Any runner who has beaten the pavement and has the miles to show for it has had at least one or mnay episodes of blackened or lost toenails. The culprit behind these ugly, thickened, colorful nails is the constant, repetitive pressure and abrasion of the nail from the overlying shoe. The thickening, however may also be due to the invasion of the nail plate by fungus or yeast.
That's right, "there's a fungus amongst us!"
Trust me, this is one condition you absolutely want to try to prevent.
The problem is, all runners are at risk for this condition. In addition to wearing short, ill-fitting shoes and a tight toe box, running downhill and on the downward slope of bridges are examples of the foot and big toe slipping forward and striking the end of the shoe. This physical insult can cause trauma, which can translate into bleeding of the tissue beneath the nail (sub-ungual hematoma). The blood buildup can put an extreme amount of pressure on the toe and cause it to throb. Anyone in the latter stages of a marathon who has developed a "runners nail" knows the pain. Many of these runners have to stop along the course to have the first aid station people release the fluid. That scenario happened to me in the London Marathon in 1991.
How do you spell relief? Remove the blood from the nail thats how!!!!
As for fungus, a frequently asked question is, are "athletes feet" and fungus the same? The answer is, "Sometimes." Oftentimes "athletes feet," a skin fungus, and a nail fungus, are the same. However, on occassion the nail infection may be due to yeast or other nonfungus micro-organism. So another frequently asked question is, "How do I get rid of it, and are those oral anti-fungual pills safe?"
Answer: We've come a long way in the treatment of nail fungus, and the use of oral anti-fungual medication has helped us in combatting this nuisance. The oral treatment has gone through the rigors of FDA testing and been proven very safe and effective. The only draw back is that the medication must be taken for a minimum of three months, and as a precautionary measure many doctors advise pre-medication blood testing. Periodically, the runner/patient returns to the podiatrist/dermatologist to remove any portions of involved nail, and to monitor the nail's progress. Considering the thickness and discomfort that some fungal nails cause, the outcome of using anti-fungals has been tremendous.
Another “underlying” problem that can develop as a result of the thickened, damaged nails, id the formation of a bone spur underneath the nail (sub-ungual exostosis). This spur can cause the nail to lift even higher, causing it to rub the top of the shoe even more. Talk about pain! In addition, it can cause the nail “spoon”, or incurvate, into the corners, which can result in an ingrown toenail. These sub-ungual spurs can be clearly detected on X-ray and look like a tip of an iceberg underneath the nail. The usual treatment for such a painful nail condition is surgical removal of the spur, as well as the thickened fungal nail. The nail is treated post-operatively and trained to grow back in a more normal fashion.
Speaking of ingrown toenails, there are a number of questions as to how they occur, and what the underlying causes are. The most common factor is the way in which we trim our nails. The rule of thumb is to remember to cut them straight across, and avoid digging into the corners. When aggressive nail diggers have finished playing “bathroom” surgeon,” they usually leave a sharp edge that can find its way into the surrounding soft tissue. Once that skin is punctured, an extra point for bacteria has been established, and a red hot, swollen, draining big toenail corner develops. Soaking can help reduce the swelling and inflammation, but it does not rid the offensive nail spicule from irritating the skin and re-infecting the area. The only solution in this case is to remove a section of the corner of the nail, with or without permanently “killing” the root, a procedure referred to as “chemical matrixectomy.” This procedure can help prevent a recurrence of this chronic condition, with very little post-operative discomfort. Often a runner can resume running activities within a few short days. The problem I see is that most runners ignore the problem until it becomes very infected and they can no longer put a shoe on. Do not wait for this to occur!!! Have it evaluated early, before it progresses and becomes a potential bone infection. That is something you do not even want to think about!
So what about blackened toenail. What should we do about it?
Answer: It may be as simple as just getting the proper measurement and fit. Try a variety of shoes with various widths and toebox volume. Run with the shoe in the shop to make sure your big toe doesn’t hit the roof of the shoe.
Another solution may be to add a piece of extension material to your orthotic device to allow the big toe to rest on the floor of the shoe, and prevent it from elevating during the propulsive phase of running. Remember, if the shoe does not fit properly after you have purchased it, take it back. A reliable specialty running shoe store will have a policy for this situation. Keep in mind that unlike dress shoes, running shoes do not need a “break in” period. They should fit like a glove from day one.
In cases where a sever blackened toenail occurs from bleeding under the nail, it may cause the nail to lift off the nail plate surface. This means you are going to lose that nail. Eventually, the new nail will push out the loosened nail in about 6 to 9 months. It’s important to train the new nail to grow in properlym and to prevent it from becoming infected with fungus. Keep in mind that any drainage from a blackened nail can be a sign of a possible melanoma, and should be seen by your foot specialist.