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Toe nail ripped off

Discussion in 'Ask your questions here' started by NoToe, Jul 6, 2009.

  1. NoToe

    NoToe Guest


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    I was at a concert and someone jumping around landed with their weight on the edge of my big toe. It looked as if the pressure forced the nail to dislodge from the the nail bed/cuticle (I believe this is the correct terminology) at the base of the toe. I browsed some other forums which told me to try and wrap the toe and leave the nail on as long as possible to allow the regrowing nail a shield or protective layer, I was caring for it by pouring hydrogen peroxide on the nail and applying triple antibiotic ointment where i could in and around the nail, and wrapping with gauze. The nail would then ooze and bleed from the nail tear and the fluid would stick the the gauze which made replacing it painful as the nail was extremely sensitive. The injury to the toe was bad enough to where i knew the nail would not stay on long enough for the nail to start regrowing which i've read can take a year or more... after a few days of wrapping the toe i was going to a pool party and wasn't going to swim with the toe wrapped so i decided to forgo doing so to give the toe some air. At which point I accidentally kicked the back of my friends foot walking which completely removed the nail. This was extremely painful because it was within days of the initial injury. I came home poured peroxide on it and applied a ton of triple antibiotic ointment so the gauze would not stick to the raw skin. The toe was still very tender but i was able to walk around, but when i went to unwrap the toe t the end of the day the gauze had in fact stuck to the raw skin. I soaked the foot so i could remove the gauze and decided to let the foot air out over night. But when I awoke this morning the toe was killing me I took a painkiller and it seems to be feeling better as i write this post but I don't know if should continue airing it out and enduring the pain or if I'm doomed to buying a truckload of gauze and wrapping it up for the next 6 months, because the toe definitely feels better when wrapped but I don't know if this is delaying the healing process (If the toe even grows back at all).
    I live in the US have no insurance and have recently lost my job. I cannot afford to see a doctor or podiatrist so any advice I could get to take care of this as far as home treatment is concerned would be invaluable. If needed I can take a picture of the toe or lack thereof and email it but I am completely lost on what to do from here its pretty painful

    Thank you sooo much,

    Jim Giles

    jamesgiles602@yahoo.com
     
  2. FootDoc

    FootDoc New Member

    Insurance or not, responsible advice from a doctor should be offered only after a medical evaluation of your entire situation to ascertain the full extent of the injury, which may well not be limited to the nail plate, and may already involve complications. The fact that advice is offered free of charge and anonymously does not relieve a doctor from his/her ethical responsibility to first do no harm. See a podiatrist and negotiate payment terms.
     
  3. Unregistered

    Unregistered Guest

    I completely understand your responsibility as a doctor but for the time being is there any advice you can offer until i can see a podiatrist. With no income it can be difficult to negotiate a payment plan, I don't want the situation to worsen, should i continue to keep the toe wrapped or is it Ok to air it out even if it causes pain. I would greatly appreciate any advice you could give me.
     
  4. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    From my understanding of what you've posted, the proximal portion of the nail plate seemingly has popped out of the area the eponychium and is no longer contiguous with the nail matrix. If that is the case, there would be no point in attempting to retain the remainder of the nail plate as, if any new nail grows, it will not reattach to the old nail plate. I don't know how much, if any, nail plate is still attach to the nail bed by means of the hyponychium, but given time, it will generally detach with or without your intervention. It would generally be appropriate to protect it from being traumatically detached. The key to the determination of appropriate treatment depends on several factors, including what damage was done to the nail bed and the hyponychium, whether there is infection present and what if any other damage was sustained by the toe, including but not limited to fracture of the underlying phalanx. General care, which may or may not be sufficient and/or appropriate to your individual situation would probably include luke warm soaks, sterile precautions, aseptic care and a sterile dressing. Of course, it is essential that any existing or ensuing infection be properly treated and resolved. This is clearly not intended as other than a general description as to how a situation as I infer to be your case might be treated, but it is not recommended or intended that YOU employ these general instruction in lieu of advice from an examining doctor.
     
    Last edited: Jul 7, 2009
  5. Unregistered

    Unregistered Guest

    Gee... he was SO appreciative of your advice he never bothered to respond with a thank you.

    Sorry... was just browsing to see if anything was relevant to my crappy toenail, and noticed that u'd spent a bit of time responding, against your better judgement.

    You deserved a big thank you. cheers :)
     
  6. FootDoc

    FootDoc New Member

    Just par for the course. Unfortunately, more folks have no trouble replying nastily when they don't get what they want than those unwilling to offer a simple "thank you" when they do.
     
  7. Unregistered

    Unregistered Guest

    Hello Foot Doc... May I please ask a question? I too have just ripped my big toenail 98% off. It is still attatched in a tiny spot on one side but all else is detatched. The bottom of the nail has ripped out from under my cuticle and exposed a 1/4 inch point of nail that I didn't even know existed under the corner of my cuticle. It is too painful tonight for me to try to clip or finish pulling off and it was clean and I instantly pressed the nail back onto the nailbed and just wrapped it. Even looking at it made me feel like passing out. I know that tomorrow I will need to face it. Being uninsured also... I'd like to try to deal with it myself. I totally read your disclaimer and understand it and am going to phrase my question so that you don't even need to give 'me' advice.

