Bad Toenails at Western States

July 7, 2017 by · 1 Comment
Filed under: blister care, Foot Care, Footcare, General, Health, Sports, toenails 

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 tops of bad toenailsThe 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 front of bad toenailsThe 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.

Bad Toenails at Western States

July 7, 2017 by · 1 Comment
Filed under: blister care, Foot Care, Footcare, General, Health, Sports, toenails 

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 tops of bad toenailsThe 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 front of bad toenailsThe 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.

12 Foot Care Tips for Success at 100’s

June 18, 2016 by · 4 Comments
Filed under: blister care, Foot Care, Foot Care Products, Footwear, toenails 

Next week is the Western States 100 Mile Endurance Run and all the fun and hoopla that goes with it. I ran the race from 1985 – 1989 with a best time of 24:32. It was a challenge but I had fun every year. Ever since then I have been associated with the run in some capacity and for the last 16 or so years have provided foot care help at an aid station or two and the finish line. In that time I have seen a lot of runners come through aid stations needing foot care.

Feet at the finish line of Western States

Feet at the finish line of Western States

This year I decided to make a list of my top 12 foot care tips for success at 100’s – whether Western States or any other 100-mile run. You don’t want feet like in this picture.

  1. Make sure your shoes fit. That means a bit of room in the toe box and good grip in the heel. It also means that the shoes are in good shape.
  2. Make sure you wear good socks. That means no cotton, but only moisture wicking or water-hating socks. If you are prone to toe blisters, consider Injinji toe socks.
  3. Trim your toenails short and then file them smooth so when you run your finger over the tip of the toe, you don’t feel any rough edges or points. This goes for thick toenails too – file them down.
  4. Reduce your calluses with a callus file and moisture creams. Trust me, you don’t want blisters under calluses.
  5. Wear gaiters over the top of your socks and shoes. This keeps dust and grip from going down inside the shoes and inside your socks. Understand though that the mesh in today’s trail shoes does allow dirt and grits inside the toe box, even with gaiters.
  6. Use a high-quality lubricant like SportsShield, Sportslick, RunGoo, Trail Toes, or ChafeX. Do not use Vaseline.
  7. Know how to treat a hot spot and blister between aid stations – and carry a small kit in your hydration pack. Early care is better than waiting until a blister has formed or until the blister has popped and its roof torn off.
  8. Just as you have trained by running and conditioning, you need to know what your feet need to stay healthy and blister-free during the race. Just as you have learned what foods you can tolerate during a race and during the heat, you need to be prepared for foot care problems. Your feet are your responsibility.
  9. Make sure you have a well-stocked foot care kit(s) with your crew and they know, in advance, how to care for your feet. Trailside, at an aid station, is not the time to learn or to train them what you like done.
  10. When you pour water over your head and body to cool off, lean forward to avoid water running down your legs and in your shoes. Getting wet feet or waterlogged socks can lead to maceration very fast.
  11. Consider using RunGoo or Desitin Maximum Strength Original Paste liberally on your feet and toes to control moisture from excessive sweat, stream crossings, snow melt, and water poured over your head that runs down into your shoes. Reapply at aid stations. Maceration can quickly lead to skin folds, tender feet, skin tears, and blisters.
  12. Finally, DO NOT assume that every aid station has people trained in foot care or have the supplies necessary to treat your feet. If you have a crew, have them work on your feet. Many times the medical personnel are backed up or dealing with more serious medical emergencies. And, truth be told, blister are not a medical emergency. Heat stroke, heat exhaustion, dehydration, and the like are more serious than blisters.

Every year I am amazed at the number of runners who are ill prepared. They put extra socks in their drop bags – that have holes in them. The have open Athletes foot sores between their toes. Their shoes are shot and should have been replaced. They have not done good toenail care. They have thick calluses. They start the race with old unhealed blisters. Their shoes don’t fit. They wear full-length compression socks and then are amazed when we can’t get them off at the aid station to work on their feet. Tight fitting compression socks may feel good but are almost impossible to get off and even worse to get back on over patched feet.

While medical people will always try to help you, we can’t work miracles with your feet when you have neglected caring for them from the start. Again, your feet are your responsibility.

8 Top Tips for Foot Care

8 Top Tips for Foot Care    

If you are a subscriber to Backpacker magazine, check out the October issue, page 34 for a full page of eight top tips to care for your feet. I have included an image of the page in this post. If you click on the image, you’ll get a larger view.

I was contacted by Backpacker several months ago and did a phone interview. Here are the eight tips:

  1. Trim nails
  2. Get in shape
  3. Fix calluses
  4. Prep your shoes
  5. Pack camp sandals
  6. Two ways to treat blood under a nail
  7. Wash your socks
  8. Lance right
8 Top Tips for Foot Care

8 Top Tips for Foot Care

The tips are good whether you are a backpacker, runner, walker, adventure racer, or just plain person who loves the outdoors.

