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Treatment of Runner's Nail

Runner's Nail - diagnosis and treatment

Spring is in the air and many of the patients that I've seen this week are getting out and getting active.  Many times new activities mean new shoes and new shoes can mean problems.  One of the more common foot problems I'm seeing with this increase in activity is runner's nail.  Runner's nail is a bruise that forms beneath the nail.  This bruise is called a subungual hematoma.  The most common contributing reason for runner's nail is shoes that are too short, but even more often, loose shoes that allow the foot to piston within the shoe.  With a loose shoe, the nail repeatedly slams into the toe box of the shoe resulting in runner's nail.  And in the vast majority of cases, patients don't realize that there is a problem until they notice darkening of the nail long after the injury.

Runner's Nail - prevention

Treatment of runner's nail includes prevention, acute management of the subungual hematoma and long term management as the Tongue Padold nail is lost and the new nail begins to grow in.

The best method used to prevent runner's nail is the use of a tongue pad.  A tongue pad is an adhesive-backed felt pad that is placed under the tongue of the shoe.  You can apply one or more tongue pads depending on your individual case.  The purpose of a tongue pad is to push the foot into the heel of the shoe, limiting the pistoning of the foot and keeping the nail from hitting against the toe box of the shoe.

Runner's Nail - treatment

If you do sustain a bruise under the nail,  the bruise should be drained within 24 hours of the injury.  Draining the subungual hematomaNaileezer nail Dril (bruise beneath the nail) will decrease pain and improve the chances of salvaging the injured nail.  The bruise can be drained using a Dremel Drill or heated, sterile paper clip.  heat the tip of the paper clip with a lighter and gently pass through the nail to release the subungual hematoma.

And last is management of fungal infections of the nail.  Any injured nail is susceptible to a fungal infection.  Fungal infections of the nail (onychomycosis) cause the nail to become thick, yellow and permanently separate the nail from the underlying nail bed.  Use of a topical antifungal is an important part of care following the onset of runner's nail.  Be sure to continue to use the topical antifungal until any evidence of the injury has completely grown out.


Dr. Jeffrey Oster
Jeffrey A. Oster, DPM

Medical Advisor

Updated 12/26/19

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