Trauma to the toe nail can result in a number of different conditions, but the most common is a bruise beneath the nail called runner’s nail (also called walker’s nail). Most patients present to the office with no clear history of injury. They don’t recall any direct trauma to the nail, but when questioned further, they recall a recent event where they were more active than usual. Examples include a 10k road race, hike in the woods or even a marathon. These events usually contribute to runner’s nail by distracting us; we’re so involved in the activity that we don’t realize the degree of injury that the nail is being forced to endure.

The physical appearance of runner’s nail is a bruise (subungual hematoma) that encompasses part or all of the nail. Often the bruise is asymptomatic. Again, that leads to the confusion of how and why the condition occurred in the first place. What happens in most instances 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.

Treatment of runner’s nail is broken down into two stages. The first stage, or acute stage, is the management of any infection surrounding the outer edge of the nail. The first stage lasts approximately a week. If possible, any bleeding beneath the nail should be drained to relieve pressure beneath the nail. Epsom Salts soaks can be used to evacuate debris or dead tussue from beneath the nail.  Antibiotics are only necessary is the adjacent soft tissue becomes infected.  If infection does occur, the nail will most likely need to be removed.

The second stage of care can last 3-12 months depending upon the degree of initial injury. During this stage, a portion or all of the nail may fall off. During this time it’s extremely important to apply a topical antifungal medication to the nail to inhibit fungal infections of the nail. Try to keep the nail in place as long as possible. 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, keep the 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.  The nail can be held in place by a thin 1/4 inch strip of tape or a Band-Aid split longitudinally into three strips, using just one strip at a time.

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• Toe Nail Fungus

• Toe Nail Injuries

• Toe Nail Trimming

This article was written by Jeffrey A. Oster, DPM and last updated 6/27/07. No additional information is available for this topic.