Black Toenail: My first running injury

I want to post about different running injuries that I’ve experienced (hopefully there won’t be TOO many!) on my blog because I think it could be helpful to new runners looking to prevent and/or treat common injuries. I have no experience in the medical field, and I’ll make clear what advice/ information comes from the internet, myself, or a reputable physician that I visited.

My very first running injury occurred during my marathon training last year, after my first 16 mile run. I came home from the run, took my shoes and socks off, and almost passed out when I saw the second toe on my right foot. Now, a word about my feet; my second toes are my longest toes, which is why it makes sense that this injury occurred to that toe.
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My feet with gel toecaps on the second toes…continue reading to see what that’s all about.

What is a black toenail?
A trip to Google confirmed that the grayish/purple toned toenail was my first “black toenail” (mine wasn’t actually black). Black toenail occurs when you damage the toenail bed by repeatedly hitting the edge of the nail against something – in this case my shoe! The toenail separates from the nail bed as blood pools underneath and dries. Hence the black/ purple color. FT9 I wish I had pictures of my foot with the black toenail, but it freaked me out so much that I just wrapped it up with medical tape and didn’t look at it for weeks at time. This picture is kind of what it looked like though. Not very pretty :( I was lucky and my nail stayed on until it grew off, but sometimes the nail is separated from the nailbed enough that it falls off. Don’t worry, a new one grows in its place!

Why does it occur?
Black toenail can occur to runners who are increasing their mileage, for a number of reasons. One can be that your shoes were too small for your feet to begin with. Another is that your extremities tend to swell as you run (even faster if you run in the heat), so your toes may start coming in contact with the inside front of your shoe more often. If you start running downhill more as well, it makes sense that your feet slide to the front of your shoe and possibly increase contact between the nail and shoe. But quite simply, as your long runs increase in distance, your toenails are experiencing the pressure from the shoe for longer periods of time – which is why so many long-distance runners have black toenails.

How can I treat it?
If it is painful to run, you should probably take a few days off. I continued to run as long as the pain was manageable (it was never crippling for me). In general, the consensus in the running community seems to be to leave it alone and continue running as long as the pain isn’t blinding. If the pain is extreme and continues that way for more than a day or two, you should consult a doctor – you don’t want to re-injure or permanently damage the nail bed. The Jeff Galloway link at the bottom of this post also describes methods for releasing the pressure underneath if the pain doesn’t go away. These scare me and sound like Chinese torture methods, but if you’re interested/ desperate/ slightly masochistic, check it out.

How can I prevent it from happening?
While some runners consider their black toenails a badge of honor, I find them uncomfortable and a little gross. So if you’re like me, keep reading!

Some prevention techniques:
1. It helps to make sure your toenails are clipped short; clip them so there’s just a little border of white at the top. See the photo of my feet up top!
2. Maybe trying buying sneakers a half size bigger, to give your feet room to expand. I have two pairs of sneakers, one in a size 6 for my shorter runs, and one in a size 6.5 for my long runs. This works pretty well for me, and the bigger shoe is essential during the summertime, when my feet (and hands) really swell!
3. Try incorporating more uphills into your run. This is entirely my suggestion, but it makes sense to me that running even slightly uphill would push your feet to the back of the shoe and prevent your nails from making contact with the shoe. It’s not always easy to find a running path entirely uphill, and it becomes impossible if you do loops, but for those that love treadmill running, just put your treadmill on a slight incline.
4. Gel toecaps. I’ve saved the best for last, as I think these will save my toenails from future black toenails. I bought these ProTec Athletics Toe Caps from Amazon and wore them on my second toes on all my runs after the injury occurred (to prevent the formation of a black nail on the left foot, and protect the one on the right). It prevented me from re-injuring the right nail, which can happen! As the nail grows back, sometimes runners just damage the nail bed again and end up with another black toenail growing as the first one grows out (or off). I had to trim the caps to fit my toes (see pic above), and while it feels weird at first, you get used to it fast. I’ve never had them fall off my toes while running, and they’re very comfortable (no toe chafing!).
5. Oh, one last tip: don’t paint your toenails. I know this is a tough one for some of you out there, but it’s important to be able to see your toenails to assess their health and make sure they are proper clipped, per tip #1, if you’re a long distance runner! Toenails falling off are less sexy than bare toenails, I promise.

My progress:
My black toenail grew out, and I was happy to clip off a little more every two weeks or so and see the healthy nail growing underneath (literally, I had two layers of nails on the toe).

My almost healthy toe!
My almost healthy toe!
Probably about two months after the injury, all the black was gone and my nail was a normal color again. There is still a weird horizontal ridge near the middle of the nail, but it looks like that is growing out too.
I haven’t had another black toenail since, but I also haven’t started my 2013 marathon training yet. I’ve continued to wear the gel toecaps for all my runs, so we’ll see if they keep my toenails completely healthy this year!

Other great resources:
http://www.jeffgalloway.com/training/injury_archives/black_toe.html
http://running.about.com/od/commonrunninginjuries/p/blacktoenail.htm

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4 thoughts on “Black Toenail: My first running injury

  1. Black Toe

    Thanks for the information. I have a black toenail from not properly tightening my ski boot. Its good to know what I have to look forward to in the next several months. BTW, you have cute feet. :)

    1. Dawn H.

      Oo, I hope it heals soon. Good news is that it definitely looks worse than it is! I’m glad you found my post helpful!

  2. Pingback: Sneaker Therapy Turns 1! | sneaker∙therapy

  3. Stef

    If you look back please consider going to a food doc. See the way your big toes point in? That’s because you have fallen arches, as the arch falls, the large toe bones push forward causing the large to to bend inwards. It is likely to become problematic as you age (50’s) but orthotics will go a long way to prevent further toe movement. Without them, the toe will continue to move farther towards the 2nd toe, and eventually crowd it out so that one rides upon the other. You don’t want that.

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