How to Deal With a Gnarly Black Runner’s Toe

Emily Laurence
·6 min read

Michael Houtz; Getty Images

Tucked inside their favorite pair of running shoes you’ll find what runners consider both a disgusting side effect of the sport and a badge of honor: bruised, black toenails (if the nail is still even there at all). Hardcore runners talk about their toenails like friends injured or lost along the way. I lost the nail on my second toe while training for the Brooklyn Half. Big Toenail got destroyed on this crazy trail run. It will never be the same.

It’s one thing to talk about your gnarly toenails. It’s another one to force people to look at them. Now that summer is here, your toes will be on display for all to see—at the beach, pool, or while sporting your new leather sandals. In other words, it’s time to deal with your battered, black toenails.

What exactly is runner’s toe?

James Yakel, DPM, a sports medicine podiatrist based in Colorado and a runner himself, says that the actual term for runner’s toe is subungual hematoma. “What happens is, the longest toe—which can be either the big toe or the second toe—is experiencing repeated trauma by jamming into the shoe, which causes bleeding underneath the nail,” he says.

“[Runner’s toe] is very common— I call it ‘Nike nail’ because Nike shoes are cut very small, narrow, and shallow,” says John Senatore, DPM, a podiatrist and marathoner who experienced runner’s toe himself after the New York City marathon. This means that if you have runner’s toe, you’re wearing the wrong size shoes. “It’s critical that you have enough room where you can wiggle your toes and you have a thumb’s width of room at the end of your shoe,” Dr. Yakel says.

Dr. Senatore seconds this (he calls it the “rule of thumb”), adding that it’s important to try running shoes on instead of just ordering a pair online that looks cool. (Once you find a pair you love, he says it’s okay to reorder them online without trying them on.)

Similar to a bruise anywhere else on your body, both podiatrists say that black toenails look worse than they actually are. They aren’t dangerous, but they can be painful—and that’s when you’ll want to see a podiatrist to deal with it. “If it’s painful, get it checked out. If it’s not, it’s okay to leave it alone,” Dr. Senatore says.

How to treat runner’s toe

If you come back from a run and notice that you have now been awarded a black toenail for your efforts, time is of the essence if you don’t want to be left with blackness that won’t go away for a while. (We’re talking months, or even a year.) Dr. Yakel says you have between one and five days to drain the blood before it dries. To do this, you can book an appointment with a podiatrist who is trained to do this kind of thing, or if you’re not squeamish, you can attempt to do it yourself.

“You want to evacuate the blood from under the nail plate,” Dr. Senatore says. To do this, Dr. Senatore says to straighten out a paperclip and heat one end under a flame until it’s super hot. Then, touch the hot tip to your toenail, which will melt a hole, allowing the blood to drain. You may cringe looking at it, but it shouldn’t hurt. When the blood is done draining, soak your foot in soapy water and if you feel the need to, stick a Band-Aid on the affected toe.

Already too late for that? In that case, Dr. Senatore says the only option is to pop off the nail—something you definitely want to leave to a professional. Again, you don’t have to do this. If your black toenail isn’t causing you any pain, you can leave it alone. But if you do want to treat it, or, if there is any redness in front of the nail plate (which Dr. Senatore says could be a sign of cellulitis, a bacterial infection), you need to see a podiatrist who will pop off your toenail after numbing your toe. Then, he says you have to wait roughly a year for the toenail to grow all the way back out.

More feet tips for runners

As the docs already pointed out, the best way to avoid runner’s toe is by having a pair of running shoes that’s the right size and not too small; you want to prevent your longest toe from repeatedly hitting the roof of your shoe. But there are some other precautions you can take too. One is wearing thin, moisture-wicking socks.

“Thick socks are not a good idea for running because you need room at the toe box. The more you run, the more the foot is going to swell and the tighter the shoe becomes,” Dr. Senatore says. Dr. Yakel adds that moisture-wicking socks decrease friction so the shoe isn’t sliding so much in the shoe, which can cause toenail trauma.

You can also employ the heel lock lacing technique, which Dr. Yakel says it is especially helpful for preventing your heels from sliding (resulting in jamming your toes into the front of the shoe) when running downhill. To do it, lace your shoes as normal, stopping before the second to last eyelet. Lace the thread through the last eyelet, creating a loop between the top two eyelets. This is going to cause the lace to come out on the inside of the shoe. Do the same thing on the other side. Cross the laces, putting each lace through the loop on the opposite side. Pull tightly and finish tying your shoe as you normally would.

Last, but certainly not least: Keep your toenails trimmed. That way, they’re less likely to hit the roof of your shoes.

People don’t need to know you’re a runner by looking at your toes. They’ll already know from your Strava updates and humblebrags. With the right shoes, you’ll never have to deal with damaged toenails ever again. Smelly feet, however, is a whole other story.

Originally Appeared on GQ

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