Lost a toenail after running? Doctors explain how to treat and avoid runner’s toe

Runner’s toe can range from a simple darkened nail to a toenail that comes off entirely, so treatment can vary too. Getty Images

I’ve had runner’s toe several times, and each time I ended up losing the nail. It’s a familiar problem for runners, especially during long-distance training or race day itself. The reassuring part: doctors say it is both treatable and preventable. Whether you have a bruised black nail or one that has already fallen off, here’s what experts recommend.

What is runner’s toe?

Runner’s toe is a common term for a subungual hematoma, meaning bleeding beneath the nail bed, says Dr. Jacob Wynes, a podiatric surgeon and associate professor of foot and ankle surgery at the University of Maryland School of Medicine. The toenail may turn red, purple or nearly black, and it can sometimes ache or throb from pressure. In some cases, the nail may partially or fully detach. Any toe can be affected, though it usually happens on the longest toe, often the big toe or second toe.

Despite the name, runners are not the only people who get it. Anyone can develop a subungual hematoma, especially with shoes that do not fit well, Wynes says. Other at-risk activities include soccer, football, tennis, skiing, hiking and golf. It can also happen if you stub a toe or drop something on it; in those sudden-trauma cases, Dr. Kristin Hullings, an assistant professor of clinical orthopaedic surgery and sports medicine at Temple University’s Lewis Katz School of Medicine, says it is wise to see a doctor to rule out a fracture or break.

What causes runner’s toe?

Runner’s toe is usually caused by repeated trauma to the nails while running, says Dr. Rull James Toussaint, chief of the foot and ankle division in the department of orthopaedic surgery and sports medicine at the University of Florida College of Medicine. Downhill running, high mileage, shoes that are too loose or too tight, long toenails, and heat or moisture buildup can all increase friction and pressure between the toes and the front or top of the shoe. Over time, that repeated contact can rupture blood vessels in the nail bed and allow blood to collect under the nail plate, Hullings says.

How do you treat runner’s toe?

Because runner’s toe can vary in severity, treatment depends on the situation. Below is a breakdown of how to handle mild to moderate cases, along with the supplies doctors recommend.

No matter how serious the injury seems, the key is to figure out what caused it and correct that problem so it does not worsen or return. If you have major pain or swelling, or if those symptoms are getting worse, seek medical care.

If your toenail is still intact

If blood is trapped under the nail but the nail is still attached, not loose, and there is no exposed nail bed or significant pain, the condition will often improve on its own as the nail grows out, Toussaint says. Focus on preventing it from getting worse or recurring. If the nail later loosens and begins to shed, follow the steps below.

If your toenail partially or fully falls off

If the nail comes off completely or in part, the main goal is to keep the exposed nail bed clean and protected so infection is less likely and regrowth can occur, Hullings says. A fully detached nail leaves the nail bed more exposed and vulnerable, while a partially detached nail offers a bit more protection. The basic approach is similar in both cases.

Clean the affected toe

Start by gently cleaning the toe to remove dirt, Wynes says. Mild soap and water or a saline solution can be used.

NeilMed saline solution contains 0.9 percent sodium chloride and water, making it a gentle wash. Its spray nozzle can be used at different angles, including upside down, which can make it easier to reach your toes.

Trim away loose parts of the nail

If only part of the nail is detached, leave the attached section in place. It can act like a protective splint and help healing with less risk of infection, Hullings says. Trim away any loose or snagging edges so they do not catch on socks, pants or sheets. Preserve as much nail as possible, but make the edge smooth, Wynes says.

For trimming sharp loose edges, cuticle nippers can be easier to use than standard clippers because they are smaller and more precise. The smaller head helps avoid removing too much nail. Tweezerman’s stainless steel Rockhard Cuticle Nippers are one example; they are designed for both right- and left-handed use and require only light pressure.

Apply a topical ointment

A topical antibiotic ointment can help prevent infection, keep the area moist and support healing, Wynes says.

Neosporin’s ointment uses three antibiotics to help kill germs and prevent infection for up to 24 hours after application, according to the brand. It can be used up to three times per day.

Apply a bandage and change it daily

If the nail has fully fallen off, or if a large part of the nail bed is exposed, keep the area covered with a clean bandage and replace it daily, Hullings says. A non-adherent bandage is best because it covers the wound without sticking to the healing tissue. A standard Band-Aid works well, Wynes says; avoid hydrocolloid bandages, which adhere over the entire surface.

Waterproof Band-Aids tend to stay on my toes longer than standard ones. When feet get warm in shoes or in hot weather, regular bandages can start to shift or peel, which defeats the purpose. Waterproof versions stay in place, block dirt and germs, and remain flexible around the toe.

If the nail is loose, do not pull it off or cut it away, Toussaint says. Leave it alone and let it come off naturally. I sometimes use adhesive butterfly wound closure strips to hold a loose nail in place when I’m wearing socks and shoes, especially if it feels unstable or likely to snag. If the nail bed is not exposed, I place one end of the strip on the nail and the other on the skin. Once the nail fully or partly comes off, I switch to a standard bandage.

Wear a protective toe sleeve while running

You can still run with a mild to moderate case, but you should take precautions so it does not worsen. Along with fixing the original cause, Wynes suggests using silicone toe sleeves, even over bandages if needed, to cushion and protect the nail while it heals.

ZenToes makes soft gel covers designed to protect toes with partially or fully missing nails from friction and pressure. A pack includes six reusable, washable sleeves: two large ones for big toes and four smaller ones for other toes. They are thin and flexible, and they extend beyond the nail to help them stay in place. If needed, they can be trimmed for a better fit.

