Should we worry about toenails?

She may earn a lot of money and be our new British hopeful, but Emma Raducanu is but human. “It’s not just my foot, my shoes, they’ve been sliding around a lot.” Thanks to Emma I have written an article that offers some self-help advice for sportspeople. It would appear from this Daily Telegraph report on 14th April (2022), that this started as a niggle at a prior event. The revelation of having no toenails might sound cosmetic but it can be far from a joke.

This article includes a printable advice sheet

The story was picked up by The Guardian and The Daily Mail so considered of high interest. By the end of the day, another digital report came out, despite her “latest physical ailment” she went on to win her latest match against Tereza Martincova in the Billy Jean King cup singles. A sigh of relief and of course now the suggestion – who needs nails anyway? Of course, days later we learned that Emma had lost the next match when she lost to Marketa Voundrousova 6-1,6-1.

Now you may not be into tennis but another sport but it all comes down to the same thing. Feet contact the ground in shoes and foot problems happen!

 

A single (second toe) nail is damaged with a haematoma. Longer toes are more prone to damage

Do we need nails?

The nail in humans is often considered vestigial – in other words, through generations, they have lost their original function like the opposable big toe. In the animal world, nails are tools and weapons. Primates rely on nails for some actions but for humans, it is in the hand that nails retain a high value.

In truth, we can lose all our nails and not suffer. In fact for podiatrists, this is a common procedure. Podiatrists remove diseased nails and can prevent them from returning permanently.

Pressure gives rise to pain and the end of the toe and nail bed is packed with pressure sensory type nerves for a good reason. The toe is our radar when it comes to touch and we can work out hot, cold, deep and light pressure and so toes together with their nail are packed with sensors that tell us how much we hurt when stubbed.

Click below on the link for my self-help article and quality diagram of the nail

The nail is made of protein bonded in three layers and grows from a point below the ‘quick’ or ‘lunar’ area (lunule) demarcated in healthy toes and fingers by a half-moon shape. This is paler compared to the remaining pink nail bed. The illustration provides an idea of the complex anatomy showing the blood supply and nail matrix which contains the growing cells for the nail. The matrix is very sensitive to damage.


What is foot pistoning?

This is where the shoe is slightly too large and the foot moves backwards and forwards with movement into the toe box where damage can arise from impact forces.
 My SELF-HELP guide article covers “nail care is essential in sports” with links and a video of how to release blood from a nail.

The Sports Angle

In sports, the foot must fit around the heel snugly. Unlike most of the population, the foot becomes very warm and can sweat and slip around if not secure in the shoe. The foot pistons into the front toe box end and damage soon arise. It should be pointed out that both friction and shear forces come into play and the skin is also prone to blisters with excess foot movement. This follows the idea that for ‘every action there is a reaction’  (another Newton Law of motion)  so that the toe kicks the shoe and the shoe kicks back. Guess who loses? 

The natural competitive nature of high-level sports means minor injury can be tolerated until after the competition ceases; this is when pain escalates and the damage is done. Podiatry is the only profession that manages nails and their structure as a dedicated specialty.

Distinct from pedicure we focus on tissue preservation, pain and deformity allied to medical problems. Today podiatrists are very keen to screen for nail bed cancers, foreign bodies and bone spurs.

Damaging effects in feet

Two features arise with the buffering of the toe. The joints and nail bed are compressed with constant forces. Once we stand and move, our bodyweight exerts greater forces (Newton’s second law of motion). The forces at rest increase with motion (acceleration) and when we move quickly we come off our heel and go onto the toes for longer. This is true for sprinters but the toe pressure is still huge for the tennis player as they reach up to serve and then twist and turn rotating across the ball of the foot.

The nail bed (haematoma)

The nail is damaged at the edge (hyponychium) and the sensitive connection is broken, causing the nail bed to bleed and lift the nail. The blood turns black if not released urgently, the blood clot adds to the existing pressure lifting the nail and leads to chronic damage.

Emma’s nails were damaged previously so renewed injury makes matters worse. In the long term, the nail may thicken and attract mycotic infection (fungal). The colour changes to a darker colour – yellowing because there is no longer a tight connection between the nail bed and the nail plate but also caused by infectious pigments.

Long-standing effects from toenail damage (a fungal or mycotic infection)

Toe joint deformity

The small toe joint receives a similar insult due to impaction forces and over time will scar and may deform into a mallet toe or hammertoe position. If the nail or joint continues to be insulted the quality alters and will age prematurely. When small toe joints become stiff they then transfer pressure to the skin and this then forms blisters, callus, corns and cysts. Long term those with such deformities suffer the effects of chilling and chilblains. 

Nails without doubt carry humour and why not? We need plenty to laugh at, but there is a downside and that is to ignore the nail as harmless in the face of injury. The foot remains hidden as does the profession of podiatry, but modern-day podiatry acts as the night watchman for the GP –  now a diluted service following the pandemic.

Well, we can only hope Emma continues to do well on the circuit and thank her for bringing this news, although a little unsavoury in the meantime here is some advice in managing these problems nail care is essential in sports also you can read  “Pain and prevention of blisters

Download my article on self-help for nail injury management and prevention


Thanks for reading “Tennis Player Loses her Toenails” by David R Tollafield

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Why not read  – Podiatry as a career choice? on ConsultingFootPain

You can now read Foot Health Myths Facts & Fables by David R Tollafield published at Amazon books

Published by Busypencilcase Communications Est. 2015 for ConsultingFootPain