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.

Hydration, Dehydration, & Sodium – and Toenails

June 14, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

As long as we are on the topic of toenails, we need to review the effects of dehydration on our skin, which includes toenails. This subject is often overlooked by athletes.

Dehydration and the loss of important electrolytes can have a negative effect when hours of physical exercise cause stress to the extremities as fluid accumulates in the hands and feet. Fingers and toes often swell as they retain fluid because of low blood sodium (hyponatremia). This causes foot problems as the soft, waterlogged tissues become vulnerable to the rubbing and pounding as we continue to run and hike.

Make sure that you replace electrolytes, especially on long events. Drinking water or even sports drinks may not provide the proper replacement of sodium and other important electrolytes. The popular energy bars and gels may also be low in the electrolytes needed by the body.

Karl King, developer of the SUCCEED! Buffer/Electrolyte Caps, points out that the maintenance of proper electrolyte levels will reduce swelling of hands and feet even after many hours of exercise, and reduce “hot spots” and blisters on the feet. “When there is heat and humidity, the sweat rate is high and sodium is usually lost in significant amounts,” he says. “The sodium comes from the blood stream, and when the plasma gets too low, the body reacts to maintain the minimal tolerable level by pushing water from the blood into extracellular spaces. Thus, hands and feet swell. When the tissue on the feet swells, the feet become soft and more susceptible to blisters and damaged toenails. The feet swell inside the running shoes, putting extra pressure on the tissues, and those tissues can be rubbed to the point of physical damage. We see blisters form as layers of skin separate, and we see toenails move more, damaging the weakened tissues that normally anchor them.”

Ultrarunner Jay Hodde, a Badwater veteran, notes, “Proper hydration and well hydrated should not be used interchangeably. Being well hydrated with fluids says nothing about the sodium content of the fluid; both are important.” When you are well hydrated yet have low sodium, extra fluid accumulates in the tissues of the feet and the likelihood of blister formation increases. When you become fluid-deficient, the skin loses its normal levels of water and in turn loses its turgor. Then it easily rubs or folds over on itself, which leads to blisters.

Ultrarunner Rod Dalitz says, “I am convinced that electrolyte balance may be a big factor in blisters. With too much or too little salt, the layer just under the skin swells, and your skin is easier to disconnect from underlying tissue – which makes a blister.” Many athletes have found out the hard way that simply drinking a fluid replacement drink often will not provide the necessary electrolytes in the proper concentrations that the body needs. The use of a sodium replacement product in prolonged physical activity can help in the prevention of blisters.

Electrolytes and Black Toenails

Karl King emphasizes, “Black toenails are often a result of insufficient electrolyte management. Too little sodium makes hands AND feet swell. You can see your hands, but you can’t see it happening with your feet because they are in your shoes. When the tissues swell because they have excess water, the mechanical strength of the nail footing goes down. Then any movement will do tissue damage. Most of the damage is done in the second half of an ultra when electrolyte status is often thrown off if you don’t take care of it. Not many people get black toenails from a 15-mile run. Before I figured out electrolytes, I had black toenails like all of my ultra friends. After improving the way I handled electrolytes, my toenails gradually healed and black toenails were a thing of the past.”

Whether you have a 100 mile race on your calendar, or a 50 miler, or a marathon, make sure you manage your electrolytes and hydration level.

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 ( 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.

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