More on Prevention
Last week I wrote about prevention and being proactive. I emphasized that you are the key to prevention. I want to share an email I received from a friend that is a great example of this in action. Lisa told me about her friend and gave me permission to share the story:
My friend ran a 50km x 2 (100km total, over two days) race a few weeks ago. Over the past six months he has put a lot of work into his running training and has been running beautifully.
I was away so when I got back I dropped him a text to see how his race went. He told me what happened and in the conversation said that he would be losing many of his toenails. I ask why and he said he forgot to cut his toenails.
As you can imagine I didn’t reply to this at all because I would have thrown some insulting words his way.
He has been trail running for more than a decade and been doing adventure racing for over a decade. He spent a fairly sizable amount on his race entry and it must be about 900km to travel to the race. He put in six months of training to get stronger and faster. And he forgot to trim his toenails! This is more than elementary and is totally stupid. It’s tough to have sympathy (I have none!) when friends do silly things like this. He knows better.
Lisa de Speville, Johannesburg, South Africa
Lisa’s Adventure Racing website
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Lisa’s Blog
This story speaks for itself. I have often talked about how athletes spend a lot of time and money in preparation for an event but fail to plan for good foot care. More times than I care to remember, I have seen athletes quit a race or be pulled from a race because of feet gone bad. It doesn’t have to be that way.
I’ll say it again, you are the key to prevention.
Having Toenails Removed
Continuing the toenail theme, this post covers a question many people ask- should I have my toenails removed?
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
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.
Toenail Trimming
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.
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.
Flip-Flops or Sandals?
Warm weather is here and with it comes flip-flops and sandals. These range from the inexpensive throw-away-after-one-year flip flops to more expensive sandals. Given a choice, which are better for your feet?
Flip-flops, sometimes called thongs (not to be confused with underwear), are typically a piece of foam the shape of a foot and about ½ inch thick, with a rubber piece that come up between the big 
and first toe and extends to the sides. They are a simple design. As your foot moves through a footstrike, the heel often comes up and slaps your heel, making the tell-tale flip-flop noise. They offer no support, little cushioning, and no degree of control over the motion of the foot and ankle. Depending on the wearer, their toes may curl against the foam to keep the flip-flops in place. They may also be worn tight on the foot to keep them from coming off.
Variations on the flip-flop included designs with a strap over the top of the foot, a loop to hold one or two toes in place, nubs on the top of the foam to massage the feet, and various types of foam for durability.
Flip-flops are fine for around the house and at the beach. Too many people wear them out in public when they should have tossed them a long time ago. The foam is compressed down to nothing and the foot seems to roll off the top. As you step down from a curb or over a rock on a trail, there is nothing to control where your foot goes.
Sandals, on the other hand, with their variety of straps and strapping methods, offer more support and control. Usually, the sole is stronger and thicker, offering cushioning, can be safely worn on trails. Many sandals have a strap around the heel that locks the sandal on the foot. With well made sandals that have a good strapping system, stepping down from a curb or over a rock on a trail will provide a small degree of support and control. Strapping variations include toe loops, quick-release buckles, and straps over the forefoot and around the heel, or just over the forefoot.
Sandals also offer a classier look in public. Many people wear sandals everywhere and with all types of clothes.
Given a choice, I’d choose sandals over flip-flops any day.
Of course, if you are going to wear flip-flops or sandals, make sure your skin and nails are well cared for. Nothing says “poor foot care” more than unclipped toenails, toenails with fungus, heels full of calluses, or an obvious case of athlete’s foot. Previous blogs have discussed Dry and Cracked Feet?, Filing Toenails, and Trimming Toenails – It’s Not That Hard!.
Trimming Toenails – It’s Not That Hard
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.
Circulation