Monday, December 27, 2010

Skier's Toe

Ever been skiing and noticed your toenail had turned black and incredibly painful at the end of the day? Was it black in part or all of the nail? This is a very common injury from skiing, and in fact, is often referred to as a "skier's toe".

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big (so your foot slams back and forth) ski boot.

The good news is that this can be quickly remedied in a clinic if you head in within hours or a day of noticing the black nail. If you wait several days trying to tough it out, we have less success treating the nail. The doctor typically burns a tiny hole in the nail, which allows the drop or two of blood to come out. (Sorry for the yucky description, but that's what we do.)

The BETTER news is that again, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. This painful injury does NOT occur if your shoes/boots fit correctly!

BOTTOM LINE: Make sure your ski boots and socks fit properly, and avoid getting skier's toe!


Frisk said...

Thank you for the helpful article, it was exactly what I was looking for!

About 2 weeks ago I got skier's toe and both of my big toe nails have turned completely black since, but not fallen off. I noticed they have not grown since then either. I went skiing again today for the first time since it happened and they were relatively painful at times. Should I avoid skiing until the bruising has gone away? I have made an effort to make sure my feet fit better inside my boots.

Dr. Jill Grimes said...

The black discoloration will remain on your toenail for a very long time...often until the nail grows out. You only need to avoid skiing as long as it HURTS. If you are treated promptly for for this condition- meaning, you have it drained immediately- there may be little or no discoloration as well as little or no remaining pain, which means you are back on the slopes (in DIFFERENT, better fitting boots) as soon as the next day!
Happy skiing!

berkeryc said...
This comment has been removed by the author.
berkeryc said...

I had this happen to both of my big toenails last year because my boots were most certainly too small. I bought a full size bigger boots this year, but I still had the same problem last weekend. I don't know what else I can do other than stop skiing. Any suggestions?

Brett said...

I have been very fortunate (considerable sarcasm!!) to have this happen on the first or second day of the season for the last 5 years. I have had my ski boots worked on 3 times and will be heading in again. I may be scrapping the boots I have (high end boots. All fitters say it is the right size). Regardless of that, I have been doing the home version of piercing the nail. Hate to say it, but a drill with a small bit works the best (being very careful of course). The last two times this has happened I will get pain in the balls of my feet a few days after draining the nail. Is this a typical reaction? Perhaps some drainage to the bottom of the foot?

Dr. Jill Grimes said...

Okay- 2 years later just seeing this, but my firm medical advice is ABSOLUTELY NO DRILL BITS! Though I understand Brett's reasoning, it scares me to death thinking of the damage that could potentially cause with a simple slip (or dog bumping you unexpectedly, etc).
A "home remedy" that many clinicians use is burning a hole through the nail with an opened up paperclip that is heated at the tip by holding in a flame till it glows. This being said- I am not recommending this, either- partly because I have seen more patients (and family members of patients) pass out from toe nail interventions than any other procedure...and a painful nail is one thing, but a head injury from passing out is far worse!

As for what to do for prevention when this is a recurrent issue- my best answer is thin ski socks (the thick ones can aggravate this)and a different style of boot or consider custom orthotic supports.

MicPie said...

Hi - I am an avid skier and on my 2nd or 3rd year in a pair of Head boots that I just love. This year however, I am stricken with severe "skiers toe" on both my feet. I live in a ski town in the winter so I'm certainly not planning to abandon my passion but how could my boots or feet have changed that much since skiing in them last May? Can I wear a toe guard or will that make things worse?