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Relieve Smashed Fingernail or Toenail Pain

Updated on December 28, 2016
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Richard Fan is a practicing emergency/trauma physician assistant in a busy Southern California ER.

We've all smashed a finger or toe at some point in our lives. Ouch! Sometimes you can smash a digit so badly that you can see a pool of blood—sort of blood blister—underneath the nail. The injury can be so painful that you can feel every heartbeat throbbing in your nail.

So what we have to do is somehow drain the blood from underneath the nail. The following lesson is easy, safe, and simple to follow.

Why Does It Hurt So Much?

If it were not for the fingernail or toenail, the injury would probably heal within a few days, like a common bruise—and have no lasting effect or pain. However, because the tips of our fingers and toes are highly vascular, minor trauma, such as a crushing injury or a blow to the fingertip, will cause them to easily bleed underneath the fingernail. Your skin, and the anatomy of the fingernail or toenail, naturally seals that area below the nail and does not allow the blood to drain. The blood therefore pools in the nail bed, causing an increase in pressure and intense throbbing pain. This is how the fingernail or toenail becomes darkened, and you can often literally feel throbbing pain with each heartbeat.

Treatment and Expectations

Immediate treatment includes ice and elevation of the limb to minimize the swelling of the injury. Sounds easy you say? Well read on! The next part is not for the faint at heart.

If the pool of blood under the nail is painful and you can feel a throbbing sensation (your pulse), then relief can be achieved only by actually releasing the pressure. This can be done by creating a hole in the top of the fingernail itself and allowing the blood to drain. Now this may sound like the last thing you want to do to an already painful finger, but if you get in the car and drive to an urgent care center, this is exactly what they would do. The following section describes two basic ways to painlessly achieve this, one by drilling a hole, and one by burning a hole. Neither technique is more painful than the other, and they both are very easy to do.

One way to do it: The hole can be made with a jeweler's drill (a really small drill bit that you can twist by hand), or an 18 gauge syringe type needle. Clean the top of the nail off with alcohol and begin drilling the hole directly over the largest and darkest part of the blood pool. Use a quick twisting motion of the needle or drill with very little pressure. You won't feel any additional pain because the nail has no nerves in it. When you get through the nail, blood will spurt out of the hole, often with surprising force, and relief will be instantaneous. You can also try to gently squeeze out any remaining blood from the hole.

The fastest and best way to do it: The other method involves melting a hole right through the nail. Although it sounds horrifying, in my experience, it is easier, faster, less traumatic and more sterile since it cauterizes and kills bacteria with the heat. To begin, first straighten a small paperclip. Then holding it with a pair of glove or pliers, heat the paperclip in a flame until it gets red hot, and then poke a hole in the nail. You really should not have to push the paperclip, as it will melt through by itself. Apply just a little pressure, right over the darkest spot, and continue until you feel a little pop, or blood is released. You want to do this procedure quickly enough so that you wonât have to reheat the paperclip again to finish the job. When you get through the nail, blood will spurt out of the hole, often with surprising force, and relief will be instantaneous. You can also try to gently squeeze out any remaining blood from the hole.

Whichever method you choose, you don't want to go deeper than about 1/16 in. (2mm) below the nail. (Don't stress about this, just estimate it with your good judgment and get it over with!!) After you're done, soak in some hydrogen peroxide solution, repeat the soaks three times a day. This is to prevent a clot from forming and causing pressure to build up again. You might have to squeeze once or twice again, but usually, the first time does it.

Other basic urgent care and first aid techniques can be found in the 5-star rated book The American Red Cross First Aid and Safety Handbook. This book is concise, informative, and user-friendly for anyone, including non-medical people.

When to seek professional medical attention:

  • If there is any sign or symptom of infection.
  • You lose any movement or range of motion in the body part as a result of the trauma.
  • The injury appears to be worse than a simple bloody fingernail.
  • Whenever you're in doubt, it's always safest to seek medical attention.

Drill with tiny jeweler's drill over darkest part

Drill with tiny jeweler's drill over darkest part
Drill with tiny jeweler's drill over darkest part

Apply light pressue and let if flow for sweet relief!

Apply light pressue and let if flow for sweet relief!
Apply light pressue and let if flow for sweet relief!

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      Vicki Copp 4 months ago

      Happened to me this week, the pain was so bad I nearly fainted. My "surgeon" friend used a LARGE paper clip. Be SURE the clip is glowing hot so you can get it right the first time. The benefit of the scary puncture far outweighs the throbbing. WHAT A RELIEF--instantly! Thank you for this great article. I posted it on my page to inform others.

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      Dana 6 months ago

      Thank's for posting this. I crushed my big toe and within a half hour it was black and swelling up and hurting so bad I couldn't see straight. I did the heat/paper clip method. I held a paperclip with pliers and heated it with a small blow torch that I use for creme brulee. It took me 3 tries, but it finally went through and the blood did spurt out just like you described. It took about 10 minutes of pushing gently on the nail before the blood stopped coming out of the hole. It doesn't look pretty, but it feels a lot better (it still hurts but nowhere near how it did before I poked the hole). I totally recommend saving yourself a trip to urgent care and using this method.

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      Sergio Freddson 2 years ago

      These are some great tips! I'm afraid to take care of these types of injuries on my own so I usually just go in for urgent care if it gets too painful. Is this something they would do at a doctors office or is it a bit more of an off-the-wall home remedy? Thanks for sharing your experience with us, I'll have to keep this fix in mind! https://www.harrisonmedical.org/home/location/519

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      JackCool 6 years ago

      This needs to cut off the nails so that the dead wounds could evaporate.

      How do you get rid of yellow nails

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      EliteCareEmergency 6 years ago

      Wow, I didn't expect to find such a well document article on this subject. Great use of images to accompany the instructions.

      http://elitecareemergencylc.com