Bad Toenails at Western States

July 7, 2017 by · 2 Comments
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.

Toenail Blisters – 7 Causes

August 18, 2014 by · Leave a Comment
Filed under: blister care, Foot Care, Footcare, Health 
BlisterPrevention's website

BlisterPrevention’s website

Today’s blog post is a little bit by me and a lot by Rebecca Rushton. Rebecca is a friend and podiatrist from Australia. I admire her work regarding blister formation and prevention. I follow her website and whatever she writes.

Having worked many events over the past years, I have seen hundreds of toe blisters. These may be at the tip of your toes, between your toes, or under your toes. They are very common, especially in ultras, adventure racing, and multi-day stage races. Understanding the causes of toe blisters, and ways to prevent them is important, not just for you but for your crew too.

Rebecca’s recent blog post details seven likely causes of toenail blisters. Here’s the link to Toenail Blisters.

  1. Shoes too small
  2. Shoes too big
  3. Nail shapes and deformities
  4. “Cocked-up” big toe
  5. Clawed toes
  6. Downhill terrain
  7. Long, thick or rough toenails

Make sure you sign up for Rebecca’s emails and you’ll get a free copy of her premium resource The Advanced Guide to Blister Prevention. The sign-up box is in the upper right corner of her web page. While you’re on her website, be sure to check out the rest of her content.

Feet Tell a Story

August 15, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, toenails 

I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.

I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.

The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.

A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!

I believe that feet tell a story.

Hurting Toes

Hurting Toes

The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.

Here are my observations about the story behind these feet.

  • Almost every toe has something going on.
  • The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
  • These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
  • My bet is the shoes’ toebox was too short in length and/or too low in height.
  • The runner may have worn two pairs of socks, which could have made the fit too tight.
  • The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
  • These toes scream pain – especially if they are encased inside shoes.
  • It’s possible the toes received some degree of care, but it is hard to tell from their condition.
  • Four of the toes have major trauma.
  • We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
  • The left big toe has blood showing in the blister on the outside edge.

That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.

My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.

What story do your feet tell?

Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.

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.

Toe Blisters at the Gore-Tex TransRockies

September 10, 2010 by · Leave a Comment
Filed under: blister care, Foot Care 

Toe blisters at the TransRockies were a huge problem. We saw many of the same runners day after day during the six-day race. One lady kept coming in every day after her run. She finally told me she was removing all the tape from her toes before running the next day. Bad idea. I informed her tape would act as a skin protector for the day’s run and not to take the tape off.

Every day we saw all kinds of toe blisters. Big ones and little ones. Ones filled with clear fluid and others filled with blood.

Most had the usual blisters between toes and after draining these were patched with Kinesio Tex tape first wrapped from bottom to top and then a second strip from side the side. The second strip going side to side prevents there being a seam hitting on the neighboring toe.

Draining a blister under a toenail

Draining a blister under a toenail

Blisters under the toenails were very common. Many were blood filled. In the photo you can see the thin edge of a blister at the forward edge of a toenail. When possible, I drain the blister there. Since the lifted skin is dead, there is no pain associated with this method. I always use a scalpel or needle and give a test ople to make sure the runner can’t feel the point. If the can’t, it is safe to make the drain hole there. If they can, I have to go through the nail.

Drilling through a nail is pretty straightforward. I use a nail drill but you can also use a needle or even, in a pinch, a paper clip. Hold pressure on the drill or needle as you spin it back and forth until the nail is penetrated. At the TransRockies I drained four or five blisters with my nail drill.

Once the hole is through the nail or a hole is made in the skin, pressure will expel the fluid and the pain and inside pressure will be gone.

Covering the tip of the nail with a strip of tape will help prevent it from catching on socks.

Toe Blister Causes

In my experience, toe blisters are typically caused by too long or rough toenails, and poorly fitting shoes. When toenails are too long, the socks catch on the long nail, or on a rough nail, and are pushed into the quick of the nailbed. A blister forms underneath the nail and pain starts. The answer is to trim nails short and then file them smooth so when you run your finger over the tip of the toe, no edge of a nail is felt.

Of course, toe blisters can also be caused by shoes that are too narrow or too short in the forefoot, overlapping toes, old and worn socks, downhills, and rough fabric on insoles. At the TransRockies there were long steep downhills.

With a bit of forethought and planning, you can avoid painful toe blisters. The best way to start is to do good toenail care.

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