I like Backpacker magazine. It’s one of my favorites. I encourage you to pick up a copy and check it out.

Foot Care Preparation for Primal Quest – or Your Next Event

The seven tips below are written for the Primal Quest Expedition Adventure Race starting next week. They are also applicable to any race you may have coming up.

Primal Quest is less than two weeks away and here are seven things you can do to improve your chances of finishing with healthy feet.

1.    Wear the best fitting shoes you can. Have a bit of space in front of your longest toe and enough height in the shoe’s toe box to avoid squishing the toes from the top.

2.    Bad toenail care can result in toe blisters and black toenails, where fluid or blood is under the nail. Trim your toenails short and then use a nail file to smooth the tip of the nail. File the nails from the top over the edge down toward the tip of the toe. The goal of the trimming and filing is to remove any rough or sharp edges. File the nails so when you run your fingertip up and over the tip of the toe no rough edges are felt. It’s even better to file the nail so that no tip of the nail is felt. If you have thick nails, file the top of the nail down to reduce its thickness.

3.    Any time you can, remove your shoes and socks to dry and air your feet. Your feet will be wet from water disciplines, stream crossings, cooling yourself off by pouring water over yourself, and simply sweaty feet. When stopping to eat or rest, remove your shoes and socks. Lay your socks in the sun to dry and switch to a clean dry pair if possible. Issues caused by wet feet will multiply over time and can end your race or at the least, result in extremely painful feet.

4.    Do everything in your power to prevent and reduce maceration. This means not letting water poured over your head get into your shoes by bending over before dousing yourself. If means following the tips outlined in # 2 above.  Use a moisture-controlling agent to help prevent the skin on the bottoms of your feet from macerating. Several include Desitin Maximum Strength Original Paste (available at drug stores, Walmart, etc), zinc oxide, Chafe X, SportsSlick, Trail Toes, and RunGoo. Apply liberally and before all water segments to help prevent damage to your skin. Once serious maceration happens, only drying your feet and letting them air, with the help of powder and warmth, will reverse the condition. If left unchecked, the skin can fold over on itself, split open, and tear layers of skin off the bottom of your feet.

5.    Use gaiters to prevent pebbles and rocks, trail dust, and other debris from getting inside your shoes and socks. These become irritants and can lead to hot spots and blisters.

6.    Take care of small issues before they become larger problems. Lance and drain small blisters whenever you feel them to keep them from becoming larger. Put a dab of ointment over the blister and then apply a strip of tape over the top to protect the skin.

7.    Finally, make sure you have the supplies to treat your feet out on the course. Waiting to get to a TA to repair a blister can make a small problem much larger.

Toenails – Again #@!$#@

July 31, 2015 by · 1 Comment
Filed under: blister care, Foot Care, toenails 

A month ago I provided foot care at the Western States 100. Then two weeks ago I worked the Tahoe Rim Trail 55KM, 50M, and 100M. And finally this week I worked Badwater in Death Valley. As much as I hate to say it, I saw a negative common denominator as I worked on or saw runner’s feet.

The common negative was runners’ toenails.

I wish I didn’t have to say the toenails were bad, but a lot of them were. While not every runner suffers with their bad toenails, many do. Enough to warrant this blog post.

The picture here is an example of nails that could be better – much better. I won’t identify the runner or the race because I saw these same toes at each of the three events.

Bad Toenails

Bad Toenails

Toenails that are thick can be smoothed with a nail file. In severe cases, a Dremel tool can be used to reduce the nails quicker, especially when the nails are really thick and tough.

Your nails don’t have to be thick. They don’t have to be rough. They don’t have to have an upward curl or edge. They don’t have to be wavy. They don’t have to stick over the end of your toes. In short, candidly, they don’t have to look like your toes are 90 years old and you live in a nursing home. If you think you might have toenail fungus, check with your doctor – and take care of it.

An inexpensive toenail clippers will set you back about $5. If you have tough nails, you may want to buy a stronger set of clippers that look something like wire cutters. Then get a file for another $1 or $2.

Toenails that are too long, too thick, have rough edges or corners, will catch on your socks, which will push the nail back into the nail bed and cause trauma, fluid or blood under the nail, or toe blisters. During a race, these nails become painful to touch – meaning you can’t trim or file them without pain.

So we see you at an aid station, and you are hoping we can fix your feet. If there is fluid or blood under the nail, we can drain them. We can run a strip of tape over the tip of the nail to provide a bit of protection to the nail. But we cannot fix the discomfort and pain.

I can patch most anything on your feet, but I cannot fix a thick toenail that sticks up way above normal. I cannot smooth the rough edges if you cannot tolerate the filing. I cannot trim the nails if you cannot tolerate the pressure.

