Blisters & Nail Injuries in Runners Feb 21 2018

Most runners, whether novice or professional, will have a skin or nail disorder that may prompt them to seek medical attention.  Having spent time in the medical tent working at the London Marathon, I have seen and treated some very nasty blisters and nail injuries post marathon.  So, here is some advice from someone who has worked on the front line on marathon day which might mitigate your risk of developing blisters and nail problems.

Blisters plague many running enthusiasts. A review of the marathon literature showed that up to 39% of runners reported to a medical tent at some point in their race as a result of blisters.  It was originally thought that increased heat, moisture and friction was the cause of blisters.  However, it is now known that horizontal shearing forces in combination with repetitive and excessive movements, like those that occur in running, is what leads to blister formation.  

Some tips on blister prevention include, wearing two pairs of socks, or consider a blister preventing sock.  Ever wondered what that second shoe lace hole is on your trainers is for?  That is part of a locking mechanism that helps keep the trainer on and prevents slippage.  It is important to make sure your trainers are secured well on your foot to prevent movement within the shoe during running, as this can result in shearing and blister formation.  Taping can also help, however there is a poor evidence base for taping and it can also cause problems if applied incorrectly or the wrong type of tape is used.  It is always best to seek professional advice about taping prior to trying this.  In terms of treatment, if a blister is small and the fluid inside is clear, the best dressing in the world is your skin, so leave it alone.  When the blister bursts, cover it with a clean plaster and change it daily until the area has healed.   If the blister is painful and needs draining, it is best in this case to seek medical advice.

‘Joggers toe’ is another common running related ailment, I am sure you know what I am talking about!  Research shows that up to 14% of runner’s injuries are related to toe nail injuries on marathon day.   Subungual haematoma (blood under the nail plate), which is the result of repetitive excessive micro-trauma caused by running, can lead to pain and the nail lifting (nail lysis), or eventual loss of the whole nail plate.  To prevent this, again, lacing up your footwear securely will prevent movement in the toe box.  Making sure that your footwear has adequate room in the toe box, not only in length but in width and depth which are also important to allow the digits unrestricted room to extend and flex with minimal contact on the upper of the shoe.  Fit of the shoe is also key, anything too small will increase pressure in the toe box and increase the risk of nail injury.  In terms of nail care, cut your nails straight across and not too close to the skin as there is a protective seal in-between the nail plate and the nail bed which is best left intact.

These are only two issues that could happen during training or on marathon day.  Should you need further advice about footwear, nail and skin health and injury prevention prior to ‘the big day’, please come and see us at the London Podiatry Centre to talk to an experienced podiatrist and our colleagues from Executive Physiotherapy, so we can help optimise your foot health in preparation for your next marathon.

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