This problem usually occurs during long walks in walking shoes, mountaineering boots, trekking boots or after long runs in running and trail running shoes. It often affects one of the big toes or sometimes even both at the same time. We’re talking here about bruised toenails – a nail that looks like a bruise – except that the bruising is directly beneath the nail.
Medical information about bruised nails
In medical terminology, a bruised toenail is called a “subungual haematoma”, i.e. a bruise under the nail. A subungual haematoma can occur on any of the fingernails or toenails.
A knock or being trapped is often the cause. Anyone who has ever missed their target with a hammer, got their finger caught in a door or dropped a bottle on their foot will probably vividly remember the stabbing pain and the resulting bruised nail injury.
Sudden or gradual injury
With robust walking shoes, it is almost impossible to trap or knock the toes in such a way that a haematoma of this kind forms. Even trail running shoes are usually equipped with reinforced toe caps. However, the risk of bruising a nail while trail running is still generally higher, because trail running shoes offer less protection than hiking or mountaineering boots and trail runners are also faster off-road.
As well as a sudden injury caused by a knock, bruised toenails can also be caused by continuous vibrations and constant rubbing. For example, if you constantly bump your toes on the inside of your shoe while running downhill, you will be running towards a bruised toenail with every step you take.
As the injury progresses gradually, many small haemorrhages can grow into a large bruised nail by the end of the day, so outdoor athletes may be surprised how an injury has developed when they remove their aching toe from their hiking boots after the hike.
What factors can lead to a “bruised nail” when hillwalking or trail running?
A gradual injury and eventually a bruised nail is usually caused by a combination of the following circumstances. Sometimes one single trigger is enough.
Poorly fitting shoes
If you hit the front of the shoe with your toes with every step when hillwalking or trail running, you are usually wearing shoes that are simply too small. There is a reason why outdoor athletes are advised to try on shoes in different sizes, try them on with appropriate sports socks, try them in the evening when feet tend to be at their largest and wear them on your feet for half an hour or even longer.
Shoes that are too small, too big, too narrow or too wide can cause the foot to bump, slip or “swim” inside the shoe. As well as painful toes, feet and legs, this can also result in a subungual haematoma. New shoes usually need to be broken in for a few days before you can go on demanding day hikes or tours lasting several days without pain.
Even if the best hillwalking or running shoes are useless if they are not well laced. Mid-cut walking shoes and trekking boots usually have 2 zone lacing. This means that the lower area of the lacing on the instep and the area above the ankle can be laced at different tensions.
A “clamping” hook between the two areas means that you can lace them individually. Hikers should always make use of this option and lace the shoes so that the foot cannot slide forward or can only slide forward slightly. It is also useful to adjust the shoe to the terrain (e.g. ascents and descents) and the conditions during the course of the day.
Too long distances
The longer the distance, the more steps hikers and trail runners take. With each step, the fine vessels on the toenail are subjected to a little more strain, so it is important to eliminate all other factors that can lead to a bruised nail. With the right shoes, the right socks and the right lacing, you can create the best conditions for long hikes and runs.
Poorly fitting socks
What applies to shoes can also be applied to walking socks, trail running socks and multisport socks. They have to fit well, must not slip and, ideally, should protect the toes, ball and heel with suitable reinforcements. This is a great way to prevent bruised nails and blisters on the feet.
Incorrect foot care
Walking shoes and running shoes are best and you should cut your toenails short. Nails that are too long not only increase the risk of a painful bruised nail, but also increase the possibility of the nail coming off either partially or completely. This is really unpleasant.
What can you do about a bruised toenail?
If you suffer pain in the nail after a walk or run and notice that it has turned blue, you should first rest the foot, elevate it and cool it down. Of course, you should not wear the same shoe again in the near future, instead you should wear open shoes (e.g. trekking sandals) where the toes do not touch anywhere and are well-ventilated.
If the nail becomes completely or partially detached from the nail bed or detaches over time, there could be a risk of infection. The resulting wound must be treated professionally. If you are unsure, you should consult your GP.
If the pain becomes too severe, a doctor can also provide relief. They can reduce the pressure on the nail with a “trepanation” and help the bruise to heal more quickly. It is important to prevent the nail bed from becoming inflamed, because this will become very painful.
How long does it take for a bruised nail to heal?
Even in the best case scenario, i.e. the nail does not come loose and is “only” bruised underneath, it can take a very long time for the toe to completely heal again. The bruised nail has to completely grow out. This means that even if you have nails that grow back very quickly, it will take at least four months for the nail to regenerate completely. However, it can often take a year before the injury is no longer visible.
It can be more difficult if the nail has fallen off, because the nail that grows back often grows at an angle, crooked and even into the skin. Therefore, outdoor athletes with a severely damaged or completely detached nail should always seek medical help.
However, most of the time the nail does not fall off. After a few days, when your toes will be very sensitive to pain, the bruised nail becomes more of an aesthetic problem that will resolve itself after a few months.
Anyone who has ever had to struggle with a bruised toe should carefully examine their gear so that they can enjoy the mountains pain-free in the future.