[post_ads]Many runners are familiar (read: all too familiar) with the black toenail. The condition involves bruising, blistering
or bleeding beneath the nail from repetitive trauma, either of the top
of the shoe banging against the nail or the toe slamming into the end of
the shoe. It’s most commonly experienced by marathoners and those
training at especially high intensity. Some even see it as a badge of
honor: the more black nails, the more badass.
But not all black toenails are from running. In certain cases, a dark
nail tells a darker, more dangerous story. Here, two podiatrists
explain the difference between the benign and malignant.
The most common culprit for black
nails, repetitive trauma can result from running, or from wearing any
type of ill-fitting footwear. If a black nail crops up shortly after a
workout or a day spent in too-tight or too-loose shoes, this is likely
the cause.
Repetitive trauma ranges from mild (i.e. a small, painless,
black-and-blue discoloration beneath the nail), to severe (i.e. large,
bloody blisters between your nail and nail plate), explains Dr.
Jacqueline Sutera, DPM and spokesperson for the American Podiatric Medical Association. In mild cases, no treatment is needed and the black nail will simply grow out.
In severe cases, beneath-the-nail blisters can cause the
nail to detach—either partially or fully—from the nail plate. This
process can be quite painful if the detachment is only partial, warns
Dr. Lori Weisenfeld, NYC sports podiatrist, explaining that once the
nail fully separates from nail plate, it is officially dead and will
never reattach.
The good new about this: it’s no longer painful. The bad
news: it can take a long time for a new nail to grow in—about a year
for big toenails and 3 to 6 months for smaller nails. In certain cases, a
fresh nail can begin growing underneath an old, dead nail. If there’s
additional repetitive trauma, the new nail can become bruised and
detached as well. To prevent this, Weisenfeld recommends visiting your
doctor who can trim down or entirely remove the dead nail, which will
allow the new nail room to grow in properly.
Another time you should visit the doc: if the skin
surrounding your blackened nail is red, inflamed and/or oozing. This may
be a sign of an infection, says Sutera, and you should apply neosporin
until you can get an appointment.
Dropping a heavy object (say, a
dumbbell) onto your foot can burst the blood vessels under your nail bed
and cause blood to pool underneath, explains Wiesenfeld. This type of
blackened nail—clinically called subungual hematoma—is especially easy
to ID, as it will appear almost immediately after an incident.
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The build
up of blood typically causes a painful throbbing sensation that can be
addressed by pricking a tiny needle through the nail to drain out the
blood. This procedure will alleviate both the pressure and dark color
under the nail—and should always be done by your doctor, says Sutera, as
at-home attempts are often unsanitary, ineffective, and more
excruciating than in-office care.
Fungal infections—like athlete’s foot—can
spread to your toenails and turn them shades of yellow, blue, green,
brown, purple, and black, explains Sutera. This range in color is unique
to fungus, as is the presence of subungual debris—a chalky white
substance that lines the nail bed and often carries a funky odor.
If you think you may have a fungal infection, head to your
doc. He or she can clip and biopsy a portion of your nail to confirm a
diagnosis. Treatment options vary depending on the severity of the
infection—mild cases are often addressed with topical medications while
more aggressive funguses require oral medication or even laser
treatment.
Here’s another reason to use sunscreen: Melanoma—the most serious form of skin cancer—can
grow underneath your nail bed on the nail plate and cause
hyperpigmentation of the skin, explains Sutera. It’s often a slow and
painless growth, which makes it especially tricky to catch.
[post_ads]One ominous sign: discoloration that extends beyond the nail and onto the cuticle, says Weisenfeld. “If you’ve had no incidence of trauma and your nail is slowly starting to change color—especially if that color goes beyond your nail—you should get it checked out by your doctor,” she advises, adding that regularly pedicured patients should do a quick scan of their toes in between polish changes to catch any new developments. While melanoma can be deadly, it’s extremely rare and treatable if detected early.
MORE: 6 Skin Care Tips for Runners
Occasionally, dark discoloration of the nail
bed is merely a matter of skin tone. Sutera sees this most often in
patients of color. “There’s skin underneath your toenails, and just like
skin anywhere else on your body, the pigmentation can change over
time,” she explains.
Oftentimes this type of discoloration is symmetrical and seen on multiple toes—for example, both of your pinky toes may develop discoloration of a similar size and shape. Another telltale sign: similar coloring underneath your fingernails. These factors can help distinguish this type of benign black nail from more malignant ones, which are usually contained to just one nail. Even so, Sutera recommends getting any new and usual color changes checked by your podiatrist, just to be safe.
[post_ads]One ominous sign: discoloration that extends beyond the nail and onto the cuticle, says Weisenfeld. “If you’ve had no incidence of trauma and your nail is slowly starting to change color—especially if that color goes beyond your nail—you should get it checked out by your doctor,” she advises, adding that regularly pedicured patients should do a quick scan of their toes in between polish changes to catch any new developments. While melanoma can be deadly, it’s extremely rare and treatable if detected early.
MORE: 6 Skin Care Tips for Runners
Oftentimes this type of discoloration is symmetrical and seen on multiple toes—for example, both of your pinky toes may develop discoloration of a similar size and shape. Another telltale sign: similar coloring underneath your fingernails. These factors can help distinguish this type of benign black nail from more malignant ones, which are usually contained to just one nail. Even so, Sutera recommends getting any new and usual color changes checked by your podiatrist, just to be safe.
