What is the number one most worrisome problem when you lose a toenail from running? Well, that is what we’re talking about today on the Doc On The Run Podcast.
All of us who run have at some point probably had a toenail that turned black and blue, and maybe even got so much blood under the nail from that bruise that the nail fell off. A lot of runners kind of think of this as a badge of honor for doing super long runs and beating up the toes so much that you’re losing toenails.
Well, number one, you do not have to do that. That is a different episode, but I am going to talk about the number one problem and why you do not really want to let that happen. Believe it or not, I have had a bunch of runners ask me over the years if I would permanently remove their toenails for them so that they do not get that problem, and you can do that, but I do not typically recommend that, although I have done it a couple of times for some unique circumstances. Let’s talk about it.
So, this is the toe, and again, I’m a podiatrist, not an artist, so if you don’t like my drawings, go ahead and make all the comments you want, but I’m going to do the best I can do. So, you have the toenail. You have the bone in the middle, and when you look at this, so you’re looking down on your nail.
You’ve got skin folds on the sides. You have the nail sitting out here. You have the proximal skin fold back here and the lunula, that little white part, and what happens when you get a bruised toenail? Well, all that is really happening is you’re impacting the leading edge of the nail one way or another.
So, if this is the toenail, looking at it from the end like that, you’re basically hitting the end of the nail, and then you get bruising. You’re beating it up so much that you get bruising underneath the nail here. It’s in between the nail plate and the nail bed, and it can be anywhere.
It could just be one section. It could be the entire thing, but you have a nail bed that the nail sits on, on the nail bed, and when you lose the nail and the nail’s gone, then you just have the nail bed, and the nail bed has grooves in it, and if you look at your nails closely, you might be able to kind of see these grooves. There’s a whole bunch of lines going in this direction, and the nail plate sits in those grooves and slides outward, and when you lose the nail, what happens is that once the nail’s gone, these skin folds on the side can start to contract, and then as your nail grows in and it’s growing in from the end after you’ve lost the nail, it’s growing outward on the nail bed. Well, the nail bed starts to contract.
It not only contracts side to side, but it also contracts end to end, and you start getting more skin out here at the edge of the nail, and you have what is referred to as a disappearing nail bed. There are a lot of different articles you can look up that have been published in medical journals about this, but there’s one that is really interesting called The Disappearing Nail Bed, A Possible Outcome of Onycholysis.
Onycholysis, onycho means nail plate. Lysis means it separates, so onycholysis is what you had when you bruised the nail, lifted the nail off the nail bed, and then the toenail fell off. Onycholysis is not good because you are traumatically losing the nail. Number one, that can make the nail thicker, but that is not the most worrisome problem. The most worrisome problem is you can develop this thing that Dr. Daniel talked about in this article that was published in 2005. If you want to read it, I’ll have a link in the show notes at docontherun.com on this episode that’ll have a link to that article where you can go pull up the abstract and see what it’s about.
But what they’re talking about is that when you lose the nail plate, that the skin will contract and start to make the nail bed smaller, and the nail plate cannot sit on the toe without the nail bed and the nail plate being firmly attached to it. So, you start to get this permanent separation of the nail plate from the nail bed.
Number one, that makes you more prone to ingrown toenails because there’s not enough room for the toenail to grow into the end of the toe in this place. And then also, if the nail plate, this is not complicated, the reason you’re beating up the nail is that the shoe is sitting here and you’re hitting the inside of the upper. So, if the nail plate separates from the nail bed and it then slopes upward because it’s not as attached, it’s going to be more prone to hitting the inside of the shoe whenever you run, which is why some runners get one nail that gets lost and it kind of separates a little bit and then it happens more frequently. They run less, they run shorter distances, and they get the same problem that they used to get when they’d run a marathon.
They start to get it when they’re having a half marathon. You don’t want a disappearing nail bed. There’s not a way you can fix that. You cannot really make the nail bed bigger. You can’t do plastic surgery on it. It doesn’t work. So, you want to avoid that problem. So, if you’re beating up your toenails, you need to figure out why and you need to make sure that you’re not doing that so that you don’t wind up with this problem.
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