by Dr. Brant McCartan
It’s easy to pick out the runners come sandal season. Blackened, discolored toenails are prevalent at pools and beaches. Subungual hematomas are caused from downward pressure or horizontal separation of the nail plate from the nail bed. Luckily, these are not painful most of the time, but if they are, the slightest touch can be severe. Contributing factors are downhill running and ill-fitting (too small or too big) shoes. Hammertoes may be more susceptible, and runners with a hypermobile first ray may compensate with the lesser toes gripping the ground for support. Also, some runners toes are dorsiflexed, or lifted, during gait, and can catch on the seam of the toe box of the shoe.
How do you prevent runner’s toe? The answers can be simple, starting with proper shoe gear and nail maintenance. Nails should be well trimmed, and not left too long. If abnormal, they can be taped down during runs. A shoe that is too small will increase likelihood of the nail catching on the end of the shoe. Shoes that are too loose leave room for the toes to thrust forward and jam into the end of shoes. Before and after each run, shoes should be tied and untied – don’t slip them on and off. If you are between sizes, there are some lacing tricks such as using those top holes in shoes and lacing under the upper loop can help stabilize the foot and prevent forward thrusting of the toes into the toe box. This and others can be found on the AAPSM website. Lastly, avoid downhill running until the pain subsides.
Treatment for runner’s toe depends on if you are in pain. If you are in severe pain, the blood trapped between the nail and nail bed should be drained. If there’s concern of a severe nail bed laceration, or distal phalanx fracture, it may be beneficial to remove the nail and repair the nail bed. If it is not painful, it will heal on its own as the nail grows out (typically around one mm/month).