A year ago, I had a masked conversation with an avid runner who casually mentioned she lost all of her toenails throughout her running endeavors over the past couple decades. I reacted sympathetically, aiming to conceal my shock. In hindsight, it did not occur to me at the time that I may one day face a similar problem.
Because after one of my recent runs, I noticed one of my toes was hurting a bit. I pulled off my sock and realized blood was pooling under the nail. And as a result, the affected toenail appeared maroon. I’d come to find out that this is incredibly common among runners and often results in the loss of the toe nail.
What is “runner’s toe,” anyway?
Runner’s toe is a subungual hematoma. “Subungual” meaning under the nail, and “hematoma” referring to the pooling of blood that causes the discoloration of the nail. This occurs from trauma to the blood vessels from the repeated stress of running. The movement involved in running causes repeated blunt force to the toes, as our toes are repeatedly smashing into the “toe box” of our shoes. In turn, the hematoma (blood) build up underneath the nail can cause the nail to appear blackened, loosen, and fall off.
Symptoms of runner’s toe
Throbbing or sharp pain and discomfort
Soreness or tenderness at the tip of the toe
Red, purple or black toenails (from the blood pooling)
At the risk of sounding a bit dramatic, it is troubling to reckon with the reality that my body is temporarily disfigured due to my physical activity. On the other hand, (or shall I say foot), apparently many runners consider their first case of runner’s toe a “rite of passage.” Indeed, from the research I’ve done, some runners discuss their first case of runner’s toe with pride. Apparently for them, the ailment demonstrates an achievement, indicative of their dedication and hard work.
So whether you’re like me and mildly disturbed by runner’s toe, or you’re feeling a renewed sense of power about what runner’s toe signifies for you in your fitness journey, there are steps we can take to prevent and heal.
Check your shoes! As I have matured and worried less about the size of my apparel, I started wearing a half size larger in shoes. I realize that I hate tight clothing/shoes, and when it comes to running, a comfortable fit is vital. Our toes need plenty of space to move around in the toe box. I suggest getting fitted at your local running sports shop and investing in a pair of shoes that will support your overall health. Cheap materials won’t last as long, so in the long run (pun intended) you will end up spending $$ no matter what. Remember the literal rule of thumb—a thumb print between your toe and the toe box, at least.
Additionally, keep your toe nails short and opt for cushioned and moisture wicking athletic socks. Lastly, research demonstrates the importance of lacing up shoes correctly. Properly laced and tied shoes protect our feet from excessive trauma. Ankles too.
How to treat runner’s toe
If your runner’s toe isn’t particularly painful, it may be safe to simply wait it out and let the nail grow out for a few months. I’m no podiatrist, of course, so if you’re unsure, check with a professional. In moderate to severe cases, the blood may need to be drained. This should not be tried at home, as it may cause infection! So again, if in doubt, seek professional medical care.
Alternatively, if you’re comfortable/confident taking matters into your own hands (like me), you can try the following to help jump start your healing process:
Decrease your downhill running, as running downhill causes toes to smash up towards the toe box.
Consider taking a break from running all together. Take long walks, do yoga, or incorporate some HIIT to maintain cardio fitness during your recovery.
Try incorporating anti-inflammatory foods and supplements into your recovery plan. You can also try soaking the affected foot in warm water to relieve discomfort.
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Photo: Nathalie Desiree Mottet via Unsplash