    IF you were me........ after cleansing, and antibiotic ointment, would you keep the nail over the wound for a few days or would you cowboy up and cut it away, or even finish pulling it off? Do I try to dry out the nail bed or keep if moistened so the new nail that eventually grows will attatch itself? BTW I am 50 and slow to heal, I have RSD from a previous injury, so I really need to do this right.

    Also, I have read that the new nail often grows in badly malformed and that this can be prevented via wearing a fake nail to 'guide' the new growth. If this is true at what point would one do that?

    Thank you in advance. It hurts so bad It's all I can do to not flat out cry. I'd sure like to give myself the best chance possible of regrowing a healthy, nice nail.
     
  8. FootDoc

    FootDoc New Member

    And so you think that asking someone on the Internet who has only your description as a guide would be the one whom you would ask to ASSURE that your are doing it right??
     
  9. Friday

    Friday Guest

    Foot Doc,
    First I want to say that a heartfelt "thanks" was in order for you very responsibly lending advice.
    My question is for Home Care as well, but only temporarily. The soonest I can get in to our Podiatry Clinic is Friday - ugh! Until then I could use some simple steps to minimize the pain/annoyance of a sliced toe & partially torn toenail. Last night, I being the graceful woman I am (lol), stubbed my toe on a wrought iron table leg. I managed to do this so nicely, that the leg smashed into my big toe (leaving a 1/4 in slice on the top of my toe) and tearing the 1/3 of the right side of my toenail from its bed. I poured peroxide on it and watched the foam... now would be a good time to mention I have high pain tolerance, but a weak resolve. I have cleaned and wrapped the toe 3 times since late last night. I also managed to clip the piece of nail that was catching on the bandage and socks. Should I be applying Neosporin? Ice packs?Taking an anti-inflamatory? Should I be allowing it to get air? I called my doc first thing, but he was booked until Friday. Obviously I am anxious to have him take care of this, but until I can get into my wonderful Army facility - how can I make this a little less cumbersome & painful? I truly hope you can offer some temp care instructions... I would be beyond grateful! Sincerely, Friday
     
  10. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***************************************************
    Sight unseen, the only responsible instructions I can offer to you are to employ first aid principles to mitigate the chance of infection by using an antiseptic such as Betadine and a sterile dressing until your condition can be properly evaluated and taking OTC pain medication if needed.
     
  11. Friday

    Friday Guest

    TY! Will do the basic first aide cleaning, and dressing. No need for pain meds... the pain seems to have become minor. Wasn't sure if I should go with an actual bandage or airy gauze... opting for gauze to allow "breating". Only a few more days to go. TY again!
     
  12. isabelle

    isabelle New Member

    My experience with this: I was backing up my moped and forgot to put the kickstand up. It went under my big toe nail and popped it off except for one corner. I kept a bandaid on it for a week. But tried to go swimming and that didn't work, my nail was flapping around - ouch! I had a friend with a pair of pliers yank off the nail. It was gross - the first yank didn't do it but he followed up quickly with a harder yank and twist. :eek: It never gave me any troubles.
    I would say to anyone using peroxide, it might not be the best idea - but check with your dr. And while my injury worked out, I didn't have any other health issues and I was living on a relatively secluded island so didn't have much of a choice in treatment.
     
  13. colorado mom

    colorado mom Guest

    I did this 4 weeks ago, moving a couch. My toenail was like the open hood of a car... one of the most painful things I've ever done! It happened late at night, and I wasn't going to the emergency room over a toenail, but I couldn't sleep with it sticking up. I soaked it for a couple minutes in a mild soap and water solution. At first I tried to pull it the rest of the way off, since it was barely hanging on. When that was too painful, I just pushed it back down, covered it with neosporin and a couple of bandaids, and wrapped the toe up. I almost couldn't sleep that night from the pain. However, when I went into the doctor the next day, it looked much better and had gone nicely back to it's correct place. The doctor told me REMOVING the toenail is not recommended unless infection is present. Even when the toenail is entirely removed, they often recommend placing it back over the empty nail bed to protect that extremely tender area. So... the doctor told me to leave it alone, soak it for several minutes once each day, and keep it covered and wrapped up with neosporin and non-stick guaze pads with tape. After 4 weeks, I can attest that that was terrific advice! It practically re-attached to the nail bed and was pain free after only a week or so. I do give it air each day, and I am sure that I will lose the toenail, but I can see that a new one is growing underneath.

    Just keep in mind that if it ever gets red or looks infected, you should see a doctor in person.

    I only have one other thought for the foot doc who responds to these posts. I'm sure your advice would be more well received if people could understand it. When you talk to patients in person, I'm sure you use simpler language. You would be doing the public much more good if you could tone down the doctor speak and write in plain, practical, layman speak. Thank you anyway, though!
     
