Tennis Toe – What Does It Mean? Prevention & Treatment

Tennis toe is an extremely painful condition of big toe caused by the collection of small to large hematoma under the nail of toe. Also known as subungual hematoma, skier’s toe and runner’s toe.

The most common cause of tennis toe is repetitive injuries or blunt trauma to the big toe and that is why it found to be occurring more commonly in athletes.

In response to an external trauma, capillaries underneath the area of trauma get ruptured and leads to blood collection underneath the skin. This leads to the blackish discoloration of skin.

Same mechanism occurs in subungual hematoma, when big toe gets repetitive trauma it leads to collection of blood under the nail plate.

This collection of blood further causes blackish discoloration of toe nails.


The most common causes of tennis toe includes:

  • Repetitive trauma
  • Ill-fitting shoes
  • Repetitive involvement in stop-and-start action sports


Trauma is the most common reason behind the tennis toe.

People who tend to walk barefoot and athelets are more prone to develop subungal hematoma because of repetitive trauma, friction or pressure on nail plate.

Suddenly stopping or changing the direction while running or walking can expose big toe to sudden trauma.

Usually this happens while playing the tennis, so it is known as tennis toe.But it can also occur in other sports like in football, basketball, skiers & runners.

Ill-fitting shoes

ill-fitting shoes can also be a reason behind this condition.A

thing called ‘Toe Box’ from our shoes can put pressure on big toe or may develop friction leading to runners toe.

Symptoms of Tennis Toe

The common symptoms of tennis toe includes:

  • Throbbing pain in toe
  • Discoloration of nail bed
  • Feeling of pressure build up under nail
  • Often found in big toe

As per the AOCD (Amercial osteopathic college of dermatology), early symptoms of subungal hematoma includes the onset of throbbing pain near the nail bed of toe.

Often, person suffering from tennis toe feels that there is a pressure building up under the nail of toe. It is caused due to the pooling of blood from the surrounding ruptured capillaries.

Accumulation of blood under the nail plate, occupy the space and start to put pressure on surrounding tissues which leads to throbbing pain.

Black discoloration of nail plate is marked sign of skier’s toe.

Blood collection either gives rise to red, purple or blackish discoloration to the nail plate.

Diagnosing tennis toe

Usually, a visual inspection is sufficient to diagnose the tennis toe. Your doctor of health care provider will inspect the nail bed and will look for the signs of recent trauma.

If the nail bed has blackish discoloration and you recently injured your toe then doctor will diagnose the subungual hematoma. He may ask for an x-ray to see if toe bones had any fracture or not.


Tennis toe caused by minor injury does not cause any serious problem and home remedies like ice application can help to reduce the pain while injury heals.

As suggested by the AOD, RICE method that includes rest, ice application, compression and elevations of affected leg can help in faster recovery.

RICE method includes –

  • Rest – Reduce the use of affected toe and provide sufficient rest.
  • Ice – Apply ice pack to the affected nail and surrounding area for 15 minutes. 2 to 3 times a day.
  • Compression – After injury apply immediate pressure to affected toe to reduce the bleeding underneath the nail bed.
  • Elevation – keep the affected leg elevated to reduce the swelling.

Conservative Measures

In the mild cases where pain is tolerable, conservative treatment can be used.

Like, using antiseptic to clean the toe and dressing will be applied to heal faster by preventing bacterial infection.

In mild cases nail plate will fall off or will be replaced by new and healthy within few weeks or couple of months.

Toe nail Removal

If the case is sever and infected or having bleeding along with other sign of inflammation like prominent swelling then your doctor will remove the nail under the anesthesia for proper examination of nail bed.

Doctor may create a small hole through the nail to remove the hematoma and relieve the pressures & throbbing pain.

How to prevent subungual hematoma?

  • Keep your toenail clean and trim them regularly.
  • Don’t let them grow beyond toe level.
  • Use good fitting shoe.
  • To avoid friction and pressure trauma use a shoe that have wide toe box.
  • Avoid walking on hard surface without shoe.
  • Barefoot walking or running can lead to tennis toe.

Pictures of subungual hematoma

Images: Wikimedia commons

Runner’s Toe FAQs

What is a runner’s toe?

The runner’s toe is one of the common condition seen in the athletes which leads to the big toe pain with reddish-blue or black color discoloration under the nail.

Usually, it is caused by the repetitive trauma while running. This traumatic injury result into bleeding & pooling of blood under the nail of big toe.

Is Runner’s toe painful?

Yes, runner’s toe often leads to the throbbing pain due to increased pressure under the nail bed of big toe. Repetitive trauma to the big toe causes bleeding underneath the nail which occupy the space under the nail and causes pain

How long for tennis toe to heal?

Usually, tennis toe takes few weeks to heal and can be managed at home using the OTC pain relieving pills and self-care. Tennis toe may have throbbing pain and nail will turn into various shades of blue and will eventually fall off.