Black Toe Nails

Black Toe Nails – is my toe going to fall off?

  • Contributed by Dr. Darrin Bright. Medical Director for MIT & OhioHealth Max Sports Endurance Academy

  • I vividly remember traveling home from the Chicago marathon when I received a frantic text message from one of my patients.  I had seen her earlier in the week and I knew she was running Chicago as well.  Her message said “foot pain, can’t walk c u soon.”  I immediately thought she had suffered a stress fracture or perhaps a more traumatic injury to her foot.  Fortunately, when I returned her call I was comforted in knowing that it was a black toe nail.  I knew this was something she would recover from quickly with some very simple measures.

    Black toe nails are another rite of passage for the marathon or half marathoner.  It is very much debated among fellow runners, running shoe experts, and physicians what causes black toe nails.  Some believe it is the repetitive trauma of the toe nail repetitively impacting the front of the shoe’s toe box with each foot strike.  Others believe it is the constant friction and pressure that develops between the top of the nail and the roof of the shoe.  Others believe it is a sheering forces between the tissue under the nail bed and the toenail as your foot strikes the ground.  My opinion is that all these factors play an important role in the development of a black toe nail (aka subungual hematoma in the medical word).  The reality is that for whatever reason, the trauma to the nail leads to bleeding between the nail and the nail bed.  The tissue underlying the nail is very sensitive and not very accommodating to this collection of blood – the result is a painful black toe nail.  Draining this collection of blood can provide immediate relief.  Some people advise heating a paperclip over a flame and then pushing the paperclip through the base of the nail.  I find this method to be very painful because it requires significant pressure on the already painful nail.  There are other methods that can be employed that are much more humane.  If you develop a black toe nail I highly recommend seeing your physician to have it drained.  The sooner the better – after a few days, the blood collection becomes more solid and won’t drain nor provide the relief you desire.  Prevention is key.  I find that increasing the size of you running shoe by ½ to 1 size larger can reduce the likelihood of developing a black toe nail.  Having a conversation with your running shoe specialist is a great first step…and no, your toe will not fall off.

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