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Summary

Runner's nail, also known as walker's nail or jogger's nail, is a common injury sustained by sports enthusiasts. Most patients don't recall a direct incidence of trauma to the nail, but when questioned further, they recall a recent event where they were more active than usual. Examples of these activities might include a 10k road race, a hike in the woods or even a marathon. The activity acts to distract us from the repetitive injury sustained by the nail during the activity. Runner's nail is very common in marathon and ultra marathon runners.  The primary appearance of runner's nail is discoloration of part or all of the nail due to a bruise beneath the nail (subungual hematoma)

Symptoms
  • Discoloration and darkening of the nail due to bruising
  • May be asymptomatic or painful depending upon the nature of injury
  • Nail is progressively pushed off and replaced by new healthy nail

Description

runners_nailThe physical appearance of runner’s nail is a bruise (subungual hematoma) that encompasses all or part of the nail. Often the bruise is asymptomatic. Again, that lack of blunt injury to the nail confuses patients as to how and why runner's nail occurred in the first place. The most common contributing factor in cases of runner's nail is that the foot slides forward in the shoe and the nail is subjected to damage by hitting against the inner toe box of the shoe. The more this event is repeated, the greater the chance for disruption of the nail and bruising beneath the nail.  Runner's nail is most common on the great toe but may be found on the lesser toes.

A subungual hematoma (runner's nail) will create a mechanical separation of the nail from the underlying nail bed.  The pressure created by the subungual hematoma will force the nail float or separate from the nail bed.  The new nail, as it grows in to replace the old, damaged nail will reattach to the nail bed.


Causes and contributing factors

The cause of runner's nail is direct or indirect trauma to the nail.  Contributing factors may include poorly fitting shoes or wearing the wrong shoes for an activity.

Differential diagnosis

The differential diagnosis for runners nail includes;

Benign tumor of the toe
Ingrown nail
Lister corn
Malignant tumor of the toe
Onychomycosis
Subungual exostosis

Treatment

The first and most important step in the treatment of runner's nail is prevention. Be sure that you're using a shoe designed for the activity that you're participating in. For instance, wear arunner's_nail hiking boot for hiking and not a tennis shoe. If you foot does tend to slide forward in the shoe, be sure to use a tongue pad to secure the foot a bit better in the shoe. A tongue pad can limit damage to the nail by preventing the foot from sliding forward into the toe box of the shoe.

Once runner's nail does occur, treatment can be broken down into two stages. Immediately upon noticing discoloration of the nail, the bleeding beneath the nail (subungual hematoma) should be drained using the fine nail drill. Pedi-Boro or Epsom Salts soaks can be used to evacuate debris or dead tissue from beneath the nail. Oral antibiotics are only necessary is the adjacent soft tissue becomes infected. If infection does occur, the nail will most likely need to be removed by your doctor.

The second stage of care can last 3-12 months depending upon the severity of initial injury. As the nail continues to grow, a portion or all of the nail may slough. As a new nail grows in, it’s extremely important to apply a topical antifungal medication to the nail to prevent fungal infections of the nail. Keep the nail clean and dry. Avoid wearing a Band-Aid for prolonged periods. A Band-Aid will trap moisture in and around the nail and promote fungal infections.

If possible, try to keep the old or damaged nail in place. Removing the nail results in contraction of the skin of the distal tuft of the toe. If the distal tuft contracts from the loss of the nail, the new nail will be unable to grow back into a normal position. So when possible, keep the old, damaged nail in place to guide the new nail into position. 

When to contact your doctor

A partially de-attached nail may begin to behave much like a foreign body, causing an infection.  If the signs and symptoms of an infection occur following the onset of runner's nail, contact your podiatrist for treatment recommendations. 

References

References are pending.

Author(s) and date

Dr. Jeffrey OsterThis article was written by Myfootshop.com medical director Jeffrey A. Oster, DPM.  

Competing Interests - None

Peer Reviewed - This article is peer reviewed by an open source editorial board.  Your comments and suggestions to improve this paper are appreciated.

Cite this article as: Oster, Jeffrey.  Runner's Nail.  http://www.myfootshop.com/article/runners-nail

First published online: January 1, 2000.  Most recently updated 12/5/13.
 

Creative Commons License  Runner's Nail by Myfootshop.com is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

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