  14. FootDoc

    FootDoc New Member

    I cannot recall any occasions when my advice was not well received because of the medical terminology employed. To the contrary, I have found that most folks seem to consider the details in my posts to be quite thorough and succinct. Medicine requires specificity of language, and lay language almost never reflects the specificity which I must employ in short encounters such as are necessary here. There are no adequate and clear substitutes for using terms such as proximal, distal, eponychium, hyponychium, phalaynx, etc. Any term not understood can easily be clarified with a simple post to Google, and perhaps the questioner is all the better for having looked it up. Whenever I read even a book, I generally have a dictionary at my side to educate myself to the occasional word which I did not know. Try it, you might like it.
     
  15. scarletrs

    scarletrs Guest

    I recently ripped my big toe nail off last week. I wall sliding our dog crate toward me and it hit my toe.
    I bent down and I felt the toe was out of the bed. Didn't take my sock off till 5 am and saw how bad it was.
    I called my friend who is a nurse and I told her what I did when I talked to her at 5am I was going into
    Shock so she came and took me to the er. I had thought they were going to remove it but they didn't.
    He said he would be numbing it and drilling holes in the toe nail and stitching it back on. He said they
    Do this because the nail bed needs to be protected in order for the nail to grow back.
    He said that sometimes when they don't protect the bed the nail doesn't grow back.
    It has been a painful injury my toe is still swollen a lot and the stitches come out on Tuesday.

    I have been soaking it and changing the bandage wchich is painful I recommend neosporian with the
    Pain control. I have no idea how I am to put a shoe on next week with the pain.

    I know I will be more careful so this doesn't happen again
     
  16. Unregistered

    Unregistered Guest

    A few years ago, I stubbed my toe and partially ripped the toe nail off. I couldn't believe how much it hurt. I called my primary doctor who was just getting ready to leave for the day. He waited for me to come over. He looked at the toe and said that the nail bed was involved. He cleaned and wrapped it up and gave me the names of a few local podiatrists. It was Friday late afternoon and I didn't want to wait in pain until Monday so I called three podiatrists until I found one who agreed to wait for me. He had to numb the foot and remove about 3/4 of the nail. The podiatrist said that it was a good thing that I came in to have the injury addressed. A new nail grew in with no problem. When I had the misfortune of dealing with plantar fasciosis a few years later, there was no question who I called first.
     
  17. Unregistered

    Unregistered Guest

    yep, i just did this myself....happens all the time. i currently have one unattached on the two sides but not the cuticle. ouch. my nails are what one podiatrist referred to as "pincher nails". they grow real funky upwards and form little tents so to speak. the big toenails, if looking down at them with them pointed up to you, form a "6". it's crazy. makes cutting them a living nightmare only because it's so painful! i'm only 33 and he told me they were more associated with the elderly. who knew? never been able to get them looked at and i have no insurance so i keep a full stock of these supplies all the time. hmm...now i just gotta figure out if my feet can withstand a ny winter in sandals...lol
     
  18. Unregistered

    Unregistered Guest

    I did this first time 18 years ago in a very nasty accident with ocean sand ground into the wound and stitches required at the ER, but with care the nail grew back beautifully. Now I've done it again to the same toe without so much trauma and pain. I soak twice a day in warm water & epson salts, then apply triple antibiotic and non-stick bandage. One great trick I learned from first time around is buy a cheap pair of sneakers, laced then, velcro ones now, cut out the toe and tounge and make yourself an inexpensive shoe that protects the foot but allows the toe to be free from any pressure. Especially since it is still cold out with socks it's better than sandals. My first instinct was to head to the dr or hosp but so far am managing well myself. At the first sign of any infection though I'll head right to the doc. I have other conditions regularly monitored so will see him anyway within 3 months and can check my progress with him then.
    Good luck with yours.
     
  19. Unregistered

    Unregistered Guest

    I am waiting to get into a Dr. to have my toe checked out. I had a sandal break on basalt and managed to rip off my toenail and a pretty good chunk of flesh below and to the side of the nail. It happened on a river trip several days ago and I am just getting in from the back country. My question is shouldn't it hurt? I kayaked everyday and it only had mild discomfort if I had a shoe on. I have a pretty good divit in my toe now and everyone seems to think I should be misrable but on a scale of 1 to 10 I might give it a 2 tops. Is it possible I did some sort of nerve damage or are these injuries not very painful some of the time?
     
  20. MalMal4eva

    MalMal4eva Guest

    Ok so I just recently got out of a cast because I had surgery. I was born with bilateral clubbed feet, the doctor said it was the worst case he had ever seen, and so now I have two toes that are turned sideways, my pinkie toe and the toe to the left of that, which apparently means those toenails grow supppppper slow! So just today I pulled off my pinkie two because something seemed wrong, like it was bumpy and I was only trying to pull off the bumps but it pulled the whole nail. I got only half off. And its very painful. I know I should keep it out in the air and not wear shoes and stuff but I'm supposed to wear a brace full time! And I would like my nail to grow back as soon as possible. Any tips? Thank you:)
     
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