Best foot forward: How to treat and prevent bruised toenails
It’s such a common sight that it might seem a right of passage for runners everywhere: the bruised toenail. But why does it happen, is there anything you can do to prevent it and how can you help it heal faster?
Officially, the medical term for a bruised toenail is subungual haematoma (meaning blood under the nail) and refers to when blood vessels under the nail are broken and the blood collects with nowhere to go. It can be a common occurrence for runners, especially those who undertake long distances and frequent training, but the good news is that there are some things you can do about it, according to the experts.
Why is my toenail black?
A combination of repetitive friction, impact, pressure and swelling of the toes can lead to bruised toenails, explains Simone Paul, senior podiatrist and CEO of The Footlift London Soho & Liverpool Street Clinic. ‘The feet swell significantly during running and this creates less space in the shoe,’ she explains. ‘As a result, the toes continuously hit the roof of the footwear, rub against each other and the capillaries are put under pressure.’ Then, before you know it, bruising of the nail bed and plate can happen, resulting in a toenail that looks black with the collected blood underneath giving it its dark hue.
Paul warns that runners with congenital and acquired lesser toe deformities such as claw, hammer toe or hallux valgus (bunions) are at risk of developing bruised toenails.
An expert in biomechanics and the founder of the PODO Clinic and Workshop, Christophe Champs, points to a few other factors that can result in bruised toenails. Too small or too tight running socks and ill-fitting shoes can make your toenails prone to bruising, as can the motion of toes hitting the front of trainers, which can be aggravated when running downhill. On the subject of running shoes, having trainers that are either too big or too small can present their own unique problems.
It’s pretty clear the issue that’s faced if running with shoes that are too small; a cramped space for the foot, combined with pressure and repeated friction on the skin and nails, will lead to a very unhappy situation.
If shoes are too big or the toe box is too wide, then the twisting motion of the foot forces your body weight forward and the toes grasp to gain more stability, with the lesser toes curling up, says Champs. Essentially, when the tip of the toes are in ‘conflict with the footwear’, bruising of the toenail and blisters can form, he explains.
How to heal a bruised toenail quickly
First things first: don’t try any invasive treatment at home. It’s best to be safe, says Champ, warning that this could easily lead to an infection. ‘Respect the highest standards of hygiene when clearing and cleaning skin/nail damage – whether it’s bleeding or not, infected or not,’ he stresses, adding that if you have any concerns regarding the skin and nail damage, consult a healthcare professional.
Keeping the nail clean and dry is pivotal. Paul recommends thoroughly drying any bruised toenails after a bath or shower by applying light pressure with a towel, followed by a tissue in order to prevent fungal infections and reduce moisture in the bruise. Moisture present in the nail bed will increase the chance of the nail thickening (onychauxis), she says.
Paul also advises protecting the bruised toenails with a sterile dressing while walking as this will reduce tenderness and further bruising to the nail plate.
How long do bruises under toenails last?
Healing time varies on individual factors, such as how quickly your nails grow, and the severity of the damage, explains Champs. If the nail falls off, cover it when doing activities and then let the area breathe by night in a very clean environment, he advises. ‘Patience is key, just keep the area dry and clean at all times.’
Essentially though, you’re looking at weeks to months. For the big toe, which contains more capillaries, the bruising may last six to eight months and in some cases, it can take over a year to grow out, says Paul. For the other toes, it can take up to three months.
Do you need to adapt your running during this period?
There are a few things Paul recommends changing up if you’re keen to run with a bruised toenail (obviously, if it’s causing you pain, give it a rest and seek advice). She advises opting for running shoes that are half a size bigger if you can and covering the bruised nail with a plaster. Running on softer terrains, such as grass or astroturf can be helpful too. Both Paul and Champs advise shorter runs, as your feet will swell, which could aggravate the injury.
If you’re set on running, then Champs would advise these adaptations:
Wear socks that aren’t too tight, are stitch-free in the area of the bruised toenail and which you can pull forward after putting them on.
Check the size of your running shoes and make sure you don’t look for the position of your big toe with your thumb if your second toe is longer.
Keep the nails short, square cut and smoothen the corners with a glass file. ‘Short to avoid catching the socks or conflict with the shoes. Square to make sure they are short enough [and] smoothen the corners to avoid any ingrown toenails.’
Last but not least: avoid running downhill.
Are there any ways in which runners can prevent bruised toenails?
As well as keeping toenails cut and filed, there are a few more ways in which runners can prevent bruising, says Paul. Her recommendations include using deeper and wider trainers, plus split-toe compression socks to prevent swelling and friction to the nail plates.
For Champs, there are two shoe-lacing methods that he uses together in his clinic with patients experiencing bruised toenails. Here is his guide:
The runner’s loop lacing method, or the heel lock if your shoes don’t have an extra eyelet: ‘This method is a game changer if you tend to run downhill. It holds the foot from sliding forward in the shoes and prevents the toes from hitting the firm and protective tip of the shoe. But before using the top eyelets of the footwear to secure the heel, you can also re-lace your shoes completely taking one lace from the top medial eyelet (medial side of your ankle) to the last lateral eyelet (near your fifth toe). Then cross horizontally towards the first toe and cross this lace only, all the way up. Because you started from the second eyelet at the top, you will still be able to do the runner’s loop. It’s a great combo to avoid any excessive traction on the big toenail when tightening your shoelaces.’
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