Oh, Toenail Woes!

Posted on October 4, 2013 by

Prevent and treat common nail injuries.

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Few problems are as painful and unsightly as a battered toenail. Sarah Chisholm, a dancer with Ballet Arizona, knows this well. She has suffered from chronic bruised and ingrown nails throughout much of her career. “It’s hard to focus on your work when you’re always worrying about how much your feet hurt,” she says. “You don’t get to think about the joy that comes from dancing.”

Dancers spend hours crammed into sweaty shoes, making them great candidates for ingrown nails, bruising and nail fungus. Though these aren’t usually threatening enough to force someone to take time off, they can cause days, weeks or even months of painful distraction. Many nail problems can be prevented by taking small precautions.

Bruised Toenails
A bruised nail might last several months, and the condition can be extremely painful. Often caused by stubbing the toe or knuckling over on pointe, the nail shifts over its bed where many blood vessels meet, causing bleeding under the nail. Long toenails and tight shoes or pointe shoe boxes that don’t match a dancer’s foot type can also put excessive pressure on the toes.

After bruising, ice the foot to soothe the pain. And regularly clean the area to prevent infection. “The dried blood under the nail bed is a breeding ground for bacteria,” says podiatrist Dr. Thomas Novella, who works with New York City dancers.

The nail may eventually loosen or fall off, but keep it intact as long as possible. “Band-Aid or tape it in place until a new nail begins to grow,” says Novella. Toenails grow just 1–2 millimeters per month, so it can take up to a year for a new one to fully form.

While growing a new nail, Chisholm applies 2nd Skin, a jelly-like adhesive that can be cut to size. “I stick it on my toenail, and it acts as a buffer,” she says. “It’s very cooling and helps with impact.”

Ingrown Toenails
Ingrown toenails are common in young dancers, whose nail plates have not yet strengthened, and those with nails that curve side to side. Chronic bruising can also damage nail beds enough so they grow back incorrectly, says Atlanta Ballet podiatrist Dr. Frank Sinkoe. “If it’s disrupted, it can cause an abnormality,” he says. Trim the nail to match the toe’s shape to help prevent ingrowns; be careful not to cut too far into the corners.

To soften the nail as it grows out, soak the foot in an Epsom salt and warm water bath. Resist the urge to pick; it could cause infection. If the pain is unbearable or there is swelling, redness and increased skin temperature, see a podiatrist. If it’s not infected, they can pack cotton deep under the nail. “This helps guide the skin away from the nail as it grows,” says Novella. In chronic cases, podiatrists can permanently remove the sides of the nail as a preventive measure.

Toenail Fungus
Fungal toenails are rarely painful, but they’re extremely unsightly and hard to treat. The nails are yellowed, thick and crumbly, and the surrounding skin is red and scaly. They often have a yeasty odor and powdery debris.

Novella says to seek help after noticing symptoms because “addressing fungus early will help a lot in the long run.” To diagnose the fungus, a podiatrist sends a snippet of the nail to a lab, and if confirmed, may suggest topical creams. Oral medications are most effective, but they can cause serious side effects like liver damage.

To prevent toenail fungus, change socks frequently and dry out dance shoes and toe pads. “Funghi is Italian for mushrooms. And where do mushrooms like to grow? Moist, dark places, like under logs—or inside sweaty shoes,” says Novella. He adds that the condition is contagious, so students should avoid sharing shoes, socks and nail clippers. DT

Toe-Strengthening Techniques
Students need strong feet for pointe work, but few concentrate on their toes specifically. “Fatigue sets in and they start knuckling,” says Atlanta Ballet podiatrist Dr. Frank Sinkoe. This puts excess pressure on the nails, causing bruising. The exercises below strengthen the arch and intrinsic muscles, which flex the toes and support the feet.

Tendus for the Toes: Sitting on the floor with the legs in parallel, wrap a Thera-Band around the ball and toes of the foot, holding the ends of the band, and tendu side, turned in. Keeping the toes straight and long, flex and extend only from the metatarsals, 10 times.

Arch Squats: In parallel position, lift one leg off the floor to the side. Plié to 30 degrees and focus on maintaining the arch’s dome shape. Hold for five seconds and return to the starting position. Do 10 repetitions.

Slow Relevés: On one foot, relevé to demi-pointe on count one. Hold count two, rolling down on three. Complete three sets of 10 in both parallel and turned-out positions.

Amy Brandt dances with The Suzanne Farrell Ballet.

Photo: ©iStockphoto.com

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