black toe nails

Many runners, athletes and skiers can experience damage to their toes and the toe nails.  When the damage has been over a period of time and the pressure excessive a haematoma or blister can occur. A blister under the toe nail can be very painful as the pressure builds and has no where to go. This is called a subungual haematoma. The increased pressure under the toe nail can cause the nail to lift from the nail bed and can result in the loss of the nail.

5 Things that can cause a nail to be damaged

  • Shoes that are too short
  • Shoes that are too shallow
  • Inadequate lacing that allows the foot to move forward in the shoe
  • Poor foot mechanics resulting in clawing of the toes
  • Overtraining or insufficient preparation for an extended activity

Shoe sizing and fit are essential for good foot comfort. Always allow a good thumbs width between the end of the longest toe and the end of the shoe. If the shoe has a removable innersole this can be used as an indicator of length. Remove the innersole and stand on it, the innersole should always be longer than the foot by your thumbs width.  If a shoe is shallow and tapers towards the front of the shoe where your toes are, the top of the shoe can place undue pressure on your toes and damage the nail. How a shoe is fastened can make a huge difference to the fit and comfort of the shoe. The shoe should have sufficient depth of lacing to allow adjustment and tightening to minimise heel slip and forward movement in the shoe.

Clawing of the digits or hyperextention of the toes are indicators of poor foot mechanics. Over time and with the constant shoe pressure and friction caused by these toe distortions  nail damage can occur. Orthoses are often used to address poor foot mechanics to optimise foot function.  Muscle imbalances which occur because of overuse of soft tissue structures can result in shortening and contracture of the digital flexors and extensors. Stretching tight foot muscles and strengthening weakened foot muscles can be incorporated to treatment. To much training too quickly can damage nails. Gradually increased training using the 10 % principle – either 10 % increase in time or mileage each week. If you experience damage to a nail a podiatrist can help you by identifying what the problem is, why it has occurred and how it can be managed. Treatment may involve draining the painful nail, use of exercise and splints to minimise toe clawing, footwear advice and Orthoses use as required.

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