How do you prevent runner’s toe?

The only real way to keep runner’s toe from coming back is to correct whatever caused it. Here are the main factors doctors recommend addressing. If you think the cause is something else, check with a medical provider.

Wear properly fitting sneakers

Ill-fitting shoes are often the main culprit, Toussaint says. Even shoes that are slightly too small, too narrow, too large or too wide can cause problems over time, so it is worth getting professionally measured at a shoe or running store. Fit experts can recommend the right size, width and toe box, and may also look at your gait and arch type to suggest shoes or insoles.

Two helpful fitting tips: get measured when your feet are at their most swollen later in the day, and make sure there is at least a thumb’s width between your longest toe and the front of the shoe, Wynes says.

Wear breathable, moisture-wicking socks

Hot, damp socks can rub against the nails, damage them and let the foot slide inside the shoe, pushing the nails into the front or top, Toussaint says. Choose socks made from breathable, quick-drying material that helps keep air moving and limits heat and moisture buildup.

For running, I wear Feetures Elite Max Cushion socks. They offer enough padding for comfort without making my shoes feel tight. The fabric helps wick away moisture and keeps air flowing, while the seamless toe helps prevent blisters. They also stay in place well, and the back tab helps reduce rubbing at the heel.

Toe socks can also help, though they take some getting used to. By separating each toe, they reduce skin-on-skin friction and the pressure that can come from heat and moisture.

Injinji is a popular option for runners. This pair is lightly cushioned, made with sweat-wicking fabric and includes a mesh top panel for airflow. A heel tab helps keep the sock from slipping, and the arch band adds stability.

Tie shoelaces in a runner’s knot

It may sound minor, but the way you lace your shoes can make a big difference. All of the doctors I spoke with recommended the runner’s knot, also called a heel-lock tie or marathon loop. It holds the midfoot and heel in place so the foot does not slide forward and slam into the front or top of the shoe, Hullings says.

1. Lace your shoes normally in a criss-cross pattern until you reach the second-to-last eyelet.
2. Thread each lace through the top eyelet on the same side, but do not pull it all the way through. Leave a loop on each side.
3. Cross the left lace through the right loop and the right lace through the left loop.
4. Pull gently and tie.

Keep your toenails short with smooth edges

Long toenails are more likely to hit the front or top of your shoes. Trim them regularly so they stay short, and use a file to smooth rough edges so they do not catch on socks.

Single-blade cutters can slice through toenails cleanly without crushing or splitting them, and they require less force than standard clippers, according to the brand. One editor said they leave nails looking smooth and collect clippings as they cut. They also include a safety stop and a blade designed to help prevent trimming too short, with a short lever that gives more control and better visibility.

A glass nail file can help seal the edges of the nail and reduce splitting over time, according to the brand. These files can be reused after washing with soap and water, and Bona Fide Beauty’s version comes with a protective case.

Frequently asked questions

Toenails usually take about 12 to 18 months to grow back fully, Toussaint says. Around the four-month mark, new growth may start appearing near the cuticle. If months have passed and you still do not see regrowth, see a doctor.

Do not be surprised if the new nail looks odd at first. It often grows in deformed before gradually normalizing, Toussaint says. If the germinal matrix, where the nail grows from, or the nail bed is damaged, the nail may never return to its original appearance.

Unfortunately, there is no way to make a toenail grow faster, Hullings says. Toenails grow slowly, so the process takes time. The best approach is to keep the toe clean, protected and give it patience.

Yes, mild to moderate runner’s toe does not always mean you have to stop running, Toussaint says. But you do need to address the cause so it does not happen again. If the case is severe, especially if there is an open wound or drainage, your doctor may advise you to stop running for a period of time.

You may still be able to get a pedicure, depending on how serious the injury is. If there is no nail loss and no exposed nail bed, the infection risk is generally low as long as sterile tools are used, Hullings says. But if the nail bed is exposed, you should avoid pedicures because the infection risk is much higher.

You should see a doctor if blood buildup under the nail is causing severe pain, throbbing or major discomfort, Toussaint says. A doctor may need to drain the nail by making a small hole to relieve pressure. Never try to drain it yourself at home.

You should also seek medical care if you have diabetes, poor circulation or a weakened immune system, Toussaint says, since those conditions may require special treatment.

Other symptoms that warrant medical attention include:

• Signs of infection, such as redness, warmth, swelling, pus, red streaks on the skin or fever
• A painful open wound, especially on the nail bed or surrounding folds
• Painful or disruptive nail shedding
• Inability to move the toe
• Toe deformity or instability
• Discoloration that worsens or does not fade as the nail grows out

Meet our podiatry experts

At NBC Selected, experts are chosen for their specialized knowledge and experience. Recommendations are reviewed independently, without undisclosed financial conflicts of interest.

• Dr. Jacob Wynes is a podiatric surgeon and associate professor of foot and ankle surgery at the University of Maryland School of Medicine.
• Dr. Kristin Hullings is an assistant professor of clinical orthopaedic surgery and sports medicine at Temple University’s Lewis Katz School of Medicine.
• Dr. Rull James Toussaint is chief of the foot and ankle division in the department of orthopaedic surgery and sports medicine at the University of Florida College of Medicine, where he is also a clinical associate professor.

Why trust NBC Selected?

I’m a reporter at NBC Selected who has covered health and wellness for more than six years, including topics like plantar fasciitis, blisters, razor burn and ingrown hairs. I also cover running and sneakers extensively. For this story, I spoke with three doctors about runner’s toe, how to treat it and how to prevent it. As a long-distance runner who has dealt with runner’s toe many times, I also shared the approaches that have worked for me.