Runner’s toe is a common condition for athletes, especially runners. It affects toenails due to repeated trauma or friction. While often a nuisance rather than a serious medical issue, awareness is beneficial.
What is Runner’s Toe?
Runner’s toe, medically known as subungual hematoma, involves blood collecting underneath a toenail. It typically manifests as toenail discoloration (black, purple, or dark red), often resembling a bruise beneath the nail.
The affected toenail may loosen or lift from the nail bed due to pressure from accumulated blood. Individuals might also experience pain, pressure, or tenderness in the affected toe. In some cases, blood blisters can form under the nail, causing discomfort.
Why Does It Happen?
The primary cause of runner’s toe is repetitive microtrauma to the toenail. During running, toes repeatedly hit the front or top of the shoe with each foot strike. This constant impact or friction stresses the toenail, causing small injuries.
Ill-fitting shoes are a major factor. Too-tight footwear cramps toes, while loose shoes allow the foot to slide forward, jamming toes into the toe box. Long toenails also exacerbate the issue by increasing contact and impact against the shoe. Running downhill also pushes the foot forward, intensifying this trauma.
Repeated mechanical stress causes tiny blood vessels beneath the nail to rupture. Bleeding then pools under the nail. This accumulation creates pressure, causing pain and characteristic dark discoloration.
How to Prevent and Manage It
Prevention
Prevention begins with proper footwear. Running shoes should fit correctly, allowing a thumb’s width of space between the longest toe and the shoe’s end. This ensures adequate toe room, preventing consistent impact with the shoe’s front. Try on shoes at the end of the day when feet are slightly swollen, mimicking their size during a run.
Well-trimmed toenails are another important preventive measure. Cut toenails short and straight across to minimize contact with the shoe’s interior. Moisture-wicking socks keep feet dry, reducing friction and preventing foot sliding within the shoe. Gradually increasing mileage and intensity in training allows feet to adapt, lessening sudden stress on toenails.
Management
For existing cases, management focuses on reducing discomfort and preventing complications. Resting the affected toe from high-impact activities allows the injured nail to heal. Applying ice can reduce swelling and pain. Elevating the foot above heart level also assists in reducing swelling and promoting circulation.
Mild cases often resolve as the nail grows out, but severe pain or throbbing pressure may indicate significant blood accumulation. In such instances, seek professional medical attention; a podiatrist can safely drain the blood to relieve pressure. Do not attempt to drain blood at home due to infection risk. Patience is important during recovery, as a discolored or damaged toenail can take several months to a year to fully grow out.