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 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.

Treatment of Runner's Nail

The first 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 a hiking boot for hiking and not a tennis shoe. If you foot does tend to slide forward in the show, 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 drill in The Nail Rescue Kit for Runner's Nail. 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. The nail can be held in place by using The Nail Rescue Kit for Nail Avulsions.

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The symptoms of runner's nail will vary.  Most cases of runner's nail will have little to no symptoms. 

If the nail becomes loose, the nail may act as a foreign object and begin to cause a soft tissue infection.  The skin may try to reject the nail by developing a soft tissue infection.  Symptoms of rejection of the nail would include increase redness, swelling and pain.

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• Ingrown Toe Nail

• Onychomycosis

• Broken Toe

• Toe Box Dermatitis

• Lister Corn

This article was written by Jeffrey A. Oster, DPM and last updated 6/1/10. No additional information is available for this topic.