I’m taking another opportunity to share a few pictures from the Western States 100 two weeks ago. The pictures were taken at the finish line. They are important because it’s very hard to get runners to learn how to manage their toenails. Maybe the two pictures will help.
The first picture is taken looking down at the tops of the runner’s two great toes. Notice the apparent forward rough edge of the toenails. See the blood at the back of the nail, at the base of the nails? In this instance, the toenails were pushed backwards into the nailbed and into the cuticle of the nail and the nail folds that support the nail at the rear and sides.
The constant trauma to the toes with the toenails being pushed backwards, caused blood to form at the base of the nail. The blood then spreads to the inside of the toe and under the nail. In the second picture, you can see blood all along the inside of the toe and moving under the toe and forward over the tip of the toe.
The downhills, or a shoe too short in either length or height of the toe box were all contributing factors. But the real cause, in my opinion, was the toenails that are too long and not trimmed short enough and then filed smooth.
In August 2005, I wrote a blog post about Trimming Toenails – It’s Not That Hard. Here is what I wrote:
How hard can it be to trim your toenails? I guess for a lot of folks, it’s a huge deal and something they never do. In all the years I have been patching feet, I have observed that untrimmed toenails are the number one cause of problems leading to toe blisters and black nails. Socks will catch on nails that are too long or that have rough edges. This puts pressure on the nail bed. Nails that are too long are also prone to pressure from a toe box that is too short or too low.
So what are some tips to keeping your toenails under control? Toenails should be trimmed straight across the nail—never rounded at the corners. Leave an extra bit of nail on the outside corner of the big toe to avoid an ingrown toenail. After trimming toenails, use a nail file to smooth the top of the nail down toward the front of the toe and remove any rough edges. If you draw your finger from the skin in front of the toe up across the nail and can feel a rough edge, the nail can be filed smoother or trimmed a bit shorter.
Use a regular nail file from your drug store, you know, those cheap “use it a few times and toss it” file. Better yet, invest a few bucks in a nice metal file that will last a long time and serve you well. If you need clippers, there are regular large clippers and for thick nails there are nippers and scissors made exclusively for toenails. If your local drug store or pharmacy doesn’t have them, check out FootSmart for a great selection.
A little bit of care in toenail trimming goes a long ways in making your socks last, and in preventing toe blisters and black toenails.
In the case of the runner at Western States, good toenail care could have prevented his blood blisters.
I have repeatedly written about toenails and how to take care of them. It’s one of the things I stress with runners. It’s so easy to do and only takes a few minutes. At our aid stations and the finish line, we saw many runners with bad toenails.
Tonya Olson, a physical therapist who does amazing foot care too, has helped at Western States for many years. She’s worked Michigan Bluff, Foresthill, and then we work the finish line together. When we see runners with toenail blisters or untrimmed toenails, we look at each other to decide which one of us will give the runner “the toenail talk.” You don’t want to be on the receiving end of the “toenail talk” because we make you feel guilty about your lack of quality toenail care. Again, it’s so simple and can save your race.
If you missed last week’s blog post about the condition of feet at Western States, here the link to the post: Feet at Western States.
Next week I’ll be in Death Valley for the 135-mile Badwater Ultramarathon. We’ll see what feet are like there.