Running is Killing My Nails! What Can I Do?

Running is a great sport for cardiovascular strength, stamina and health, but the reality is it can cause a lot of harm to the feet.  When we walk, the big toe extends and helps to hold up the arch.  A myriad of nail problems can occur in the runner. When we run we accentuate the pull of the big toe in a shoe and can increase stress.

As a podiatrist one of the most common problems I see is a blood clot, or hematoma, under the nail.  This problem is very common because of the trauma to the nail when it hits the top of the shoe. If the hematoma is covering greater than 75%, I will elect to remove the nail entirety.  The reason for this being that if the nail has greater than 75% blood, the nail will de-roof at some point anyways. Our worry is that pus will develop under the nail. Trauma caused by running often results in infected nails, also known as paronychia. This is a collection of pus under the nail often seen on the sides of the nail, but it can occur anywhere. Sometimes trauma will cause the nail to grow in irregular ways. The way it grows will cause infections.  Treatment is aimed at getting rid of the infection. Typically what we will do is numb the toe with anesthesia and remove the side of the nail that is causing the infection and write a prescription for an antibiotic.  Soaking instructions are provided to the patient to facilitate proper healing. We try to remove the entire margin of the nail permanently, so that the patient does not have a chronically ingrown infected nail.  Treatment for runners who want to be on their feet and exercising daily is taken into consideration, so that painful conditions don’t recur and cause any slowdown in runners’ ability to exercise.

Thick discolored nails, which is a sign of fungal infection in the nail bed, is also very common in runners.  Onychomycosis, or nail fungus is a caused due to injury in many athletes.  Runners can get nail fungus from their shoes and sneakers being too narrow or not having enough depth. Treatment options are multiple for nail fungus.  The most common approach for nail fungus is topical medication that kills the fungus by penetrating the nail.  Other options are removing the nail and having a new one grow back. A topical antifungal cream is applied until a new one grows back. Other avenues for treatment are oral antifungals, but the risk of liver damage is high and I question the true effectiveness.  One option that is available, but rarely use, is total and permanent removal of the nail.  One of the more popular trends for fungal nails is laser treatment that kills the nail fungus where the nail begins to grow.

For runners the most important evaluation for preventative measures is addressing shoe issues. Crowding of the toes, foot, and ankle can cause a multitude of problems in the running population.  Evaluation by a podiatrist can determine what type of shoe gear a patient will need according to their running style, stride and endurance.  Many of the above nail conditions can be treated effectively with proper sneakers.  For runners with nail fungus, not only does the shoe need evaluation, but also it is important for the foot specialist to treat the cross infection from shoe to the foot.