Runner’s Toe: Causes, Treatment, and How to Prevent Damage

Getting a bruised or blackened toenail often seems inevitable if you’re a runner. And to some it’s like a rite of passage. But is runner’s toe preventable? Before we answer that question, let’s look at the causes, talk about the symptoms, and treatments.

What Causes Runner’s Toe?

Runner’s toe (a bruised and blackened toenail) is caused by blood collecting under the nail. Another name for it is subungual hematoma or simply bleeding underneath the skin or nail.

When you run you place a lot of pressure on your feet including your toes. Typically, your big toe will be affected because most people have a longer first toe. However, for those with Morton’s Toe or a longer 2nd toe, that’s the toe most often affected.

Risk Factors for Runner’s Toe or Bruised Toenail

While anyone who runs can develop runner’s toe, here’s when you’re most likely to develop one:

• You run without trimming your toenails – when your toenails are too long, they can hit the top of your running shoe; that pressure can cause a hematoma to develop.
• Wearing running shoes that don’t fit properly –
  • wearing running shoes that are too short - as adults we often assume our feet won’t get any longer. But many adults experience an increase in shoe size due to being overweight and/or having arches that flatten out.
  • wearing running shoes that are too big or allow your feet to slide forward (runners with narrower heels may have this problem) can also lead to a bruised toenail due to the constant pressure against the top of the shoe.
• Arches that flatten – if you’re arches flatten out when you run, in effect your shoes become too short for you. Again, this can cause your toes to jam into the top of your shoe.

Symptoms of Runners Toe or Bruised Toenail

Typically, you’ll develop runner’s toe overtime but it can also happen in one afternoon, particularly if you’re running a marathon or another long race.

Symptoms can include:

• Black, red, or purple toenail
• Sharp pain
• Swelling or tenderness on top of the toe
• Loosening toenail or toenail that’s’ about to fall off – this is caused by the buildup of blood underneath the nail
• Feeling pressure on the nail
• Blood blisters
• Trouble walking or running

Other Toenail Problems Caused By Runner’s Toe

While a blackened toenail will grow out, there are two toenail conditions you need to be aware of that can go hand in hand with this condition.

• Fungal toenails
• Dystrophic toenails

Fungal Toenails in Runners

The same things that cause runner’s toe can also cause fungal toenails. In addition to causing blood to form under the nail, repetitive pressure on the nail can also cause the nail to lift off the nailbed allowing fungus to get in and set up shop.

While a black toenail will grow out and be gone, fungus in your nails will remain and often get worse as time goes by. Fungal toenails can also be spread to others, become thick and difficult to cut, and become painful. People with diabetes who have fungal nails are also more likely to develop an ulcer.

While most people come to our clinic because they don’t like the looks of the fungus on their toenails, the reasons listed above are more important for your health.

Click here to learn more about how our office treats toenail fungus.

Dystrophic Toenails in Runners

Dystrophic toenails can develop from fungus or from microtrauma. Even if you don’t develop toenail fungus the constant pressure of your toenails against your shoes can cause them to become misshapen and thick. Many people who’ve developed this condition assume they have fungal nails. At our office we’ll test your nails to be sure you have fungus, because in runners it can be hard to tell what has caused thick, misshapen nails.

Unfortunately, even when they grow out, dystrophic toenails remain. That’s why it’s important to prevent them from occurring in the first place.

Treatment for Runner’s Toe

Normally the only thing you need to do about a blackened toenail is let it grow out. However, if your toe is swollen and painful, your podiatrist can drain the blood underneath the nail to relieve the pressure.

If your toenail starts to come off because of its blackened state, don’t rip it off. To prevent infection, go to your podiatrist office so they can remove it and bandage it in a sterile manner.

5 Ways to Prevent Runner’s Toe or Bruised Toenail

Fortunately, there’s a lot you can do to prevent runner’s toe.

1. Purchase Running Shoes That Fit

The most important thing you can do to prevent runner’s toe is to purchase running shoes that fit properly. I’ve written a comprehensive blog about “How To Buy the Best Running Shoes for Your Feet” that will help you with all aspects of running shoe purchase including size.

2. Lace Your Shoes for a Snugger Fit

Even if you do get a good fit, your feet may still slip forward particularly if you have a difficult-to-fit narrow heel. The best thing to do is to use the extra holes or eyelets found at the top of your shoe. When you use these holes, your feet will feel a lot more secure in your shoes and it will prevent them from sliding forward. This style of lacing is called a runner’s loop or a lace lock. Check out the video below.

3. Trim Your Toenails Properly

It’s important to cut your toenails straight across and keep them short enough so that they don’t extend past your toe. In addition to preventing runner’s toe, fungal toenails, and dystrophic toenails, you’ll also prevent an ingrown toenail.

4. Wear Socks That Wick Away Moisture

Wearing socks that keep your feet dry can help prevent them from shifting around in the toe box of your shoe so you can avoid runner’s toe. Decreasing the moisture in your socks will also help prevent fungal nails, as this condition loves warm, moist conditions. Check out “Best Socks for Runners and Hikers”.

5. Use Toe Protectors

You may also consider using a toe protector to prevent them from rubbing against your shoes. These are typically made out of silicon and are stretchable and cover your toes on all sides.

Other Reading About Black Toenails in Runners

Never Ignore A Black Toenail

How to Prevent and Treat Toenail Problems in Seattle Hikers

Do-It-Yourself Treatment for Toenail Loss

Need Relief from Runner's Toe in Seattle, Washington? Request an Appointment Now

Don't let runner's toe cause you to miss out on the activities you enjoy. Complete the contact form on this page or call our office, the Foot and Ankle Center of Lake City, at 206-368-7000 to schedule an appointment with Dr. Rion Berg.

Most new patients are seen within 1-2 week's time. During your initial visit, Dr. Berg will spend up to 30 minutes getting to know you, your podiatry complaints, and your goals so that he can recommend the treatment best meets your needs. Don’t wait—contact us today.

North Seattle Foot & Ankle Specialist Dr. Rion Berg offers compassionate podiatry care for all foot and ankle problems to those living in Seattle Washington and the surrounding areas. Call us today at 206-368-7000 for an immediate appointment or request an appointment online.