Saturday, November 24, 2018

A Tale of Two Toenails; How to Fix Runner's Toenails

Lots of runners have a toenail story.   Here's mine, with photos and not for the faint of heart.   But if you've had blackened toenails from marathoning, you'll recognize a lot of this.   Here we go.

During the summer of 2016, as I was in a stretch of high-mileage training leading to my (failed) Boston Qualifying attempt at the 2016 Chicago Marathon, I noticed my right big toenail began to turn black and becoming "loose".   I'd seen this happen several times in higher mileage seasons previously.  I knew it would eventually fall off as a new nail formed below.

My left big toenail, however, was a different story.   Rather than laying flat on the toe, as was the case on the (blackened, ugly) right side, it was gradually pushing up, forming an "A-Frame" shape.   In fact, on the morning of that big race in Chicago, I bumped my left toenail as I got dressed in the 4:30am darkness.  It hurt like crazy but eased and I ran anyway and thought little else about the toes.

Unlike earlier times, though, both toes kept looking pretty much the same.  That right nail never fell off and the "A-Frame" started looking more like a Swiss chalet than a toenail.   Nearly a year later, they looked like this on August 27, 2017

Baseline--Aug 27, 2017
Here's a close up of the left can see how it was forming the A shape.  It was horribly misshapen. 

Left big toenail arch--Aug 27, 2017

Rather gruesome, actually.  Yet I didn't know what to do, got busy during the fall, it didn't hurt if I didn't bump it, I didn't want to think about it, so I ignored it and and and get the story.  Running continued.  

Well, I eventually qualified for Boston on November 3, 2017 with these ugly toenails still tucked in my shoes.  In the new year though, the left toe started hurting more.  Increasingly, I'd whack it against my other foot while sleeping and wake up in pain, left toe throbbing.   

I finally asked my chiropractor about the toes.   He's a runner and winced when I took off my sock.   "You need to get those fixed, Joe" he immediately stated.   "I know a good podiatrist in town who can take care of you."   

I made an appointment for January 23, 2018 and took some photos the night before.   Super ugly.   

Before Podiatrist- Jan 22, 2018
Raising the roof on my tiny Swiss chalet...that arch on my left toe just kept growing.  

Left Big Toe, Jan 22, 2018

And the right toenail was dog ugly.  While I knew a new nail was growing underneath, it was not making an appearance.   

Right Big Toe, Jan 22, 2018

I drove across town on January 23, making my first-ever visit to a podiatrist, no clue what to expect.   I walked in, filled out the insurance paperwork and was shown the exam room.   I took off my shoes and socks, plopped into what looked like a slightly elevated recliner rocker (absent the TV remote control) and soon the affable foot doctor walked in.   He looked at my toes and asked "How did we get here?"

"I'm a marathoner."

"I would have guessed.  Toes like these only happen with folks who run insane distances or folks to work on their feet for many hours every day."  I wasn't really a surprise to him.   And it's good when your doctor isn't surprised by your condition.

We talked about what he could do and he offered an unexpected question: "So, do you want me to just remove those toenails?"   So, will they then grow back?  "No, I mean permanent removal.  Toenails serve no real purpose anyway.   I'll kill the base with acid."

Hmmm...had to think quickly.   "You know what, let's just trim them back and I'll think about the permanent fix later."   He was fine with that.   Yeah, so was I.

I was surprised he then just sat down on a stool, put a bright light on my toes and began to get to work.   For some reason, I expected a little more prep work, kind of like what happens at the dentist. Instead, he pulled out some tools and got on with it.  They looked like stainless steel electrician's tools.

I decided to close my eyes and lean back.   That proved a wise choice.

He started on my blackened, right big toenail.   I felt a few clips but in a minute or so, I heard him say "OK, that looks better."  Zero discomfort.  Nice.   I kept my eyes closed and he shifted and began to dismantle the A-frame mounted on my left big toe.

The first couple of clips felt totally different from the right toe.  I could sense the snap of each clip vibrate through my toe and foot.   I could tell he was clipping carefully and intentionally. I felt him position himself for each clip.   Then one clip really hurt.   My leg shook, involuntarily.

"How you doing?"   I'm OK, doc, but sure felt that one.   "Well, I have two more clips to make...can you make it or do you want me to numb this a bit? "    I paused briefly, mentally imagining myself at mile 24 of a marathon.   It all hurts, but we're almost done.   I told him to keep rolling.  

He did...and the final two more clips hurt.   But then he was done.   Turned out those final three clips were the "money cuts" as he extracted the ingrown toenail from the fleshy part of my toe.

I opened my eyes at last, looked down and was stunned by how different my toes looked in such a brief time.   The left nail was bleeding a bit...he put on some antibiotic cream, gauze and an adhesive bandage.   "Change that up every day and it'll be fine in a couple days."   And that was it.  

My left leg hurt.  I pulled on my socks and shoes...and, to my utter surprise, even in the first few steps walking out of the office, I immediately noticed how much better it felt.

Here's what it looked like after the visit.   The two toenails were cut way back.

Post Podiatrist, Jan 23, 2018
The A-Frame was gone.  The left side of that toenail had clearly pierced the skin, causing the pain.   The podiatrist cut it way back to relieve that pain and took off a lot of the nail.  The minor ooze of blood was gone in two days.   

Left big toenail, after podiatrist trimmed on Jan 23, 2018

That ugly black right toenail?  Gone.   Only this remained.   

