Runner’s toe is a common nail injury resulting from repeated trauma, pressure, or friction on the toenail. This often leads to discoloration beneath the nail plate. The condition is generally temporary, typically resolving as the affected nail heals or is replaced by new growth.
Understanding Runner’s Toe
Runner’s toe, or subungual hematoma, occurs when repetitive stress on the toenail causes blood vessels to break, leading to bleeding and dark discoloration (black, dark red, or purple) under the nail plate. It commonly affects the big or second toe, which often extend farthest in footwear. Symptoms can include a feeling of pressure, pain, and sometimes a blood blister forming beneath the nail. The nail may also loosen or lift from its bed.
This microtrauma primarily occurs when the toenail repeatedly hits the front or top of the shoe during activities like running. Ill-fitting shoes (too tight, too short, or too large) contribute by allowing the foot to slide and jam toes forward. Long toenails are also a factor, as they are more likely to strike the shoe’s interior. Running downhill increases the likelihood due to increased force pushing the foot forward.
Recovery and Resolution
Runner’s toe resolves as the body heals the injured area and replaces the damaged nail. Recovery varies with trauma severity. Minor bleeding may simply grow out with the nail over several months. However, significant blood collection can create pressure, lifting the nail from its bed and potentially causing detachment.
When the nail detaches, a new, healthy nail grows underneath. This process is slow; toenails grow about 1.6 millimeters per month, significantly slower than fingernails. A completely lost toenail can take 12 to 18 months to fully regrow. Initial new growth may be visible within three months, with about half the nail regrown in 6-9 months.
Managing and Preventing Runner’s Toe
Managing runner’s toe involves steps to alleviate discomfort and support healing. For acute pain or swelling, rest and ice can reduce inflammation. Over-the-counter pain relievers can manage discomfort. Keep the area clean to prevent infection, especially if the nail is loose or partially detached.
Preventing runner’s toe focuses on addressing repetitive trauma. Properly fitted running shoes are important, ensuring adequate toe box space so toes can move without hitting the front. A thumb’s width of space between the longest toe and the shoe’s end is recommended. Trimming toenails straight across and keeping them short prevents them from impacting the shoe. Moisture-wicking socks and proper lacing techniques help secure the foot, reduce friction, and prevent sliding forward, especially during downhill runs.
When to Seek Professional Advice
While many runner’s toe cases can be managed at home, certain signs indicate the need for professional medical attention. Consult a healthcare provider if you experience severe or persistent pain, or if pain makes walking difficult. Signs of infection, such as increased redness, swelling, warmth, or pus around the toenail, warrant immediate evaluation.
Other concerning symptoms include continuous bleeding from under the nail, persistent throbbing, or if the nail appears to be completely detaching with significant bleeding. A medical professional can assess the injury, rule out other conditions like fungal infections, and may drain pooled blood if pressure causes considerable pain. This provides immediate relief and prevents further complications.