 2

Common Pitfalls to Avoid

• Do not remove the nail or attempt complex wound management yourself—this requires professional evaluation 2
• Do not use elevation alone as a bleeding control method, as it is ineffective 1
• Do not apply ice directly to the skin without a protective barrier 1
• Do not ignore signs of infection, as nail injuries can lead to serious complications including bone infection (osteomyelitis), particularly if the injury is deep 4, 3

Follow-Up Considerations

• Subungual hematomas (blood under the nail) and nail avulsions are the most common nail injuries and may require professional drainage or removal to prevent complications 2
• Inappropriate initial treatment can lead to permanent nail deformity and functional problems 2
• If the injury was caused by a puncture (stepping on a nail), this requires different management with potential need for antibiotics and close monitoring for deep infection 4, 3