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.
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.
