Medical Corner

Nail Problems in Runners

Enough space in the toe box and the right lacing technique will give your toes more room. This prevents bleeding under the nails.


Dr. med. Hardy Hartmut Hüttemann, Head of Medbase Basel Heuwaage, specialist in physical medicine and rehabilitation, sports medicine SEMS/manual medicine SAMM, interventional pain therapy SSIPM, altitude and mountain medicine SGGM.


Too much pressure is not good for you. Not even your nails. Excessive, repeated pressure causes bleeding under the nail – usually on the big toenail. This can cause the nail to fall off completely. Many runners are familiar with this problem when running long distances, from half marathons upwards.

The pressure occurs when your toes have too little space. This may be due to shoes that are too small, the forefoot area (toe box) being too narrow, hard shoe fabric, tight lacing, incorrect rolling behavior, the wrong choice of shoes or because your old running shoes barely cushion in the forefoot area.

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First aid for nail problems

As long as the pain is only mild, the first thing to do is to stop and take pressure off the nail. Is a seam or foreign object pressing on the front? Can you lace the shoe differently to relieve the nail? A lot can be improved with the right lacing technique.

Your toes will have more room with diagonal lacing. This involves threading the laces through all the eyelets from top to bottom. Only one top eyelet remains free. Once you reach the bottom, pull the lace diagonally up into this free eyelet. There are many instructions on the internet.

Padding usually exacerbates the problem

Padding the inside of your shoe only makes sense if the shoe is very hard – a leather shoe, for example – and the pressure on the nail is caused by this. In all other cases, padding is useless because your nail will have even less space in the shoe than before. Padding increases the pressure even more.

If you don’t want to break off or have to keep running, the last option is to cut open your shoe at the point where it is putting pressure so that the affected toenail has more space.

Trepanning the nail

If there is already a lot of bleeding under the nail, this can be quite painful. If you can make it to the finish with the nail, it is better to get help from a professional. In an emergency, for example in the middle of a competition far away from a doctor, you can relieve yourself by cleaning and disinfecting the toenail. Then use a sterile needle to carefully drill a hole in the nail from above where the blood has collected. This allows the blood to escape from under the nail and the pain subsides.

However, this method only works in the beginning, as long as the blood has not yet clotted. It is important that you work cleanly and that no dirt gets into the wound afterwards. It then makes sense to check whether your tetanus (lockjaw) protection is up to date and to have a booster vaccination if necessary.

The nail may fall off later. You can walk properly again around four weeks later. Let everything heal – and prevent it from happening again.

How to prevent

The most important prevention is choosing the right shoes. The shoe model must fit your foot shape. This is much more important than walking in a “trendy shoe”. Make sure the toe box is wide enough. This is because a toe box that is too narrow, too little forefoot cushioning or shoe fabric that is too hard in the toe area can lead to nail problems.

Some shoe manufacturers have specialized in certain foot shapes. If you have problems with standard shoe brands, it may be worth trying on shoes from such niche suppliers.

For long distances, your foot will be one size larger after the run than before. Take this into account when buying and choose a larger shoe size. No matter what distances you run: always buy your running shoes in the afternoon or evening because your feet are wider then than in the morning. It goes without saying that you should break in new shoes before you run really long distances in them.



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