Black Toe Nails

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Most runners will at some point succumb to the dreaded "black toe nails", also known as "runners toe".

I am getting pretty good at spotting if someone is a runner just by looking at their feet  and unfortunately it is often not a pretty sight. Thankfully us ladies can get away with it a bit by covering our nails with nail varnish although to be honest, I can't be bothered as it tends to come off anyway with running.

What causes black toe nails?

Black toe nails or runners toe is caused by trauma and thus bleeding in the nail bed, usually caused from your toe repeatedly hitting the end or the top of your running shoe.

This happens if your shoes are too tight or too small (remember feet swell during running so always buy a size or two bigger than your normal every day shoes) or if you have significantly increased your training time or volume and your feet are not used to it. This is why people training for a marathon or an ultra often suffer from black toe nails.

Basically anything that puts pressure or causes friction on your toe nails is going to possibly cause trauma. So tight socks, too thick socks, poorly tied shoe laces or dropping something on your toe are all something to think about.

Does it hurt and how should you treat it?

The first thing that will alert you to a possible black toe nail, is soreness. As you are running, you might feel a soreness around the nail area in the affected toe and it may even feel like your toe nail is lifting up.

To look at, initially the toe nail bed will look red with visible signs of red blood  or fluid underneath the nail. The toe nail will feel sore if you press it with your finger or if you accidentally knock it.

There is no real treatment and it is really just a question of waiting. Usually after a day or two the soreness starts to reduce and after a couple of weeks, the redness under the nail turns black as the blood dries up.

In a few cases, if there is a big build up of fluid under the nail then the soreness persists. This is when you might want to see your doctor as it might be necessary to use a needle to pierce the toe nail in order to reduce the pressure, rather like popping a blister. Lots of runners have a go at this themselves but be careful as you could cause an infection.

Will the black toe nail recover?

If the whole nail bed is black, the chances are that nail will eventually fall off. The bleeding and swelling causes the nail to be lifted away from the nail bed and it won't 'stick' down again.

It usually takes 2 - 6 months for the nail to fall off and there is nothing that you can do to stop it. Whilst waiting for it to fall off, tape it down if you find it catching on your socks. Don't rush it by fiddling with it.

When it does fall off, you'll find that there is a new nail already forming underneath. Because of the damage to the nail bed, you might find that the new nail is thicker and more bumpy than before. It may also grow upwards slightly. It might resemble a fungal nail infection but usually there is no infection at all. Unfortunately because of the nail bed damage, all future nails on the affected toe are likely to be thick too.

Preventing black toe nails

The best things that you can do to prevent runners toe are:

  1. Make sure that you have the right size shoes with a decent amount of room in the toe box. How to choose running shoes.
  2. Check if your laces are too loose. Tie your laces so that your foot is not slipping forwards in your shoe.
  3. Check if your socks are too thick or too tight. In the summer, your feet will swell more so wear lighter socks.
  4. Trim your nails back regularly. Trim the nails straight across rather than rounding them as this evenly distributes any pressure on them.
  5. Keep your feet clean and let the air get to them. This will help prevent infection in the damaged toe nail.
  6. If you do have a thick nail, you could try filing it down. Soak your feet first to soften the nail, dry and then file. Do this a couple of times a week.
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