The Anatomy of a Runner: Phalanges Maintenance

The Runner’s Pedicure in 3 Easy Steps:

  1. Choose the Proper Equipment
    A large nail clipper works well. Avoid scissors or knives. An emery board is important for filing down thick nails or smoothing rough nail edges, and a pumice will aid in reducing calluses.img_4113
  2. Wet or Dry?
    Trim your toenails when they are dry. Dry toenails are less likely to bend or tear when you cut them. For thicker toenails, cutting is easier after a shower.
  3. Use a Straight Cut

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Trim the nail straight across using two cuts – the first cut should be with the clippers slightly off the side of the nail to create the straight edge; the second cut removes the rest of the nail following the line of the straight cut. Smooth the edges with an emery board.

img_4108Don’t cut in a curved pattern or cut too short, as this may lead to ingrown toenails.

A good standard is that you should be able to run your finger across the top edge of your toe and barely feel the toenail. Trim often to maintain this length; approximately every 4-5 weeks in cool weather, and every 2-3 weeks in warmer weather.

 

Why it hurts.

Black Toenails: A subungual hematoma (bruising) under the nail that is generally caused by trauma resulting in a collection of blood underneath the nail. This collection not only causes the nail to become discolored, it also generates a tremendous amount of pressure, and can cause intense pain.

Black toenails may eventually lead to the loss of the entire nail (it will grow back). If there is pain or a foul smell (indicating an infection), seek medical treatment right away.

Fix it: the easy answer is to keep toenails short. Trauma occurs from the toenail hitting the end of the shoe.

Some suggested remedies include wearing larger shoes. While it is important that your shoes aren’t too short or small, shoes that are too large will cause other problems, such as blisters. Shoes that feature a larger toe box may help alleviate trauma to the nails, but the best place to start is to simply keep nails short.

If there are no underlying conditions, such as an infection, the nail will eventually fall off, a new nail emerges, and the injury heals without intervention.

It is possible to have a black toenail that is relatively painless. However, if pain is persistent, the hematoma can be drained to relieve the pain and pressure. Visit the doctor earlier rather than later to ensure the new nail regrows normally.

Brave runners may choose to drain the hematoma themselves. Jeff Galloway’s website contains step-by-step instructions for this procedure.

Some runners, such as ultra trail runners, may continue to be plagued by painful black toenails even after taking every precaution. Occasionally these runners will have their toenails surgically removed.

Note: black toenails can also be caused by a fungal infection, common in immuno-compromised patients, or they may indicate underlying melanoma (a malignant tumor consisting of dark-pigmented cells called melanocytes). In the case of an underlying infection, there may be pain associated with redness, swelling, foul odor, and discharge.

Thick toenails: nails can thicken with age, because of a fungus, infection, or trauma. Any alteration to the nail plate, nail bed, or root of the nail can result in thickening. This damage may be temporary or permanent, depending on the cause.

Runners may experience thickening of a nail from the repetitive pressure or continual striking of the nail against the shoe (trauma) causing it to separate from the nail bed.

Thickened toenails may or may not be painful, but they are difficult to cut, and they can increase one’s susceptibility to infection.

Fix it: use an emery board or nail file to immediately reduce the thickness of the toenail. This is the first and easiest thing to do. File the thickened nail each time you trim your nails, or as needed.

  • Soak your nails for at least ten minutes in warm, soapy water.
  • Completely dry your toenails.
  • Use the emery board or file to reduce the thickness of the nail.
  • Keep the nail trimmed, starting at one corner and continuing straight across to the other corner. Smaller cuts with the trimmer will prevent splitting or chipping thick nails.

One important note:  do not use cuticle pushers, which disturb the natural barrier that prevents the introduction of potential pathogens.

Prevention: A shoe with a larger toe box may help by giving the toes more room inside the shoe. Consult a physician if you suspect the problem is caused by an infection or other trauma.

Ingrown toenail: occurs when the edge of the nail irritates and eventually breaks the skin. Ingrown toenails are caused by several conditions, including genetics, trauma, infection, repetitive stress (usually in sports that require sudden stops), improper footwear, or improper trimming (too short or not straight across). The most common digit to become ingrown is the big toe, but ingrowth can occur on any nail.

Fix it: consider seeking immediate medical attention, or consult a nail specialist who will understand how to resolve the ingrown nail. In other words, treat yourself to a pedicure, or two.

A mild ingrown nail can be removed with careful clipping, but if it is deep or painful, consider a trip to the podiatrist. An unresolved ingrown toenail can lead to infection.

Prevention: proper cutting leaves the leading edge of the nail free of the flesh, precluding it from growing into the toe.

Never cut a V shape into the middle of your nail. Many people believe this technique is useful for preventing ingrown toenails, although it has been proven ineffective.

Footwear that is too small or too narrow, or a too shallow toe box, will exacerbate any underlying problem with a toenail.

Callus: areas of thickened skin caused by repetitive friction, or by abnormalities of the bony structure of the foot. Usually painless, calluses are a natural protective reaction of the skin over pressure sites.

