Sports & Toenail Problems

Toenail issues commonly occur due to participation in various sports, such as tennis, running, basketball or netball. Problems are usually caused by repeated trauma to the nail plate, nail bed, or nail matrix.

The most commonly reported sports-related nail problem is sometimes referred to as ‘tennis toe’. This condition is marked by darkening of the toenail  caused by subungual (‘under the nail’) haemorrhage. This subungual hematoma is caused by repeated banging of the athlete’s toes against the toebox of the shoe as a result of abrupt stops on the tennis court. Footballers experience similar issues – called ‘onychoptosis defluvium’ (nail shedding), ridging across the toenailonycholysis (toenail lifting up) that often are frequently caused by the impact force of kicking.

More nail conditions, including onychocryptosis (ingrowing toenails) and subungual exostosis, have been reported among dancers. Nail changes also have been reported among basketball players, netball players and runners.

Runner’s toe refers to subungual hemorrhage with associated nail discoloration, onycholysis, and erythema of the smaller third, fourth, and fifth toes. The affected nail(s) may also eventually become ridged, lift up and eventually fall off.  Sometimes it is just the big toe that is affected, but frequently the second toe is – especially if it is longer than the big toe.

Diagnosis
Diagnosis of runner’s toenail will also mean ruling out other causes, such as onychomycosis (fungal nail) and subungual malignant melanoma. Unlike jogger’s toenail, onychomycosis typically is characterized by subungual hyperkeratosis – a build up of hard skin under the nail. Malignant melanoma causes nail plate discoloration and can also involve the nailfold. The Podiatrist will be able to differentiate between these upon examination and may recommend removal of the nail or biopsy of the area, both of which are easily and painlessly achievable.

Runners (and other sports players) may be advised to wear sports shoes that have an adequate toebox so that the longest toe and nail does not slam into the end of the shoe – both in distance and depth of the toebox. Shoes also should fit the midfoot properly, as choosing a shoe that is too big overall will also lead to the foot slipping around inside it.

Treatment
A training shoe that fits snugly but comfortably in the midfoot prevents the foot from being forced forward into the toebox, particularly during training on downhill courses (see our guide to sports shoes). Orthotics can also aid in this function, especially if the toes are positioned / moving in a way due to a biomechanical malalignment further back in the foot and/or ankle. Most runners already keep their nails short and maintain excellent foot hygiene, and this also lessens the risk.

If you notice any changes in your toenail condition, such as discolouration, ingrowing or lifting up, see the Podiatrists at Dubai Podiatry Centre led by Chief Podiatrist Michelle Champlin. Contact the clinic on +971 4 3435390.