Having Toenails Removed

May 29, 2011 by · 3 Comments
Filed under: blister care, Foot Care, Footwear, Health 

Continuing the toenail theme, this post covers a question many people ask- should I have my toenails removed?

Feet with black toenails

Feet with black toenails

Only you can answer that question. You know your feet better than anyone else and know the problems you have and what you have tried to remedy your problem with black toenails.

So let’s start with some basic advice. Before have your toenails removed, make sure you have tried some common sense tips. Shoes that are long enough in length and high enough in the toebox. Good toenail care. This means trimming nails short and then filing them smooth. I tell people that after trimming and filing, you should be able to run your fingertip over the edge of the toe and not feel the nail’s edge. Any edge can catch on your sock, and as your foot moves through the footstrike, the sock can force the nail backwards, leading to a black toenail.

After trying to fix the black toenail problem, without success, some people consider have their toenail(s) surgically removed. Others simply keep going, losing toenails time after time.

Big toes without toenails

Big toes without toenails

Tim Jantz, a podiatrist, describes the process of removing a toenail: After the toe is numbed, the nail is removed and the growth plate is treated with 89% phenol (some use sodium hydroxide) to destroy the growth plate. The area is then rinsed with alcohol and dressed with an antibiotic and a dressing. The usual post-operation care is daily soaks and dressing with a topical antibiotic and a Band-Aid for approximately four weeks, sometimes longer. The toe has endured a chemical burn and so heals by draining. It can have a raw feeling for a week or so, and I wouldn’t want to stub it or have anyone step on it for a few weeks. You may also want to wear roomy shoes or sandals for a week. The procedure is about 95% successful. An option is to find a doctor that uses a laser, but the only difference is higher cost.

If you are prone to black toenails and have tried all the options to prevent them, consult a podiatrist about nail removal.

In fair disclosure, I have all ten toenails.

Treating Black Toenails

May 21, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

The technical name for the runner’s black toenail, subungal hematoma, describes simply a blood-filled swelling under the nail. This common occurrence is caused by the trauma of the toe or toes repetitively bumping against the front of the shoe. Blood pools in the space between the nail plate and nail bed as they separate or compress from repeated trauma. Individuals with Morton’s toe are most susceptible to experiencing black toenails. The nail becomes discolored and usually has associated pain. Most often the nail bed turns dark, almost black or blue because of the blood.

Black toenails can come from toenail trauma caused by clenching your toes. This curling downward of the toes can also lead to toe blisters. A small pad under the ball of the foot can help relax the toes but many athletes have to mentally ‘will’ themselves to uncurl their toes.

If there is no pain from the black toenail, no action may be necessary. If the pain and pressure increases, the pressure must be relieved. To relieve pressure from a black toenail, use one of the following methods, depending on the look of the toenail. The treatment may have to be repeated several times. Although the two methods below might sound painful, they are usually not. The blood has separated the nail from the nail bed and is a barrier between the nail and the live skin underneath.

  • If the discoloration does not extend to the end of the toenail, swab the nail with an alcohol wipe, and use a small nail drill, drill bit or hypodermic needle to gently drill a hole in the nail with light pressure and rolling the needle/bit back and forth between your thumb and fingers. The blood will ooze through the hole. Keep slight pressure on the nail bed to help expel the built-up blood. Stopping too soon will cause the blood to clot in the hole and the problem will reoccur. I purchased a small nail drill through EBay and like its ease of use.
  • An alternative method is to use a match to heat a paper clip and gently penetrate the nail with the heated point. The heat in this method can cauterize the blood and stop the flow of blood out from under the nail. Press on the nail to expel the blood.

If the discoloration extends to the end of the toenail, use a sterile pin or needle to penetrate the skin under the nail and release the pressure. Holding slight pressure on the nail bed will help expel the blood.

Big Toe Blister

Big Toe Blister

Care must be taken to prevent a secondary bacterial infection through the hole in the nail or at the end of the nail by using an antibiotic ointment and covering the site with a Band-Aid. If the hole seals up, use the drill, needle, or paperclip to open it up again. Loss of the nail usually follows in the months ahead. The new nail will begin growing, pushing up the old nail, and may come in looking odd.

You may find relief by wearing a metatarsal pad, a small circular pad that pushes up the ball of the foot and drops the toes down, which takes pressure off the toenails. Contact Hapad (www.hapad.com) for information on these pads.

Once your toenail has come off, a new nail will grow in. Sometimes though, the new nail may grow in odd or wavy looking, or thicker, or any other non-normal appearance. Applying Vaseline or an ointment of your choosing to the nailbed a couple of times a day will help prevent it from becoming dry and stiff.  Secondly, use a nail file to keep the newly emerging nail as thin as possible until it is fully regrown. This keeps the nail flexible and without the structural strength to cause problems.

Toenail Trimming

May 15, 2011 by · Leave a Comment
Filed under: blister care, Foot Care, Footwear, Health 

One of the most common questions on online ultra email lists are those about toenail problems, mainly blood under the nail – black toenails. I am often puzzled by these questions because, in my mind, it’s pretty basic stuff.

It’s easy to assume your toenails are fine. You trim them once a month. You really don’t understand the relationship between toenails, socks, toeboxes, and how the foot moves inside the shoe.

Thick and long toenails, and a great toe blister.

Thick and long toenails, and a great toe blister.

First, look at the picture. This runner has thick toenails. Most likely because of a continued loss of earlier toenails. The toenails are not filed down and are too long. I worked on this runner’s feet and was surprised that he did not have worse problems.

Let’s start with trimming toenails. How hard can it be to trim your toenails? I guess for a lot of folks, it’s a huge deal and something they have a hard time doing. 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 catch on nails that are too long or that have rough edges. This puts pressure on the nail bed, leading to blisters under the toenails, at the tips of the toes, or painful toenails as they are pushed back into the cuticle. Nails that are too long are also prone to pressure from a toebox that is too short or too low.

Toenails should be trimmed regularly, 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. Remember though, the shorter you trim your nails, the greater the likelihood that you will experience an ingrown toenail. Conversely, nails that are too long can rub against the front of your shoes and catch on your socks, which can lead to a black toenail, wear holes in your socks, cut into other toes, and crack the nail when you run downhill. Shoes that are too tight in the forefoot or too short can cause the nail to press into the sides of the toe.

Use an emery board nail file from your drug store. 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, and nippers and scissors made exclusively for toenails. If your local drug store or pharmacy doesn’t have them, check out www.FootSmart.com for a great selection.

When you run or walk, your foot moves forward as it moves onto the toes. The toes bend as the toebox bends, moving to the end of the toebox. Many runners’ toes make contact with the front or top of the toebox, and the toes, over time are traumatized. The nail is jammed backwards. Bit by bit, the nail takes a beating and blood forms under the nail or on the sides or bottom of the toe. Toes with long nails or rough nail edges, or Morton’s toes (2nd toe longer than the big toe), will often blister.

A little bit of care in toenail trimming goes a long ways in preventing toe blisters and black toenails, and in making your socks last longer.

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