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Looking for information on a nail bed disorder.

Discussion in 'General Issues and Discussion Forum' started by JamesSainter, Mar 9, 2013.

  1. JamesSainter

    JamesSainter Member

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    Hello, I start all of my posts by saying that I am a first year Podiatry student and this is no exception. As I have only been studying podiatry for such a short time my knowledge is limited so I thought this would be a great place to ask for advice.

    One of my friends has asked me what is wrong with his toes and id like to help. On his right 1st the nail bed is completely black. It looks as if he has banged it extremely hard and it is bruised. I can rule this out though as it is very similar on the left 1st. On his left 1st it is only bruised on the lateral side of his nail bed, it does not go all the way to the luna or the free edge.

    I am taking a guess on it being some form of vascular disorder but really dont know. :confused: I asked if his feet are usually cold and he said they were in the summer but not so much now.

    Can anyone think of any cause or suggest other questions I can ask, any help would be greatly appreciated.
  2. linda.j

    linda.j Member

    Are you able to post a picture?
  3. W J Liggins

    W J Liggins Well-Known Member


    In addition to the suggestion of posting a picture can you please give a history ie. age, sex, nature of condition, duration, onset, course, aggravating factors, any treatment thus far, social history, family history, medical history, footwear, foot function, any foot pathology, vascular condition (and history) and brief neurological status?

    In addition to assisting your colleagues to help you, this (slightly abbreviated) methodology will stand you in good stead for the future.

    Bill Liggins
  4. JamesSainter

    JamesSainter Member


    Hey guys, I have taken a photo and asked for more background.

    Started: Dec 2012 (4/12 ago)
    Health: Usually very fit and healthy, although is an occasional smoker. Possible blood pressure issue?
    Other pathologies: Had partial nail evulsion when he was a kid, nail spike present on L1st.
    Complaint: When it first started there was pain on nail bed when walking but pain no longer present.

  5. citychiropody

    citychiropody Member

    I'd say that's it almost certainly trauma about 2 months ago
  6. blinda

    blinda MVP

  7. JamesSainter

    JamesSainter Member

    I thought it was a Subungual haematoma but what I'm not sure about is the cause? I understand there are many forms of trauma but what could it be in this case?
  8. thekwie

    thekwie Active Member

    If he is a runner, tennis player, football player etc, or even went on a big hike, any of these can cause trauma without there beoing a single "bog knock" to the nails.
  9. thekwie

    thekwie Active Member

    Big knock. Too early on a monday.
  10. Ros Kidd

    Ros Kidd Active Member

    Certainly looks like a subungal haematoma but without a history of localised trauma then it may need more of an eye keeping on it. Rare though it is occasionally melonoma's do occur at this location.
  11. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    A long finger first, is of easy trauma.
    The nail plate very long, very short shoes, or down mountains is the most common.
    To climb mountains, loose shoes, to lower them, tighten your laces.
    Before walking, properly cut your nail plate
    Last edited: Mar 11, 2013
  12. JamesSainter

    JamesSainter Member

    Thanks a lot, i will have another chat and see if i can determine the cause.

    One thing no one has commented on is the fact his toes used to be very cold. Would the poor blood supply make it more susceptible to trauma?
  13. Billquiet

    Billquiet Member

    Hello JamesSainter,

    There is a particular fungal organism that causes this discolouration. It is called Trichophyton Tonsurans and has a distinctly black appearance which will mimic the appearance of a subungual haematoma. Having said this I agree with the others that say the most likely reason for the discolouration is trauma.

  14. blinda

    blinda MVP

    Nail infections caused by Tri tonsurans are extremely rare. Genetic variation of dermatophytes tend to render them location specific and Tri tonsurans is usually peculiar to tinea capitis.

    Five-Hour Diagnosis of Dermatophyte Nail Infections....
  15. Peter1234

    Peter1234 Active Member

  16. DActon

    DActon Member

    Not only am I a podiatrist, I play rugby and had a siimilar problem about a year ago. It was trauma though at the time had no real discomfort!
  17. David Smith

    David Smith Well-Known Member

    What about Aspergillus Niger nail infection?

  18. blinda

    blinda MVP

    What about it? ;)
  19. David Smith

    David Smith Well-Known Member

  20. blinda

    blinda MVP

    I dont think it is a fungal infection of any sort. Dermatophytes, yeasts and moulds can only gain entry through a compromised nail plate. That is, Distal and lateral subungual onychomycosis (DLSO), Superficial white OM (SWOM), and least common, Proximal subungual onychomycosis.

    The pics dont present as any of those, IMO. Microscopy & culture could prove otherwise, but I doubt it.

  21. JamesSainter

    JamesSainter Member

    Thanks for the responses, i feel that it is trauma but wonder if anyone can explain the cause of the trauma. He does not play sports but walks a little bit, how can trauma suddenly occur when there is no changes in footwear/lifestyle?

    no one has really mentioned the cold toes. how can a lack of blood supply cause subungual haems? is it similar to chilblains with a buildup of toxins?
  22. blinda

    blinda MVP

    Hi James,

    Repetitive micro-trauma from ill-fitting or inappropriate footwear from `walking a little bit` can induce subungual haematoma.

    Unless your friend has an underlying systemic condition, the cold toes are irrelevant. (I had them yesterday, Iceland was warmer apparently. Wearing snow boots today) Poor circulation would not cause a collection of blood to form underneath the nail.

    Out of interest; who taught you that perniosis are associated with a build up of toxins?

    Good luck with your studies :drinks

  23. blinda

    blinda MVP

    Just spotted this. Yep, that`ll do it.
  24. thekwie

    thekwie Active Member

    Yep, Blinda, sometimes our typos are more entertaining if we leave 'em and correct 'em in the next post!
  25. blinda

    blinda MVP

    It`s Ok...

    No-one`s perfect

    Did I mention I`m seeing these guys on the 22nd?


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