Monthly Archives: August 2012

The bane of Black Toenails and how to deal with them


For those who did not read the title carefully, this is not a post about how to cure black-toenails but rather this is a post about how to deal and manage black toenails once you start having this problem. You will feel nice to know that black toenails are a fairly common problem for long distance runners.

There are two types of black toenails, the first is when you get toenails which turn black and fall off after a while (sometimes they don’t turn black completely) and the second when the black toenails are accompanied with pain and swelling and at times oozing.  If you have the first type of toenail problems you are lucky, just ignore the nails and learn to accept the issue. Maybe you should buy some black nail polish and paint all the nails black so that your feet look pretty 🙂

If you have the second problem though, that is, black toenails with pain then you will have to start dealing with the problem.

First why does this condition happen – well primarily because the toes are banging the front of the shoe when you run (the foot slips in the shoes and also expands) OR they are rubbing against the top of the shoe because you flex your toes up while running OR they are banging the bottom of the shoe as you bend your toes down while running (you may also have “hammer” toes). Over a period of time the banging causes blood to accumulate under the toenail, which clots and turns the nail black (actually the black is below the nail). The trauma also causes the nail bed to separate and eventually the nail falls off on its own or can be cut off since it is all dead anyway. You will then grow a new nail and the cycle will repeat. The accumulated blood pressure under the nail and at times surrounding tissue causes the pain.

Which toe nail turns black or how many would depend on the structure of your foot. For most people it is the large toe since that is the longest, however for about 25% of the population the largest toe may be the second or third one and they will find the black toenails there.  I personally have a non-painful first toenail issue and a very painful second toenail issue in both feet.

After a very long run or a marathon if you have painful black toenails and want immediate relief you will need to release the blood from under the nail and surrounding tissue. That either means a visit to the doctor to drill a hole in the nail or if you are the non-queasy kind you could heat up the pointy end of a pin (a safety-pin works well) and simply use it to make a hole in the nail and release the pressure of the blood below. If you have inflamed tissue then heat up a knife and create some cuts to release the pressure. Make sure that you sanitize your hands before this and that you apply an antiseptic ointment to the toes afterwards (Betadine works well). Avoid wearing shoes/socks for a few days and stroll around in open sandals or flip-flops instead.

Ok now that we have the “first-aid” done lets look at the long-term management of the condition. There are several things that you may need to try before you may or may not reach a “solution” –

  1. Buying a shoe which is 1/2 or 1 size bigger than your current shoe would help by creating more space for the toes to expand when the foot strikes the ground and/or when the foot “grows” by a few centimetres when you run long. The bigger shoe will give it space to grow. Most people have nail issues only on runs longer than 18-20kms
  2. Since you may have already bought a nice new shoe, one way to create more space inside it is to simply remove the insoles. This will reduce cushioning slightly but will improve space dramatically. Make sure you run with socks otherwise the seams may cause chaffing.
  3. Also buy slightly bigger socks to go with bigger shoes. Avoid cotton socks buy synthetic, moisture wicking running socks. The Injinji toe socks definitely help.
  4. One issue with bigger shoes (and also in general) is foot slippage which causes the front to rub against the shoe. To keep your heel and foot from slipping forward in the shoe use this lacing technique and make sure you pull the laces tight. When tying laces place your shoe at a 45 deg angle so that the foot is firmly at the back of the shoe. This will help a lot. http://www.fieggen.com/shoelace/locklacing.htm
  5. Give your toe some added protection – use some 3M doctors tape to wrap the toe and nail or better still use J&J Dynaplast tape (cut a strip) and also put a gel toe cover (I am not sure if you will find this in India). However these will only help a little bit. You can put an egg in a whole lot of protection but one hammer blow will still break it !
  6. While running we tend to either curl down or flex up our toes. Both will cause constant banging/rubbing on the toes. Try to run with the feet open and relaxed (easier said than done!).
  7. Applying some Vaseline/Petroleum jelly to the toes helps. Although I am not sure why. Maybe it helps prevents friction between toe and shoe upper.
  8. If you reduce your running volume that will definitely help. The less trauma the less problems !

Well that’s it folks. Hope some of this helps in relieving your pain. I used to have really bad nail issues but a combination of all the above has helped me manage it so that the pain remains bearable.

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