Fix it: when a callus first develops, file it with an emery board or a pumice stone after bathing, and apply petroleum jelly, lanolin or other moisturizer to soften the area. Repeat this process as often as necessary. If a thicker callus has formed, you could use a peeling and softening agent such as Ultramide 25 lotion.

Runners may not want to totally remove calluses since they provide protection at pressure sites. However, if a callus becomes too big, it can crack, become tender, and it will be painful.

Calluses can also become tender on long runs or races from prolonged exposure to moisture from sweat. Blisters may also form under calluses. Resolve what is causing the callus, and it will go away on its own.

It’s good to regularly moisturize the feet (even for men). Consider products that contain tea tree oil since they are naturally antifungal.

Blisters: are small pockets of fluid under the skin caused by friction that can be a result of shoes that fit too tightly or too loosely. As your feet get wet with sweat the skin softens and leaves you at even greater risk.

Fix it: always leave a blister intact since an open blister can become infected. Cover the blister with an adhesive bandage/moleskin to protect it while it heals.

If it is particularly painful or uncomfortable, it may be necessary to drain the blister:

  • Wash your hands with warm water and antibacterial soap.
  • Using a cotton swab, disinfect a needle with rubbing alcohol.
  • Clean the blister with antiseptic.
  • Take the needle and make a small puncture in the blister.
  • Allow fluid to completely drain from the blister.
  • Apply antibacterial ointment or cream to the blister.
  • Cover the blister with a bandage, moleskin, or gauze.
  • Clean and reapply antibacterial ointment daily. Keep the blister covered until it heals.

You should visit a doctor if fever, nausea, or chills accompany a foot blister. This can be a sign of an infection.

Prevention: the most important step in preventing blisters is to identify the underlying cause.

  • If the blister is caused by friction, check your shoes to see if they are rubbing your foot in that area. Sometimes a seam or another design of the shoe can be the culprit.
  • If moisture seems to be the issue, apply foot powder to reduce sweating, (Dry Goods Athletic Spray Powder or Jack Black Dry Down Friction-Free Powder are two examples).
  • Wear moisture-wicking socks specifically designed for athletes. Socks with individual toes in the sock helps reduce friction between the toes that may cause blisters in some runners.
  • Over-striding can also cause blisters. This stride causes the foot to land in front of the body, absorbing the energy of the stride with a braking force that allows the foot to slide inside the shoe. Keep the stride short enough that the foot lands beneath the body rather than in front.

Bunions: a bunion is an (often unsightly) protuberance at the base of the big toe that forms when the metatarsophalangeal joint (MTP for short) is stressed over a prolonged period of time, causing the first metatarsal to turn outward and the big toe to point inward. (Bunions can also occur on the pinky toe.)

Fix it: the most important first step is to change your shoes.

High heels and pointy-toed shoes should be eliminated since they force the body’s weight forward, forcing the toes into the front of the shoe. Choose running shoes with a wide toe box, and consider shoes that have a lower heel drop (the height difference between the heel and forefoot often measured in millimeters).

Apply ice, use acetaminophen/ibuprofen, or visit your doctor for a cortisone injection for temporary pain relief. Using moleskin, gel-filled pads, or shoe inserts for arch support may also help.

Prevention:

Wear a toe spacer, starting with no more than 30 minutes a day. Two options are Correct Toes and  Yoga Toes.

Try shoes that are wider at the end of the toes than at the ball of the foot and that do not have an elevated heel—what is known as “zero drop.” (This website has more info and specific shoe suggestions.)

Do a bunion massage – a bunion massage stretches the adductor hallucis.

Read this article in Runners World.

Numbness or tingling sensation: numbness in the toes (unrelated to the cold weather) is often caused by shoes that are too tight or from tying your shoelaces too tight, but can also be caused by Morton’s Neuroma. This condition is caused when the tissue inside the foot becomes thicker next to a nerve that leads to a toe. The pressure against the nerve causes irritation and pain, usually between the third and fourth toes.

Morton’s Neuroma symptoms include:

  • tingling in the toes that may get stronger with time;
  • a burning sensation or numbness;
  • feeling like a pebble may be in your shoe, or that the sock is bunched up;
  • there may also be a shooting pain around the ball of the foot, or the base of the toes. 

Fix it: 

Choose shoes with a larger toe box.

Over-the-counter metatarsal pads can relieve the pressure, or your doctor may prescribe orthotics that are custom fit.

Some people find relief with cold therapy, which involves applying extremely cold temperatures to the irritated nerve to kill some of the nerve cells. There are also permanent surgical options, or a doctor may prescribe a corticosteroid shot.

Some runners have had success in resolving Morton’s Neuroma symptoms with a daily supplement of Vitamin B12.

Prevention: wearing high heels or shoes that are too tight can cause the tissues in the forefoot to thicken over time causing the neuroma. Be sure shoes fit correctly and that there’s plenty of room for the toes to move around inside the toe box. Women suffer from Morton’s Neuroma more often than men.

Read More:

Common Running Foot Injuries and Issues; Very Well fit

Thick Toenails (Onychomycosis); Healthline

Ultrarunning Problem, Solved for Good; The New York Times

Blister Prevention; Fellrnr.com

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