This series will explore the most common running injuries, their treatment, and prevention. In this entry, Black Toe AKA Runner’s Toe. What are the most common running injuries that I see and how do I treat them ? Being a runner myself, I know the need a runner experiences to be able to run. That being said, with some lower extremity running injuries, a runner may need to stop running temporarily.  Temporarily is the key word, as my goal for any of my patients is to keep them as active as possible during treatment. This series will explore the most common running injuries that I see, as well as how to treat and prevent them. Part 4 of 4 – Black Toe AKA Runners Toe What is Black Toe AKA Runners Toe? Although you can get a black toenail from a sudden, painful trauma that causes bleeding under the nail, for runners it’s not typically the case. The dark discoloration for runners is a chronic, repetitive trauma to the nail caused by the foot constantly hitting the front of the shoe. Symptoms

  • Blood pool (hematoma) in between the toenail and nail bed
  • Pain
  • Pressure from blood built up
  • Loosening of toenail

Common causes:

  • Running
  • Repetitive trauma where the longest toe (the 2nd toe is most common) hits the shoe when running


  • For Hematoma/ Blood pool with no pain or no loosening of toenail- no Rx- wait for new toenail
  • If no hematoma with pain and loosening of toenail- cut back with sterile nail clipper or see podiatrist


  • Get shoes that fit properly- make sure that you have at least 1/4 space between your longest toe and end of the shoe
  • Try on shoes at the end of the day with the sock that you normally run in (trying on shoes in the afternoon will ensure you get a proper fit, as foot swelling is at it’s greatest)
  • The injured toenail(S) will be prone to develop fungus so use topical anti-fungal ( not a cream) to prevention the development of fungus- see web site for details on fungus treatments

Common Running Injuries: Part 1 of 4 – Stress Fracture can be found here. Common Running Injuries: Part 2 of 4 – Plantar Fasciitis can be found here. Common Running Injuries: Part 3 of 4 – Hallux Limitus can be found here.

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