Some athletes are removing their toenails
Key Takeaways
Runner’s toe is a common concern for many athletes, and there are strategies to help prevent it—not including self-surgery.
Ultramarathon runners have been removing their toenails for decades, but it’s not the norm.
Black toenails can also be caused by other issues—runners may be inclined to self-diagnose and self-treat, so it’s important for physicians to provide effective patient education.
Ultramarathon runners are known for going to extremes. After all, running 50 to 100 miles across challenging terrains isn’t for the faint of heart.
However, some ultramarathoners take things a step further by removing their toenails for the sport. They say they’re tired of dealing with black, bruised, and detached toenails as a constant distraction and side effect of running such long distances.
But is this strategy actually helpful or even safe? Here’s our take.
Runner's toe
Runner’s toe is a common problem that plagues long-distance runners and other athletes.[] It’s caused by the relentless hammering of the toes against the sneaker toe box. The big toes are particularly vulnerable to the effects of this repeated impact and are prone to subungual hematomas or bleeding and bruising beneath the toenail.
Not only is runner’s toe painful and unsightly, but sometimes, it causes enough damage for the toenails to perpetually lift up, fall off, and slowly grow back (often misshapen).
But while runner’s toe is certainly unpleasant, some athletes view it as a badge of honor.[] Taking off their toenails altogether has been a trend for several years among some of the most high-performing ultrarunners.
The original poster boy for toenail removal
Marshall Ulrich is an ultramarathoner who ran the equivalent of 117 marathons in a row at age 58.[] Back in 2009, ESPN reported on Ulrich’s decision to remove all of his toenails 17 years prior.
Ulrich noted that his reputation for having no toenails started to precede his fame as an accomplished athlete.
Nonetheless, he felt toenail removal was necessary to excel in ultramarathon running and said he had no regrets about the procedure.
However, he admitted that toenail removal surgery was painful and should be viewed as a last resort. Certainly, this final measure isn’t for everyone. Even among the ultramarathon community, those who elect to have their toenails permanently removed make up a small minority of the group.
Better solutions
Distance runners must take precautions to protect their feet, and the decision to remove toenails permanently should never be taken lightly. After all, people have toenails for a reason, and removal can introduce unnecessary complications.
Tips from the Cleveland Clinic to prevent runner’s toe include:[]
Add silicone pads to sneakers for extra cushion
Get sneakers professionally fitted
Keep the toenails trimmed short
Never cover discolored toenails with nail polish
Seek flatter terrain to avoid running downhill
Tighten shoelaces for a secure fit
Wear moisture-wicking socks
If a damaged toenail must be removed, a podiatrist should be the one to do it. Runners should also be aware that black toenails can also be caused by other issues, including fungal infections from running in sweaty, wet sneakers or, in rare cases, melanoma under the nail. It’s always best to get a qualified medical opinion before jumping to conclusions about the cause of a black toenail.[]
Is the human body designed for ultramarathons?
Runner’s toe is just one of the consequences of testing the limits of the human body. Ultimately, it’s important to consider that most ultramarathon runners probably don’t participate in the sport simply for good health. While regular exercise is crucial to living well, extreme sports may not be.
When it comes to such high-intensity exercise, the bigger question really comes down to whether people should voluntarily participate in such activities in the first place. Other potential hazards of ultrarunning include damaged joints and arthritis, overuse injuries, and organ damage to the heart, kidneys, and lungs.[] While it’s an individual right to attempt an ultramarathon, choosing to do so means accepting the risks with the rewards.
What this means for you
Clinicians should be in tune with their patients' hobbies and interests, especially when they’re into extreme sports like ultramarathon running. Familiarizing yourself with the trends of the sport can prompt important conversations with patients. Runner’s toe is a problem that many avid exercisers face, and there are safe ways to help prevent it. Talk to your patients before they needlessly take things too far.