Why do runners lose toenails

11.06.2019
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Do Runners Even Need Toenails, Anyway?

Every workplace has its own unique morning-meeting culture. At Goldman Sachs, traders surely share their latest billion-dollar victories. At Vogue, editors outline next season's denim-on-denim-on-denim trend. And here at Runners World, we talk about toenails. Lost toenails. Missing toenails. Gone-but-not-forgotten toenails. And amid all these black-and-blue sob stories, we began to wonder, do runners even need toenails? What do thin little slabs of alpha-keratin do, anyway? It was time to seek answers.

So, first things first: Why do runners' toenails tend to fall off? Basically, said Allan Rothschild, D.P.M., a podiatrist in Dunedin, Florida, who has been treating Tampa Bay area runners of all ages for years, it's all that running.

Rothschild explained that during the push-off phase of your gait, when one foot is behind you and the other one is striking the ground, the toes on your trailing foot are extended up. When these toes are hyperextended, they hit the toe box of your shoe. Even though your shoe is relatively soft, that contact is a microtrauma. When youre running five to ten miles per day, or even more in a half or full marathon, and those microtraumas can add up.

Runners can experience discolored nails, which is a collection of blood beneath the nail plate (subungual hematoma) as a result of microtrauma to the toe against the shoe box, Rothschild said.

The bleeding can in turn cause the nail plate to separate from the nail bed andyupfall off. Merely losing a toenail is not cause for panic.

If youre a runner, you develop a hematoma underneath the nail plate, and the nail falls off, youre going to grow another nail back normally after, Rothschild says. Its a vicious cycleit might happen again in six months.

(Still, if you're losing toenails all the time, you might want to make sure you're wearing shoes that fit your feet properly. A good pair should give your toes plenty of microtrauma-free room to move around. Even with correct footwear, though, sometimes a lost toenail is unavoidable.)

So, if we lose our toenails only to grow them back only to lose them again in six months, whats the point of having them to begin with? Well, the answer has a lot to do with ancestry and human evolution.

Toenails are vestigial, and at one time in our ancestral tree they were necessary for defense, digging, climbing, and were used as tools, Rothschild says. Fingernails have some practical use in everyday life, such as peeling fruit or scratching, but we dont use toenails anymore. Ultimately, theyre now there for cosmetic reasons. If youre a woman and you go out and dress up, you probably have nail polish on.

That toenails are now purely cosmetic is a point of view that not everyone agrees with.

Toenails serve a purpose in protecting the tip of your toe and protecting the blood vessels and nerves at the tip of the toe, said John Krebsbach, D.P.M., a podiatrist in Milwaukee, Wisconsin. (Actually, he's my podiatrist!) Imagine dropping a rock on your foot. Would you rather have the meager protection of a toenail, or none at all? (Please, don't drop a rock on your foot to test this!)

RELATED: 7 Strange (but True) Tales of Long-Distance Running Injuries

Regardless of their differing opinions on toenail functionality today, both podiatrists agreed: Toenails don't do anything to make you run better. And at the same time, not having them doesn't make you run any worse. They don't really matter.

What's more, they agreed that, if deformed and thickened, toenails can do more harm than good. If this is you, it's time to see the doctor to develop a plan for healthy toenails. There are a couple of ways to remedy this. A podiatrist could trim down or file down the nails. She could give you a topical medication, or an oral medication to deal with infection or fungus. As a last resort, the problematic toenail can be removed with a laser or a chemical.

Dr. Jordan Metzl discusses how to deal with black toenails, athlete's foot, and ingrown toenails.

Just because surgery is a last resort doesnt mean its uncommon. Both doctors have performed thousands of these painless removals on their patients, including many runners. Even so, it would be easy to freak out after your toenail is permanently removed, especially when the sport relies so heavily on your two feet. Nailless feet are atypical and potentially a little bit gruesome. Besides, you want your toenails to look the best they can.

Which one looks more normal? A before and after shot from a toenail removal procedure.

Allan Rothschild, D.P.M.

