Tuesday, October 12, 2010

Black/Runner's Toenails

Today I want to give you guys a quick update on my recovery and then talk about another rather common running injury.

Update:  Overall, I'm feeling much better.  Sunday morning I woke up and the soreness in my muscles had set in, so I am still working on stretching them out, massaging them down, and recovering them, but it certainly is coming along.  I'm able to walk semi-normally now; no more hobbling around like a cripple or considering crutches.  My guess is that by this weekend I'll be walking normal though running may still be out of the question.  I'm going to try to make it to the gym a couple times this week both to make use of the membership I keep paying for as well as to do something physical.

Runner's Toenail or Black Toenail
The main reason for my slow recovery from Saturday's race is the fact that I got an injury during the race, three black toenails.  So what I want to do is go over what they are, how you get them, how you can prevent them, etc. much like I did with Shin Splints.  Maybe in the end of all of this I will be able to list links to all the common injuries of triathletes.  haha

What is a Black Toenail?
Black toenail, also commonly called runner's toenail, is just as it sounds; it's a toenail that has turned black.  Now, it's not the toenail itself that has turned black, but the color underneath the toenail that is showing through.  It is a bruise that is commonly obtained by runners and can cause an intense amount of pain and possibly the loss of the toenail.  But don't worry, the toenail does grow back.

For an idea of what black toenail looks like, here are a few links.  For those who are squeamish, please consider this your warning.
Black Toenail #1
Black Toenail #2
Black Toenail #3

How do you get a Black Toenail?
Most runners will tell you that if you got a black toenail, your shoes are too short.  When you exercise in shoes for an extended period of time, your feet expand up to a full shoe size and therefore in long distance running events, the common practice is to wear shoes half to a full size larger than your foot.  The reason for this is that once your toes expand, they hit the front of the shoe with each foot fall (roughly 900 times per mile).  Over an extended distance, this builds up a lot of impact on the front of your toes, eventually breaking capillaries and producing a bruise.  This method begins to answer the question of why so many people tend to get black toenails on their big toe as opposed to other toes.  It'll be the longest toe that begins to hit the front of the shoe first.

Another train of thought is the way in which your foot hits the ground.  If your foot is slamming into the ground with every foot fall, the accumulated impact over time can also break capillaries and create a bruise.  Therefore, both shoe fit and running form can contribute to black toenail.

How do you treat a black toenail?
There really is not much you can do other than wait for the body to heal itself.  Many inexperienced runners will consult a doctor out or shock and worry the first time they get one.  As long as there is no infection, which really can only happen if the skin of the bruise is broken, there is very little a doctor can do besides charge you for the visit.

Since black toenail is a bruise in all practicality and there is a lot of pain caused by the accumulation of blood under the toenail (the pressure), most experienced runners will go ahead and relieve that pressure.  To do this, you can either puncture the skin or the nail to allow the blood to leave the area.  If the bruise is only on the front portion of the toenail or you have easy access to the bruise from the skin under the toenail, I suggest using a sterilized and heated needle.  Simply be careful with applying pressure to the skin; you don't want to embed a needle in your toe further than necessary.  The alternative option for those with black toenails that span the entire nail (and are unable to drain the blood entirely from the front) is to make a hole through the nail itself.  Websites I've read suggest sterilizing and heating a paper clip, setting it on the nail and letting it burn right through.  I have not tried this, but I have been told from other's experience that a tiny drill bit works better.  Sterilize and heat the bit, set it on the nail and slowly turn the bit allowing it to drill into the nail.  In either method, releasing the blood from the bruise will decrease the pressure and the pain.  Beyond this, it will only take time for your body to heal the rest.

How to prevent getting a black toenail?
As you read above, running shoes should be adequately long enough to allow for expansion of your foot during whatever exercise you plan on doing.  If you're going to be a long distance runner, get your shoe a full size larger.  Also, be sure not to let your foot slam on the ground with every foot fall.  Running lightly will not only prevent toenails, but also blisters, and stress fractures, but also works better to transfer your energy into horizontal movement as opposed to inefficient vertical movement.  It will also help if you allow your feet to get used to the amount of pressure associated with running.  If you increase your running distance slowly, your toes will get used to the increased pressure and will be more resistant to getting a black toenail.  However, if you jump from running 5ks straight into a half marathon, your toes will be much more vulnerable.

My experience
During the half marathon on Saturday, I began to notice my two big toes hitting the front of my shoes a little over half way (maybe about mile 7 or 8).  I knew I'd probably end up with sore toes, but did not know of "black toenail" at that point in time.  It wasn't until I pulled my socks off after the race that I realized both of those toenails were black as well as incredibly painful to walk on; the pressure from the accumulated blood made it hard to walk period since I couldn't roll up onto the ball of my foot without having my toes flexed up.

That afternoon, I did some research, found this great website, and read about how most runners puncture holes to relieve the pressure.  It made sense, so I gave it a try.  I sterilized a needle, heating it up to red and punctured a hole through the skin under the toenail; blood quickly oozed out with every hole I made.  It took some time, a lot of patience, and half a dozen kleenex, but I managed to remove a good amount of blood.  I bandaged the toes up for the night and the next morning, they were no longer "black" toenails, but more "purple" and certainly were less painful.

The lesson that I took away from this was that if I plan on continuing long distance running (which I do), then I need to buy larger shoes.  I also need to keep a  better hold on my running form.  After 8 or 9 miles I could tell my feet were taking a beating, but I didn't do very much to try and correct it and subsequently paid the price. 

As always, if you have any questions, concerns, or comments, I would be more than happy to hear them.  Ciao!

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