Brief Outline of Black Nail

A subungual haematoma is bleeding under the toenail caused by an injury or infection to the nail bed. Crushing injury is the most common mechanism for this type of injury. The bleeding under the nail causes pressure and pain to the nail bed. The pocket of blood maybe small or cover the whole area under the nail.

Anatomy and physiology

The nail protects the area under the toenail, the nail bed, but when crushing trauma, an object under the nail, or infection causes damage to this soft area, bleeding may occur. Because the nail is a hard surface, it holds the blood in and this bleeding causes pressure and pain. Depending on the initial injury, the bone underneath may also be involved.

Cause of injury

Crushing injury to the toe. Foreign object under the nail causing a laceration to the nail bed. Infection under the nail causing bleeding.

Signs and symptoms

Pain and pressure under the nail. Red, maroon or other dark colour under the nail.

black toenails

Complications if left untreated

The bleeding and resulting pressure under the nail may cause damage to the underlying tissues, killing them over time. The nail may fall off and this could lead to infection if not treated properly. If the bone was fractured during the initial injury, chronic pain may result.


Rest, ice and elevation. If the nail comes off, it is important to keep it covered and protected. If the possibility of a fracture exists, such as with a crushing injury, seek medical attention.

Rehabilitation and prevention

The nail may need to be removed during treatment, or may fall off on its own, leaving the nail bed exposed. It is important to keep this area protected to prevent infection. It is also important to protect the affected toe while it is healing. Padding over the toes may be needed. Avoiding impact to the toes and protecting them during activities will help prevent this injury.

Long-term prognosis

A subungual haematoma will usually respond well to treatment, although in cases involving more than 25% of the nail bed and pressure that is unrelieved by initial treatments, a physician may need to drain the blood from the nail bed. If an infection is the cause, oral or topical antibiotics may be required.

Call (+65) 64712 674 (24 Hour) to fix an appointment with our doctor to treat Black Toenail today.

Tur Toe

Brief Outline of Turf Toe

Tur Toe

Pain at the base of the big toe may be a result of turf toe. Athletes who jam their toe or repetitively push off when running or jumping are susceptible. Also caused by hyperextending the metatarsophalangeal joint of the great toe. The name turf toe comes from the fact that this injury is common among athletes who play on artificial turf.

Anatomy and physiology

Turf toe develops at the metatarsophalangeal joint of the great toe. The capsule that covers this joint is torn, leading to instability and pain. This can lead to dislocations, cartilage wear and eventually arthritis. The tendons that cross the joint can become involved as well. Jamming the toe, or pushing off when running or jumping puts stress on the capsule and can lead to tearing.

Cause of Injury

Jamming the toe. Repetitive pushing off the toe, especially on a harder surface such as artificial turf.

Signs and symptoms

Pain at the base of the toe. Some swelling may be noted in the joint. Pain increases when pushing off with the toe.

Complications if left unattended

Turf toe can lead to chronic pain and the inability to run or jump. When left unattended, turf toe can lead to other conditions such as toe dislocations and arthritis.


  • Rest
  • Ice
  • Anti-inflammatory medication
  • Lubricant injection to the joint

Rehabilitation and prevention

As the pain subsides, it is important to work on the strength and flexibility of the toes. Adjusting the way the pressure is applied to the foot when pushing off will also help to correct the conditions(s) that caused the turf toe. Alternating workouts from hard to softer surfaces will help prevent the development of this condition. Special inserts, which support the toe may be used when returning to activity. A gradual return to full activity is important.

Long-term prognosis

Turf toe does have a tendency to return when working out on the same surface. In most cases, pain will subside and normal function will return. In very rare cases, surgery is required to alleviate the symptoms.

Call (+65) 64712 674 (24 Hour) to make an appointment with our doctor to treat turf toe today.

Brief Outline of Sesamoiditis

The tendons surrounding the sesamoid bones can become irritated and inflamed, causing a condition similar to tendinitis. Runners, dancers, and catchers in baseball are all susceptible to this injury. Increasing activity too quickly causes additional trauma to the small sesamoid bones.

Foot Sesamoiditis

Anatomy and Physiology of Sesamoiditis

A sesamoid is a small nodular bone that is not attached to another bone, but instead is embedded in a tendon or joint. The knee cap is the largest sesamoid bone in the body but there are also two small ones in the forefoot. The sesamoid bones in the foot are located along the plantar fascia surface of the first metatarsal head, with one on the lateral aspect, and the other more medial. The sesamoid bones are spherical and embedded in the tendon of the flexor hallucis brevis. They provide a smooth surface for the tendon to travel over and help the tendon to transmit the force generated by the muscles. The sesamoid bones in the foot also help elevate the bones of the big toe and assist in weight bearing.

Cause of Sesamoiditis

Increased acitivity without proper conditioning. Little natural padding in the forefoot, leaving the sesamoid bones unprotected. High arches leading to running on the balls of the feet.

Signs and Symptoms of Sesamoiditis

Gradual onset of pain. Pain over the bone and surrounding tendon. Pain increases with activity.

Complications If Left Sesamoiditis Unattended

If left sesamoiditis unattended, this condition can worsen to the point that the pain becomes debilitating. The inflammation in the tendon can cause irritation to surrounding tissue. As with tendinitis, a complete rupture may occur if the condition is allowed to go untreated.

Immediate Treatment for Sesamoiditis

Anti-inflammatory medication or anti-inflammatory injection.

