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Blood under your toenail after a marathon? What you should do.

The Akron Marathon was this past Saturday and I’ve seem multiple patients this week already from the race. By far the most common injury presenting initially in the week that follows is blood under the toenails. Correctly defined as a subungual hematoma. The cause is micro trauma to the toenail which produces irritation and bleeding to the nail bed (skin under toenail). Tight shoes and poor form are typically the usual suspects creating this painful condition. Blood and fluid then accumulates under the nail creating pressure which lifts the nail creating pain. The simplest approach to treating this is by removing the toenail. This allows the fluid and bleeding to be expressed reducing the pressure and resolving the pain. If this is not done, the pressure can build leading to further damage under the nail and possibly bacterial infection. The removal is temporary as the nail will grow back. The nail bed usually remains tender for only 24-48 hours at which time running can resume. The post procedure care is simply a band aid and antibacterial ointment for 7-10 days. It then takes approximately 6 months for a new nail to full grown in.

The example below is the result of a marathon runner and treatment was performed 3 days after the run.

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Here’s a post from 2 years ago demonstrating a similar situation.

Runners Nail – Subungual Hematoma
May 18, 2011

Recently a patient was referred to me who had just completed the Cincinnati Marathon and had pain and “bruising” under the under the right great toe nail. He was not sure of what to do as far as continuing to run, and whether or not the nail would fall off.  He was running another marathon within a week. 

Initial Presentation

We recommended removing the nail plate for 2 reasons.

1. It will allow a decrease in pressure under the nail to prevent further injury and allow for faster healing.
2. He could get back to running within 24 hours with no restrictions.

There is always a risk of permanent nail damage from removing a nail, but typically this damage has already been done by the initial trauma (in this case micro-trauma from running) that caused the injury.

The cause of Runners Nail is typically biomechanical in relation to a loose or tight fighting shoe, or landing incorrectly putting to much sheer force on the sole and the foot jams into the toebox.

He was able to run the next day and did complete the Pittsburgh marathon with no toe pain!

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Initial Presentaion
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Immediate Post Procedure
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Night Before Marathon
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2 Hours after Marathon (less then a week later)




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