Somehow my bare feet got tangled up in my down comforter that was partially hanging off of the bed, causing me to trip and fall. The peculiar way that the material latched onto my right foot caused me to fall forward on the big toe. I heard a "crunch" sound and immediately knew this wasn't going to be a simple toe stubbing incident.
The pain was significant, but not unbearable. I could see blood forming at the base of my nail bed. I quickly hobbled over to the kitchen, put together an ice pack, and applied it to the toe. I figured if anything, it would be best to keep any swelling down.
There wasn't a lot of blood, but applying any kind of pressure to the nail would cause blood to seep out from under it, enough to soak up a paper towel pretty good. Even two hours later, there's still fresh blood pooling behind the nail. Once the pain receded enough, I took off the cold pack to make a visual inspection. No noticeable swelling. The nail is still attached, but there is an obvious gap at the nail bed--this nail is definitely done for. Using my fingers, I gently tried to flex the toe knuckle. It would flex without any pain. There was a slight "click" noise, though. But overall, I did not feel any abnormal pain.
So, I'm hopeful that I may have escaped a broken toe problem. Are there any telltale signs to look for? There's also this ugly issue with the nail. I'm assuming it best to just leave it as-is, let it heal and eventually fall off. Is there anything I can do to promote the healing?
Well, I went to the doctor. And thankfully, GOOD NEWS!
When the big toe is hyper-extended at the outermost joint, the nail can snap off from the nail bed. The ligaments and cartilage are highly resilient and can endure a hyper-extension of this nature. What becomes more of a problem is when the extension is extreme, bending all the way back to the top of the foot. This requires a significant impact, usually in an accident or sports incident.
Anyway, my doctor removed the nail in order to give the new nail free room to grow, plus alleviate undue pressure from the dead nail that is usually pressed upon by footwear. There was no sign of other damage. No torn ligaments, no broken bones. Thankfully I escaped more serious injury. The prognosis is that the nail will be fully grown in about 8 to 14 months.
It is now slightly more than 4 months since the accident. It was a very good idea to have the toe nail removed, as leaving it in place would have impeded growth, as well as been painful when wearing shoes.
When a toe nail is removed, the entire nail bed is exposed. The nail "matrix" is below the cuticle line and is where the new nail will grow from. I had expected that the nail would start behind the cuticle, but this is not true.
After my toe nail area healed, to the point where the scabs wore down and crumbled away, I noticed a small band of it remained next to the cuticle. It was a different texture than the scab area, appearing more hardened. I soon realized that this was the new nail forming.
For nearly two months after the scab was gone, this "nail starter" part did not move. I began to fear that something went wrong and that my nail would not be regrowing. However, it has started to show signs of growth. Also, because of the scabbing that was in place before, the surface was not smooth. It was actually a bit jagged. So, I took out a nail file and smoothed it down somewhat. It is still raised a bit more than the nail was originally, but is less than it was before. It looks to me like in time, as the nail grows out, it will lie more flush to the nail bed. Thankfully it looks like the growth rate is good and that I should expect a full nail back in place by next December.
When I dealt with the doctor and asked about what to expect in all this, he couldn't provide me this level of detail. Nothing said about how the nail reforms, when I will start to see signs of it growing, and what I might do to help it (like filing it down to help prevent it from getting snagged). So, I've posted here in case anyone has suffered the same fate and wants to know what will happen. For each person, the experience may be slightly different. I have heard in some cases where the nail matrix is badly damaged, the nail can't grow back properly and may actually cause pain later... and in those cases, the nail matrix is cauterized to prevent re-growth. The good thing about a big toe missing the nail is that it's not very eye catching. However, from a practical standpoint, that toe is more vulnerable and so extra care should be taken.
I've also upped my protein intake, which seems to be helping. Eggs are a really good source, although be careful not to eat too many yolks (it has a fair quantity of the "bad" cholesterol, along with the good, so don't consume too much). I've also gotten into the practice of flexing my toe joint. It was painful to do it in the beginning, but gradually I'm seeing flexibility return. Strength has returned as well, but not as it was before. I expect it won't ever be quite the same, but as long as it isn't a significant difference that's OK. I was able to comfortably resume jogging about 3 months after the toe nail removal.