Black Tuesday, black widow spiders, black holes—when we think of black, we often think of trouble or danger. So when you see a black spot on your nail you might panic, unless you are a runner like Chiropodist Tony Abbott. Then you know that trauma to your toes while running is a common reason for black toenails to develop. There are many other causes as well.
Toes Banging Around in Shoes
When you train intensely for long distances or do a lot of hill running, you need to be extra careful when choosing your footwear. If it is too tight or not laced properly, your feet can slide forward and the nails can bump repeatedly against the front of the shoe. Some runners may also have biomechanical issues that cause their toes to lift up against the shoe or grip too tightly with each step. This can cause bruising to the tissue under the nail, and the small amounts of blood that pool there can make it look black.
If it’s just a small spot, and not painful, there is no need to panic. If it is large and painful, though, you’ll want to get it checked out. We can examine it to make sure there are no broken bones or damage to the nail bed that could lead to more serious problems. You can help prevent black toenails by wearing shoes with enough room and keeping your toenails trimmed so they don’t bang against the front.
Heavy Things Dropping on Your Feet
A dumbbell, a heavy box, or someone else’s foot could all land on your toes and injure them. It could happen while you are playing sports or just walking in a crowded place. You could also injure it by stubbing your toe on a bedpost or chair leg at home. Any crush injury like this could lead to a subungual hematoma—a pooling of blood under the nail. This is more serious than the simple bruising we discussed above. As more and more blood collects under the nail, it causes pressure that can result in throbbing and quite severe pain.
Don’t panic, but don’t ignore these symptoms, either. Let us examine your toe and take X-rays to see if there is underlying bone damage. It may be that we need to decompress the hematoma (drain the pooled blood from under the nail). This can be done in various ways under local anesthetic—using cautery (a heated wire tool), a sterile heated paper clip, or a large diameter needle to make a hole in the nail for the blood to disperse. Your toe will be bandaged and you will have to use cold compresses and elevation the first day or longer until the toe is healed.
Where the Wild Things Grow
Another cause for black toenails can be a fungal infection. The fungus grows under the nail and feeds on the keratin, and the waste it generates can turn the nail black. It can also cause a bad odor and make your nails thick and crumbly.
Much more rarely, a black spot under your nail could mean malignant melanoma. This might well cause a moment of panic, for it is a dangerous cancer that can be life threatening if not caught and treated early. That’s why it is so important to monitor your feet and keep an eye out for anything unusual that doesn’t resolve itself.
What You Can Do to Prevent Black Toenails
For healthy feet and nails, footwear should be breathable, roomy, and offer protection against injury. Socks should be of a fabric that keeps dampness away from your skin. Keep your feet clean and dry, and your toenails properly trimmed. You should avoid polish if you suspect nail problems, as it can mask symptoms. It is a good idea to always wear something on your feet. Even house slippers might help prevent a badly stubbed toe.
If you suspect a toenail injury, don’t hesitate to call Chiropodist Tony Abbott at Abbott Foot & Ankle Clinic in Collingwood, Ontario at (705) 444-9929 to set up an appointment. Our staff is dedicated to finding the source of your pain and treating it as conservatively as possible.