Ive treated thousands and thousands of patients who have that look in their eyes and say, Well, dont I need it for protection? Rothschild says. The skin grows back after the nail is removed, and tougher, like it does on your heel. It is not sensitive, and you will be able to run pain-free. If patients are worried about look, they can put nail polish on it, similar to when you have your eyebrows plucked and draw them in with an eyebrow pencil. The nail bed is clear, so no one can even tell you are missing a toenail from far away.

Krebsbach doesnt completely agree.

In some individuals, once the nail is gone, the skin and fat pad at the tip of the toes thins or recedes, leaving the bone at the tip of the toe vulnerable and at times painful to touch and irritable to shoe pressure, Krebsbach says. Others can live comfortably and continue active lifestylesincluding runningwithout issues.

RELATED: 5 Causes of Black Toenailsand How to ID the Harmless From the Harmful

While according to Krebsbach theres no absolute guarantee that running sans toenails will be completely pain-free, both experts agreed theres a pretty high chance youll be alright.

Toenails are like our appendix, Krebsbach says. They do serve a purpose, but we can live without them.

You can run with toenails, and you can run without them. Either way, you're still runningwhich is all that matters in our books. But please make sure you're wearing the right shoes.


why do runners lose toenails
Why do runners lose toenails?
Home Health Why do runners lose toenails?

Why do runners lose toenails?

Runners are people who are considered to one of the many athletes. Although some are considered to be part of a sports team, there are runners that engage into running as a form of their exercise or they have it as a daily habit. For most runners, they have gradually developed an increase in muscle tone, endurance, muscle strength and cardiovascular tonicity. Running involves the use of the bodys over all body parts and it is vital that one is prepared in engaging into such habit.

However, it is quite inevitable that any form of exercise or sport do entail certain fall backs, particularly in ones physical appearance. In the habit of running, one of the most common problems encountered by runners is the fact they are losing their toenails. As runners, do the habit continuously, they tend to lose their toenails from time to time. In medical terms, such condition is called onychoptosis. Onychoptosis is an original Greek word which literally means falling nail. Usually caused by stress or injury, the mechanism of losing toenails starts as one walks or runs. Walking or running, as runners do, slide their foot forward towards the shoe, banging the toes against the top, front, and sides with each step. The feet also have the greater tendency to swell as it is compressed by the presence of the socks and the shoes. Because of the pressure and impact present, its either the nail beds of the toe get damaged or blisters form under the toenails. When this happens, the extra blood and fluid cause the toenail to separate from the toenail bed, giving the toenail a black color due to the blood under it.

To prevent this from happening, it is important that the shoes fit perfectly well.

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5 Causes of Black Toenailsand How to Tell If Yours Is Serious or Not

Many runners are all too familiar with black toenails. The condition involves bruising, blistering, or bleeding beneath your nail from repetitive trauma, either from the top of your shoe rubbing against your nail or your toe slamming into the end of your shoe. Its most commonly experienced by marathoners and those training at especially high intensity. Some even see it as a badge of honorthe more black nails you have, the more badass you are.

But not all black toenails are caused by running, and in certain cases, one can signal something more serious. Heres how to identify which ones you need to worry about and which ones are totally harmless.

Repetitive Trauma

Ictor / Getty

The most common culprit for black nails is repetitive trauma, which can result from running or from wearing any type of ill-fitting footwear. If a black nail crops up shortly after a workout or a day spent in too-tight or too-loose shoes, this is likely the cause.

Repetitive trauma ranges from mild (think: a small, painless, black-and-blue discoloration beneath the nail), to severe (large, bloody blisters between your nail and nail plate), explains podiatric surgeon Jacqueline Sutera, D.P.M. In mild cases, no treatment is needed, and the black nail will simply grow out.

In severe cases, beneath-the-nail blisters can cause the nail to detacheither partially or fullyfrom the nail plate. This process can be quite painful if the detachment is only partial, warns sports podiatrist Lori Weisenfeld, D.P.M. She explains that once the nail fully separates from nail plate, it is officially dead and will never reattach. The good news is that its no longer painful. The bad news? It can take a long time for a new nail to grow inabout a year for big toenails and three to six months for smaller nails. In certain cases, a fresh nail can begin growing underneath an old, dead nail.