Caring for one’s toenails isn’t that hard. Once a week, use a clippers and nail file to trim them. Clip them fairly short and then run the file over and down the tip of the nail, removing any rough edges. The goal is to have nails that you can’t feel when you run your finger over the front edge of your toes.

If you have lost a toenail, as the new one comes in, file the top of the nail thin. Wrap a Band-Aid around the toe to help train the nail to curve naturally to the shape of your toe.

Toenails are not complicated. But just as you care for other parts of your body, you need to care them them too.

Common Toenail Question

March 17, 2015 by · Leave a Comment
Filed under: blister care, Footcare, Health, Sports, toenails 

I get questions by email all the time. Toenail questions are quite common, so I thought I’d post this one. Here’s the question.

“I am emailing you because I have a 50K trail race this Saturday and for some reason I am just starting to get pressure from under my large toenail. It is in its early stages and my nail has not turned black yet, but it is starting to be uncomfortable. At what point do I decide to puncture thru my nail and lance the fluid under the nail? Also, if I should be lancing the fluid, what are your thoughts of using a really thin and clean drill bit (turned by hand) to get thru the toenail? I lost a toe nail once before and tried using a really hot paper clip and needle, but I had a hard time getting all the way thru my toe nail. Any help and advice you can give me would be much appreciated… thank you!”

The answer is pretty straightforward.

Draining a blister under a toenail

Draining a blister under a toenail

Can you recall any nailbed trauma? Once fluid is underneath the nail, the pressure becomes painful You’ll know. If you can see the fluid from under the tip of the nail, lance it there. A drill bit works better than a paperclip. Be forewarned that as it goes through the nail, it can go into the soft tissue underneath, so go slowly. Then press on the nail to expel as much of the fluid as possible. Cover with a Band-Aid for now (tape on race day) but don’t plug the hole with ointment, as it will still need to drain for a few days.

Relieving fluid from underneath a toenail is a simple skill that every runner should know how to perform – just in case. It could be on one of your toes, or the toe of a friend. If you have ever experienced the intense pain of a black toenail with blood or fluid underneath, you’ll appreciate knowing how to fix it.

Foot Care Tips That Can Save Your Race

September 14, 2014 by · 2 Comments
Filed under: blister care, Foot Care, Footcare, Footwear, Health, toenails 

Here are a few foot care tips I wrote to help runners at the Amazon Jungle Marathon. I’ll be there in a few weeks to help with foot care on the medical team. The tips are valuable for anyone doing a 24 hour race, a multi-day event, an adventure race, or a long backpack. Remember, your feet will carry you day to day only if you take care of them.

Start with good toenail care. Trim your nails short and then use a file over the front edge to remove any rough edges. File the tip of the nail so when you run your fingertip over the tip of the toe and over the nail, you don’t feel any rough edges. You can also file the top of the nail if it’s thick. Coming to the race with bad toenails will ensure toe blisters and black toenails.

Make sure your shoes fit well. Have enough room in the toe box for your toes to wiggle. Your feet may swell over the race and you don’t want shoes that are too tight. Some shoes, like Hokas, retain water and become heavy over the days, as they are wet so much of the time. Wet and waterlogged shoes are heavy.

Get good socks. Don’t show up with cotton socks. Socks made with Coolmax or wool are good choices. Injinji toe socks are great. Have several pair and wash then after each day’s stage or have one pair per day. Also don’t show up with old socks or ones with holes in them.

Do whatever you can to reduce any calluses. Getting a blister under a callus can be painful and it’s very hard to find the pocket of fluid for draining. After showering, use a callus file or pumice stone to shave the callused skin from your feet. Then apply some callus cream. This is something that should be done several times a week. Calluses are the result of friction and pressure between your shoes and feet. Make sure your shoes will drain water.

Shoes that hold water inside will increase the maceration effect of your feet being wet to long, leading to wrinkled and soften skin that can fold over, crease, and split open. Check this by filling your shoes with water and seeing whether it will drain out. You can heat a nail (at least 1/8 inch round) or an awl and make several holes at the inside and outside arch, and the heel of your shoes. Learn how your feet respond to being wet for long periods. Do some long walk or runs three to six hours long with wet feet. Try several products like Desitin or similar cream for baby bottoms that works to control moisture on the skin. Google “baby bottom cream” to see many options.

Do not skimp corners on your foot care kit you need to carry in your pack. Have several yards of a good quality tape, several needles to drain blisters, and learn how to drain and patch blisters. The medical team will try and help with your foot care needs, but we can become overwhelmed by the number of people wanting help. Part of your responsibility as a runner is to know how to do good foot care.

Carry a good pair of camp shoes to wear in the camp after each day’s stage. You don’t want to walk around barefoot and doing so will destroy the taping or blister patching done by you or the medical team. Lightweight Crocs, flip-flops, or sandals are easy to strap to your pack. Change into these after running to allow your skin time to heal from the moisture.