Long-term Prognosis for Sesamoiditis

Sesamoiditis responds well to anti-inflammatory treatments. Complete recovery can be expected, with no lingering effects. In rare cases where the condition does not respond to preliminary treatments, surgical intervention may be required.

Call (+65) 6471 2674 to fix an appointment to treat Sesamoiditis today.

Pain that Is Deep Inside the Big Toe Joint.

Location of the Big Toe Pain

The most common injury of the big toe is in the joint where the big toe meets the foot. Most commonly the pain is felt deep inside the joint, but there may be some tenderness on top of the joint and toe.

  • If the big toe hurts almost entirely on top, the injury is called Hallux Limitus.
  • If the big toe hurts almost entirely on top and the joint id enlarged on top with limited ability to bend the toe upward, the injury is Hallux Rigidus.
  • If the big toe joint hurts only on the bottom, is is Seasamoiditis injury.
  • If the big toe hurts on the inner side of the joint toward the other foot and there is an enlarged joint, is it a bunion.
  • If the big toe hurts at the joint near the back of the toenail, it is injured interphalangeal joint.

Description of the Big Toe Pain

The big toe pain is usually achy and starts as a dull feeling that grows.

Running and walking usually causes the pain to increase during the workouts as an achy feeling. In most cases, the pain decreases over several days of rest. The pain may be on the surface or on the joint, but it may also be surface pain or located near or on the bunion bump (if present).

Big Toe Pain that hurts with everyday activity and does not go away after resting from running / walking is more serious and should be evaluated by a doctor.


Less common is an intense throbbing pain that is especially noticed at night and is not directly related to workout, called Gout. This is the result of a process where production of a chemical that is normally present in the body, increases significantly. The big toe joint is a common target for this substance. The body then attacks the “crystals” of this chemical as if they were irritating foreign objects. This damages the normal tissue and causes pain, redness, and swelling. Any sore big toe can hurt at nigh and feel stiff upon awakening, but Gout pain is intense and increases at night.


Seasamoiditis is noted by pain on the bottom of the foot at the base of the big toe, beneath the joint, that may feel like bruising – sometimes with sharper pain qualities. Sometimes the area can swell and feel thicker. If this occurs, it is a worse injury, sometimes a fracture. See a doctor.

Causes of Big Toe Pain

Excessive pronation is the primary cause for runners. This is especially true when it occurs after the heel starts to lift – a condition called “propulsion pronation” or “late mid-stance pronation.” This often occurs inside the shoe and has no visible signs. The repetitive motion of running and walking, as the distance increases, results in irritation.

High-arched feet are more likely to put extra pressure on the ball of the foot under the big toe base. This triggers impact-caused sesamoid pain, and is not related to pronation.

Those with bunions are likely to have pain because the joint no longer works correctly. The size of the bunion is not related to the quantity of pain, however.

Gout can be triggered by the same motions that produce other types of big toe pain, but high Uric Acid levels must be present. Uric Acid is elevated by many factors. Certain foods, alcohol, medications, and an inherited inability to process Uric acid are causes.

Treatment for Big Toe Pain

  • Icing
  • Anti-inflammatory medicine
  • Anti-inflammatory injection
  • Immobilisation
  • Surgery if conservative treatments fail

When to Stop Running

The common sense guidelines apply to these injuries. Swelling, redness, inability to stride normally, increasing pain, and pain with daily activity – all are reasons to rest.

Consequences of Running or Walking Through Pain

Athletes often wait too long to seek help. The pain may be intermittent and not severe, often occurring only during longer workouts. The fear of surgery may also cause a delay in diagnosis. Unfortunately this denial allows a small progression of changes to the bones and possibly permanent damage to the joint surfaces –  when they night have been treated. At this point, the only alternative may be surgery.

There is a small but real risk of permanent damage by pushing through a singly episode of pain. Sometimes the pain begins a few days before an important race. Realistically it may be worth the risk to attempt the race but be prepare to drop out if the pain becomes too strong.

Call (+65) 6471 2674 (24 hr) to see our sports specialist regarding your toe pain today.

What is the cause of a broken toe?

You may break your toe if something drop on it or you accidentally bend it. A hairline crack (stress fracture) may happen to your toe if there is a sudden increase in sports activity such as walking or running.

What are the symptoms of a broken toe?

  • A snap or pop sound heard at the time of the injury.
  • Intense pain felt when the toe is moved or touched.
  • Swelling and bruising to the toe.
  • Deformity in the toe. E.g. toe pointing in the wrong direction or twisted out of the normal position. A dislocated toe can also look deformed.
  • Any movement to the toe can cause extreme pain.

How is a broken toe diagnosed?

An X-ray is usually recommended to detect whether the toe is broken or dislocated, and if it’s broken, the severity of the crack can be seen in the X-ray.

How is a broken toe treated?

Treatment to a broken toe depends on the severity of the break, the position of the break and which toe. Usually buddy splint is recommended, that is buddy-taped to your uninjured toe next to it. Your injured toe may need to buddy-taped for 2 to 4 weeks for the bone to heal.

In not so common cases, treatments include:

  • Using splints to stabilise the toe.
  • Surgery, if the break is severe.

If you leave the toe untreated, the fracture may cause chronic pain, limited movement and deformity.

Call +65 6471 2674 to see our orthopaedic specialist to check your broken toe today.