If you are a runner, you've likely dealt with a bruised or blackened toenail at some point in your life. While it seems like a rite of passage for some, runner's toe is not inevitable. Today we'll explore the causes, symptoms, treatment options, and most importantly, how to prevent this common problem from recurring.

What Causes Runner's Toe

First, let's talk about what causes runner's toe. Another name for runner's toe is subungual hematoma, which means blood that collects under the toenail. Running causes us to put a lot of pressure on our feet, especially the big toe. However, for those with a longer second toe, that's the toe that's most likely to take the hit.

Risk Factors for Runner's Toe

  • Running with toenails that are too long. If your toenails are too long, they can put pressure against the top of the shoe. When you run and that pressure happens repeatedly, a black toenail can develop.

Ill-fitting running shoes can also be the culprit. If your shoes are too short, your nails will also hit the top of the inside of your shoe. If your shoes are too long or your heels are too narrow for the shoe, you can slide back and forth in the shoe causing pressure on the toenail and the same problem.

  • Changes in foot structure can also be a problem if your arch flattens out while you run can cause your toes to run into the top of the shoe.

Symptoms of Runner's Toe

  • The toenail may appear black, red, or purple.
  • Sharp pain can be felt along with the discoloration.
  • Swelling or tenderness on the top of the toe may develop.
  • Loosened toenails or ones on the verge of falling off indicate a buildup of blood.
  • Formation of blood blisters, which can then cause pressure under the nail,
  • Difficulty walking or running due to the pain.

Runner's Toe Can Cause Fungal Toenails and Dystrophic Toenails

How Runner's Toe Causes Fungal Toenails

The same risk factors for Runner's toe can lead to fungal infections, namely anything that causes damage to the nail bed can allow the fungus to get in and set up shop. While black toenails will eventually disappear as they grow out or fall off a fungal nail infection will not. It must be treated. While not all black toenails will develop a fungal infection if your nails still look black or discolored back to the cuticle after several months of laying off your activities, you should have them checked for fungus.

Don't Ignore Fungal Toenails

While some people ignore their fungal toenails, that's a mistake. Fungal nails usually get thicker over time, nails can become distorted and they can become painful. Of particular concern are people with diabetes who have toenail fungus. This condition puts them at greater risk of developing a foot ulcer or an infection under the nail. Learn how fungal toenails are treated here.

How Runner's Toe Causes Dystrophic Toenails

Even if it turns out that your nails don't have fungus, the pressure on your nails that led to the runner's toe can cause them to become misshapen or thick or what we call in podiatry dystrophic toenails.

While we can eliminate fungal toenails, dystrophic nails will remain misshapen. Keeping your nails short is the best course of action in this case.

Treatment of Runner's Toe

Most of the time, all you need to do to treat Runner's toe is let the black or discolored nail grow out. Nails take about a year to fully grow out. However, if the toe is also swollen and painful, the blood may need to be drained to relieve the pressure. But don't do this yourself. Ask your podiatrist to do it.

If your toenail is loose or detached due to the damage, don't rip it off. If you're out running when this happens, use a bandage or surgical tape to keep it the nail in place to help prevent infection. Visit your podiatrist to get it removed properly.

How To Prevent Runner's Toe

Finally, prevention is the key to avoiding the discomfort of Runner's toe in the first place. Here are five things you can do.

  • First, buy the right running shoes. Choose a reputable running shoe store. While it's easy to buy shoes online or at a regular shoe store, it's important to find a store where trained experts are there to get it right. Your shoes should match your foot type and account for any problems you may have. Be sure to get your feet measured even if you think you know your size. And be sure to bring your orthotics with you if you have them. Shoes that are too tight or too long can result in damaged toenails.
  • Switch out your inserts. Even if you don't have orthotics, switch out the inserts the shoes come with for more supportive one like Powerstep, Redithotics, or Super Feet.
  • Make sure your shoes are stable. Learn how to test them here.
  • Go shopping at the end of the day when your feet are the most swollen.
  • Be sure your shoes aren't worn out or they won't provide the stability you need and support you need.
  • Buy new shoes every 500 miles.
  • Lace your shoes snugly. All running shoes come with extra eyelets at the top of the shoe. Use the extra eyelets to keep your feet securely in your shoes to prevent them from sliding forward into the top of your shoe. Learn how to do a lace lock here.
  • Trim your toenails correctly. You want to make sure they don't hit the top of your shoe. Trim them straight across to avoid another toenail problem. Ingrown toenails.
  • Buy your socks when you purchase your shoes to ensure you get the right fit. Socks that are too bulky can be problematic. Running socks should also wick away moisture to prevent toenail fungus. Avoid cotton and choose socks made of Merino wool and or combination of synthetic fibers. REI Recreation Equipment Incorporated has an excellent selection of socks for all sports and a wealth of information online.
  • Finally, toe protectors can also help prevent friction between your toes and the top of the shoe. A fabric toe sleeve that's lined with silicone can be very helpful.

In conclusion, Runner's toe is not inevitable. There's a lot you can do to prevent it from happening in the first place, but hopefully now you have a better idea what can be done to treat it. Thank you for joining me today. If you found the information valuable, don't forget to like, subscribe, and hit the notification bell for more content to keep you and your feet healthy while running.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.