Fixing Your Feet makes The Washington Post!

June 19, 2014 by · Leave a Comment
Filed under: Foot Care, Footcare, toenails 

Several weeks ago I was interviewed by Gabriella Boston, a reporter for The Washington Post. She emailed me asking whether I was available and when could we talk. When she called we talked for about an hour. She asked all kinds of questions about foot care based on my experiences for runners.

The article came out on the 17th and is worth reading. The title is How Runners Can Keep Their Feet Happy. Sections include, run training, proper footwear, cross training, and foot care. Gabriella interviewed two podiatrists, a physical therapist, and me. Fixing Your Feet is also mentioned in the article. Click on the link in the paragraph above to read the full article. My bet is that you’ll learn something new.

Toenail Care For Athletes

April 3, 2014 by · Leave a Comment
Filed under: Foot Care, Foot Care Products, Health, toenails 

Today’s post is contributed by Gwen Lewis.

Athletes are prone to a number of injuries; torn or sprained ligaments and muscles, bruises, and broken bones. More common, irritating, unsightly and often embarrassing afflictions are situations such as athletes foot and toenail and toe-bed injuries. Athletes foot is a fungal infection that affects the areas between the toes leading them to become itchy, inflamed and painful. In extreme cases, especially for extreme athletes, infection can lead to ingrown toenails and in the worst cases, loss of toenails, which can make practice unbearably painful and slow or halt performance. Read on to discover ways to protect and repair damaged and irritated feet and toenails.

From the ground up

As an athlete, the right pair of shoes makes all the difference when it comes to preventing wear and tear on hard-working feet. A pair of running shoes that are too tight will pinch nerves and lead to ingrown toenails as well as painful bunions, blisters and calluses.

Look for shoes that allow your feet to breathe (mesh, canvas or leather). Shy away from rubber and plastic, which hold moisture in and cause feet to sweat, and infections to flourish. Allow time for your shoes to dry – forgo wearing the same pair of shoes two days in a row. Many people do not realize how important the insoles of a shoe are and what benefits they can give your feet with the right pair. Wear socks made of natural fibers that absorb moisture best, or invest in synthetics that are especially designed to draw moisture away from the foot.

Athlete’s foot

Athlete's foot discomfort

Athlete’s foot discomfort

This affliction affects quite a large number of athletes. It is a fungal infection known as tinea pedis, which targets the nails and skin, causing skin to become red, cracked, burnt, scaly and itchy. Sometimes the infection stays mainly between the toes, but in extreme cases it may also appear on the soles and side of feet and spreads to the toenails. It can also be accompanied by painful, oozing blisters. Athlete’s foot is easily spread and can be picked up in common areas such as showers, and can become exacerbated by moist, tight shoes and socks.

Prevent athletes foot by keeping feet clean and dry, and wearing the right shoes and socks as we mentioned above. Avoid walking around barefoot in public areas and wear flip-flops in locker room showers and bathrooms.

Toenail care

Trimming toenails correctly

Trimming toenails correctly

Athletes are often prone to extreme cases of damaged and injured toes and toenails. These types of injuries can lead to loss of toenails, and debilitating ingrown toenails. Prevent ingrown toenails by keeping nails clean and clipped short and trimmed straight across. The medical term for toenails that fall off due to a fungal infection or traumatic injury is called onychoptosis or onycholysis, which indicate a separation of the nail from nail bed. If there is trauma to the nail, damage will be characterized by pain, bruising under the nail bed, discoloration of the nail, and ultimately loosening of the nail. If damage is caused by an infection, look out for thickening of the nail, yellow, brown or green discoloration, swelling, pain, itching, flaking, redness, foul odor and possible discharge.

Natural remedies

If you see any of these symptoms, there are ways to treat and prevent further injury or damage. Athlete’s foot can be eased by a number of natural solutions; baking soda used as a paste can ease the itch and burn between toes, and a foot soak made of baking soda and salt will soothe affected areas. Plain yogurt is also an instant remedy for athlete’s foot, simply dab on infected areas, let dry and then rinse off. Tea-tree oil is a powerful antiseptic, mixed with olive oil and rubbed on it will clean, heal and soothe dry patches. Calendula is also a powerful herbal healer that has antifungal and anti-inflammatory powers. If your toenails are ingrown or inflamed, clean them with antiseptic, gently pull up the nail and trim what part of the nail you can off. Seek treatment immediately if the area under the nail bed is extremely painful and oozing.

Gwen Lewis is a writer who lives in California. She has a passion for beauty and health and loves to write her articles from experience. She grew up playing soccer and knows the importance of taking care of your feet. She hopes you find these tips helpful to prevent any athletes from foot problems.

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