What Causes Black Toe Syndrome?

 |  Running  | 

Of all the most debilitating issues that plague a runner during their training, black toe syndrome might top the list. For a runner, there is always plantar fasciitis, sciatica, heel spurs, IT band syndrome, and a host of chronic knee injuries that require either surgery, plenty of rehabilitation, and enormous amounts of patience until the return to running resumes.

Black toe syndrome sounds like a rather simple acute problem however it can put your running days into an entirely different set of rules. Read on to find out more about black toe syndrome and what causes it.

What Is Black Toe Syndrome?

The root cause of black toe syndrome is trauma. This is commonly referred to as subungual hematoma, which is a severe bruise underneath the nail bed caused by repeated pressure of ill-fitting shoes during the course of a run. If your shoes are too small, without at least a thumb’s distance between the end of the running shoe and your toe, chances are one of your toes will continually strike the tip of the shoe during a run.


Your feet naturally swell in this instance due to the heat incurred while running therefore black toe syndrome may result. The best option is to keep your toenails trimmed and clean at all times. The dirt and sweat that accumulates underneath the nail bed needs to be consistently washed off, otherwise you will start to notice a possible infection developing in the toenail.

What Causes Black Toe Syndrome?

Here are some of the main causes of black toe syndrome. You might fall into any one of these categories, as it is not always limited to those who run:

1. Wrong shoe size
As stated above, if your shoes are not fitted properly, any one of your toes could strike the edge or top of the shoe each and every time you run. Even walking in the wrong shoe size can cause black toe syndrome. The key is to have a professional shoe salesman at a running store observe your running style. They then should the knowledge and information to put you in the correct shoe for your foot.

Simply buying a cheap running shoe off the shelf at any department store might lead to you having the incorrect shoe for your run. There is a science to buying running shoes.  Buy the proper footwear and you will help stave off black toe syndrome.

2. Injury or trauma
Injury or trauma to an already infected toenail can also increase the risk of black toe syndrome. If you have sensitive toes or a persistent fungal infection, walking barefoot or constantly in flip-flops could put you at risk. Dropping a heavy object on your toes, bumping the edge of your toes into something hard, or someone mistakenly stepping on your toes with their solid shoes can all leads to trauma and bruising. If the toenail is already suffering from black toe syndrome then any of these types of injuries can further the infection.

3. Melanoma
This is extremely rare, however it does exist. If a fungal infection turns brown, purplish, or reddish, is foul in odor, oozes a thick liquid, this could be the onset of melanocytes that gather under the nail bed causing possible malignant tumors. This requires an immediate trip to your podiatrist.

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A good way to reduce the risk of black toe syndrome is getting a Pedicure. Pedicures are not just for women any more. Pedicures have a place in running. Your feet get buffed, filed, massaged, cleaned, and ready for action. Both men and women are noticing the benefits of having a pedicure treatment during their running days.

It doesn’t need to be fancy at all; simply having someone else cut your toenails, file away the calluses (keeping some of the pertinent ones for good measure during a run), and getting rid of dead skin underneath and around the toenail is worth its weight in gold.

If you have sensitive toenails, and frankly, who doesn’t as a runner, then you might want to make sure you let your pedicure attendant know that you run. If they are aware of this then it isn’t such a wincing experience sitting in a nicely padded massage chair and walking away with manicured toenails that last for at least a month, is a sure ticket to warding off black toe syndrome.

The causes of black toe syndrome need to be ironed out before you plan your next run, or even a visit to your doctor. After the trauma of the toenail, you will notice that in a few weeks the nail separates from the toe. If there is a sign of infection, the best solution (and most inexpensive) is to take a very fine needle and drill a tiny hole into the lower part of the nail bed to drain the discharge from underneath.

This will alleviate any pressure build-up from the infection. Once you notice the small needle inserting into the nail, the liquid will begin to emerge. At that point, dab the area repeatedly with a clean moist cotton ball.  It should be warm water, as it will continue to help the discharging liquid seep out of the wound. You can do this treatment several if you have signs of black toe syndrome, and although the toenail may look ugly and altered, it’s sure save you a visit to the doctors. If the trauma is allowed to persist, an infection would most certainly have occurred and your running days will definitely be on-hold.

If you choose to run after recovering from black toe syndrome, it’s advised to be cautious. After the nail falls off, there is nothing to protect your toe from repeated stress during a run. It might even be wise to take a little time off and walk with your properly fitted shoes. Break those shoes in with some power walking first. Allow the toe to heal a bit before venturing out for your usual ten-miler.

Eventually, another nail will begin to grow after a few weeks. The full nail bed will return after six months or so. During this time, it’s crucial to keep the toe clean and healthy. Continue to trim your toenails as often as possible. Treat your toes with respect and love. Your feet deserve it!

Have you ever experienced black toe syndrome? Share your experiences and comments below.