If theres additional repetitive trauma, the new nail can become bruised and detached as well. To prevent this, Weisenfeld recommends visiting your doctor who can trim down or entirely remove the dead nail, which will allow the new nail room to grow in properly.

Another time you should visit your doctor is if the skin surrounding your blackened nail is red, inflamed, or oozing. This may be a sign of an infection, Sutera says, and you should apply an antibiotic ointment until you can get an appointment.

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To avoid black toenails caused by repetitive trauma, Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City, recommends either trying a bigger shoe or wearing a thinner sock (thick socks may cause too much pressure on your toenails).

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Subungual Hematoma

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Dropping a heavy object (say, a dumbbell) onto your foot can burst the blood vessels under your nail bed and cause blood to pool underneath, Wiesenfeld explains. This type of black nailclinically called subungual hematomais especially easy to identify, as it will appear almost immediately after an incident.

The build up of blood typically causes a painful throbbing sensation that can be addressed by pricking a tiny needle through the nail to drain out the blood. This procedure will alleviate both the pressure and dark color under the nailand should always be done by your doctor, Sutera says. At-home attempts are often unsanitary, ineffective, and more excruciating than in-office care.

Most subungual hematomas are purely accidental, so Metzl recommends making foot protection a priority to reduce your risk of getting one in the first place.

Fungal Infections

Getty Images

Fungal infectionslike athletes footcan spread to your toenails and turn them shades of yellow, blue, green, brown, purple, and black, Sutera explains. This range in color is unique to fungus, as is the presence of subungual debrisa chalky white substance that lines the nail bed and often carries a funky odor.

If you think you may have a fungal infection, head to your doctorhe or she can clip and biopsy a portion of your nail to confirm a diagnosis. Treatment options vary depending on the severity of the infection. Mild cases are often addressed with topical medications, while more aggressive fungi require oral medication or even laser treatment.

According to the American Academy of Dermatology, keeping your toenails short, wearing properly-fitted and breathable shoes and socks, not going barefoot in public areas like locker rooms, and not using anyone elses shoes, socks, nail clippers, or nail files can help prevent a fungal infection in your toenail.

Skin Cancer

Sofia ZhuravetsGetty Images

Subungual melanomathe most serious form of skin cancercan grow underneath your nail bed on the nail plate and cause hyperpigmentation of the skin, Sutera explains. Its often a slow and painless growth, which makes it especially tricky to catch.

One ominous sign is discoloration that extends beyond the nail and onto the cuticle, Weisenfeld says. If youve had no incidence of trauma, and your nail is slowly starting to change colorespecially if that color goes beyond your nailyou should get it checked out by your doctor, she advises.

Regularly-pedicured patients should do a quick scan of their toes in between polish changes to catch any new developments, Weisenfeld adds. Everyone should ask their doctors to do a yearly skin check.

While melanoma can be deadly, its extremely rare and treatable if detected early. Surgery is the only treatment option for subungual melanoma, where the surgeon will remove your entire nail to remove the melanoma growth. Since subungual melanoma isnt caused by sun, it can be harder to prevent than other forms of cancer. But keeping your feet generally clean and healthy may help.

Skin Tone

Zero CreativesGetty Images

Occasionally, dark discoloration of the nail bed is merely a matter of skin tone. Sutera sees this most often in patients of color. Theres skin underneath your toenails, and just like skin anywhere else on your body, the pigmentation can change over time, she explains.

Often, this type of discoloration is symmetrical and seen on multiple toes. For example, both of your pinky toes may develop discoloration of a similar size and shape. Another telltale sign: similar coloring underneath your fingernails. These factors can help distinguish this type of benign black nail from more malignant ones, which are usually contained to just one nail. Even so, Sutera recommends getting any new and usual color changes checked by your podiatrist or dermatologist, just to be safe.

Jenny McCoy Contributing Writer Jenny is a Boulder, Colorado-based health and fitness journalist.
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