Right nail close up, post podiatrist, Jan 23, 2018

The improvement was instant.  That entire day, I noticed my left foot landing much "flatter" retrospect, I realized I had gradually begun walking on the outside of my left foot, avoiding discomfort due to the ingrown left toenail.  While my left leg tingled for a few hours, that quickly diminished and I felt nothing but improvement the next morning.   It made me so glad I made the appointment and got the foot fixed.

My running continued with my new and improved toenails.   Yet, another nagging problem was revealing itself, one about which I had similarly been in denial.   I noticed how my left heel would hurt, sometimes very badly, when I took my first steps out of bed each morning.   In mid February, on a planned 18 mile long run, that foot shut down, forcing me to walk home.   I had to admit...Plantar Fasciitis was in my life.   I think it was no coincidence that the PF occurred in my left foot...I strongly suspect the involuntary pivoting of my left foot to avoid pain from the ingrown toenail over many months, perhaps a year or more, contributed to the strains which describe PF.   I'll write more about the PF in another post, eventually. 

I took about five weeks off from running, getting restarted in late March, 2018.  I eased into a couple of half marathons as the PF got better, with no complaint from either big toenail.   I even ran a 40 mile trail race in late April, the second longest run I've ever had.    

By mid-May, the toenails were growing back nicely, dare I say, almost looking "normal".   It had been quite a while.   

4 months post podiatrist, May 12, 2018

I was astounded how steadily the left toenail flattened out.   

Left Big Toe, May 12, 2018.

Right Big Toe, looking better, May 12, 2018

As they grew back and not wanting to re-do this ordeal, I ordered these toenail trimmers that looked more like the podiatrist's tools as opposed to the dinky clippers that didn't get to the corners.  I've been very pleased with how precise and strong these clippers perform.   I feel like I'm staying ahead of the toenails now.   Note: these are very sharp and should never be available to children.   

These bad boys are sharp and precise

The toes faded as an attention getter to me.   My running got back on track and I finished  The Sandhills Marathon on June 2, as well as other local races.  

But by mid summer, I noticed a disappointingly familiar pain, this time in my right big toenail.  The pain showed up when I pressed down on the toenail.  The toenail, growing into the toe, pressed harder and triggered pain.   The good news in this was I knew who to call.    I set up an appointment with my friendly podiatrist and headed back.   Here's what the toes looked like the night before my second trip for a trim.   

Looking better but pain in right toe, July 16, 2018
It's interesting to me how the image of the nails is not nearly as grim as the earlier examples.   I'm sure this is because I acted sooner, rather than later to address the issue.   

This trip to the podiatrist was really quite easy and had hardly any discomfort at all.   The doctor made a few key clips and pronounced it good.  No blood, no oozing this time at all.   Here's the "after" photo.  

After 2nd trip to podiatrist, July 17, 2018
The obvious change was merely a shortening of the right nail.   But he dug it out of the flesh and the discomfort went away immediately. 

So, that's the story for now.   Here are my toes five months after the second trip to the podiatrist.   

Nov 2, 2018--How I hope they stay

A long story I hope continues to have a happy ending.   I hope this may have been helpful for you runners with similar toenail stories.  

Persevere.  No matter the condition of your toenails. 


ADDENDUM, December 1, 2018

An Ultra-running podiatrist in one of my on-line running groups read this and offered some useful professional insight.   Many thanks to Dr. Bill Johncock of Hickory, NC for his generous perspective, below, in italics.  

Podiatrist here.  Here are some of my take-aways: 

1) Toenails will likely be lost/black/irritated if you run long enough.  It's kind of a badge of honor. My record is losing 6 of 10 toenails after a 100K trail race in Virginia after kicking multiple rocks buried beneath leaves on the trail.  Yes, they all were sore, yes I lost all of them, yes they all grew back. 

2) Black toenails are OK and will typically eventually come off on their own.  But if they are infected, you need to have them addressed.  Preferably by a Podiatrist or someone that know what they are doing. 

3) If the nails grow back irregularly so as to become painful (see Joe's story above), go see a podiatrist and they may need to address the issue. 

4) Losing toenails can increase the risk of getting toenail fungus.  This can be much more challenging to resolve. 

5) Pedicures are not evil, but you must be careful to see someone who cleans their instruments well between their clients.  If they don't clean their instruments well and that person has fungus, you may well obtain the fungus yourself.  It is not a well regulated industry.  Again, pedicures are not the problem.  Bad pedicurists are.  Just be sure they are using clean instruments, clean supplies, etc. 

6) As for the question on how to prevent black toenails, having about a thumbnail length from the end of your longest toe and the end of the shoe is important to be sure the shoe is not too tight or too loose.  But again, if you run long enough, you're likely to get black toenails at some time.  My 2 cents worth!

Many thanks, Bill!



Elizabeth said...

Is it weird of me to say that I loved this post? Ha. I have a toenail in similar condition and was wondering if I should do anything about it. I may or may not, but this post was really informative. said...


Stevie said...

I started running 6 miles a day and 2 or 3 toenails on each foot started raising and change color. I assumed it was fungus and went to the doctor. He prescribed Terbinafine Hydrochloride. My wife spoke to her doctor and said fungus has a smells associated to it. I had no smell. Do I not need to be taking this medician because it is not fungus because of no smell? What adjustments can a runner make to their shoe size, type shoe, toe box, socks etc. to keep a runners toes from changing color and shape???

Joe said...

Stevie, thanks for your comment. I'm no doctor, so I can't comment on the fungus or no. But, if you go back and read the italized portion of my blog at the end, from a podiatrist, I think you'll find some useful, practical suggestions for your questions. Thank you for reading!!