Black Toenails are Common in Distance Running

Over my 30+ years of distance running, I've had many black toenails. In fact, I suffered one at Ironman Texas last weekend! A few of my friends, who also participated, stopped by the office this week for black toenail treatment. The following is my advice in trying to avoid and treat this common problem.

Almost everyone who runs will eventually get a black toenail. Getting your first one is a sign that you are now part of the endurance club. Its kinds like cycling. There are two types of cyclists; those that have fallen and those that will fall. While most runners blame a shoe that is too small, this is often not the main cause. Mine was from the well-meaning volunteers who soaked my running shoes trying to cool off the triathletes with their hose! Squish, squish, squish for 26.2 miles equals blisters and black toenails!

If a toe is under pressure from the shoe or a sock that is too tight or too thick, the sustained pressure, step after step, produces an impact or a friction problem between the toenail and the tissue surrounding it. When the tissue gets damaged, fluid accumulates. This is known as a subungual hematoma. The red or black color is the result of a few blood capillaries that become broken in the process. The more fluid that accumulates, the more pain. The extra fluid, colored by some blood, accumulates below the toenail. When the pressure gets too great, the existing toenail will be separated from the nail bed.

Really, most of the pressure that results in this "toenail injury" is produced by the regular action of the foot coming forward, thousands of times every mile. Each time your foot swings forward, a little extra blood is pushed into the toe region due to the force of the foot coming forward. If you increase your distance regularly and very gradually, your toes will adjust to each new maximum distance and only complain when you extend farther. In a marathon training program, almost everyone gets at least one black toenail. Running faster too soon and too long will increase the chance of this injury.
Hot weather also improves your odds of getting one. When it's warm, your feet swell more than they would on cold days. Because there is more pressure, and more fluid, there are more black nails generated during the summer months. This is especially true when it is humid!

How do I prevent black toenails?

You'll reduce the chance of a black nail if you ensure that you have enough room in your toe area when you fit your shoes. At least half an inch is needed, when you're standing in the prospective shoes (in the sitting position, the toes aren't all the way forward). If you've had a history of black toenails and summer is approaching (or here), you may want more toe room. When you add more room at the end, ensure that the arch of the shoe matches up with your arch. Also, run in the shoe before you buy it to make sure that the shoe isn’t too big and that your foot doesn't slide forward as you're running, which can aggravate the toe more than a tight toe box.

Do all black toenails need to be treated?

Leave black toenails alone and allow them to grow out if they are not painful. About 70 percent of the black toe problems are best treated by ignoring them. The damaged part of the nail is gradually pushed out, and the foot slowly returns to normal. If they are painful, red, or swollen; time to see your podiatrist.

Can I just stick a needle in it to drain it?

Do not attempt bathroom surgery! Many runners will heat up a needle and drain the fluid under their nail. Often this introduces bacteria and now you have a painfully infected toe!
Take any sign of infection seriously. If it continues to hurt or the pain increases, this is a bad sign. Toe infections can lead to cellulitis (blood poisoning), gangrene, and worse, especially if you have diabetes. See your podiatrist first, not last!

Will I lose my toenail?

The short answer is - yes. It will take a few weeks or months, but as the toenail continues to grow, eventually it shoves out the damaged, blackened toenail. The black toenail is raised off of the toenail bed, and underneath it is often the healthy remainder of your toenail. Your black toenail will gradually loosen from the sides and you will be able to trim it away.

When will my toes be pretty again?

If pretty toes are important to you, you can paint the black toenail or even the thin new toenail, or the bare skin. You can also stop by Healthy Steps and have a prosthetic nail put on by our licensed medial nail technician. Most people won't notice the difference if you use a darker shade of polish. Full replacement of your toenail takes about 3 to 6 months, and the new toenail will often be a bit wavy, thin in some areas and thicker in others. After 8 to 10 months your toenail should be back to normal (unless you get a side infection of fungus….another topic).

Black toenails are part of distance running, but take them seriously or they can stop you in your tracks!

The Last Road to Ironman Texas: FAANT Style!

Follow Dr Crane and Janet on their journey to Ironman Texas 2011!




Comment freely :)

Thoughts on the Eve of Ironman Texas

I'm leaving with Janet in the morning to drive down to outside of Houston, Texas, to check in for our first Ironman. The Inaugural Texas Ironman. Six months ago I felt like I had all the time in the world to train for this event. Three months ago it felt like time was standing still and it would never come. Last week I started freaking out that I hadn't done enough training and I may perish on the streets of The Woodlands, TX. Wow! The journey really is the destination. No matter what happens this Saturday morning, I know that Janet and I have grown as athletes, bonded as deeper friends, pushed our personal barriers past even our own imagination and really enjoyed all the miles we have covered together and apart over the last few months.

My thoughts turn to 30+ years of distance running and all the marathons I have done in the last 12 years; and I realize that they have prepared me for the race ahead by allowing me a glance into the depth of my soul. Let's face it, the race really happens in your head. It is a constant battle between the urge to stop so your pain goes away and the mental push to keep going because pain is temporary and the finish line is forever!

Good Luck to everyone who is racing this weekend. I will leave you with two thoughts and a short prayer:

Two Great Quotes for Endurance Athletes:

The race is not only to the swift, but to those that keep on running....Anonymous

Beyond the very extreme of fatigue and distress, we may find amounts of ease and power we never dreamed ourselves to own; sources of strength never taxed at all because we never push through the obstruction.... William James

The Triathlete’s Prayer

Oh God, you have taught us to compete with perseverance the race that is set before us.

Give me good courage to run this race to the finish.

Be with me when I am in the water and on the land, so that I may feel your presence in all things

In wind and in weather, in the beauty and the magnificence of nature in the passing scene and in the health and rigor of my body straining to meet this challenge.

May I compete in this race in a way that brings honor to You, myself and those with whom I compete.

When I finish the race, may I do so humbly and should I not finish may I accept it with equal grace knowing that I have done my best.

Thank you Lord for giving me the courage to tri.

Amen.

Tips for Your First Ironman

Tips for Your First Ironman

Since I am officially freaking out about the fact that we are one week from Ironman Texas and Janet is Miss Calm, Cool and Collected; I figured I would compile a list of all the tips for a first Ironman that I could find. Most of these are actually really good advice.

1. Simplicity trumps everything for race nutrition plans. The simpler it is, the more likely you'll stick to it. For example, consider having all your bike calories in a single water bottle.

2. Pack all your bags and race stuff on Thursday afternoon so you have all Thursday and Friday to think through it, make sure you have everything, and aren't rushed. In general, do things early. No rushing equals no stress.

3. Consider taking melatonin or another sleep aid (assuming you've used it before) on race night. Even without the anticipation, it's hard to go to sleep at 9.

4. Bring some spray on 50+ SPF sunscreen. AFTER you get body-marked, put this on every square inch of skin that might be exposed. Enough of it will stay on to save you in case you miss sunscreen later. (Good tip for me since I have been known to look like an ahi tuna after a race)

5. Try to get to transition right when it opens. An extra 15 or 20 minutes of sleep isn't worth rushing. You want plenty of time to deal with anything unexpected (flat tire on bike, long toilet lines, etc.).

6. Make as much of your pre-race breakfast as you can the night before and start eating as soon as you can when you get up. Better not to be hurried and then having to force-feed yourself or, worse yet, skipping cals. It's darn early and eating isn't what your body wants to do, so get it done early.

7. Stay relaxed and enjoy the experience. Don't let race anxiety rule you before race day. It's wasted energy. Remember how much you SACRIFICED to get there, the TOUGH part is behind you, have FUN! It’s all about the finish line, time is irrelevant!

8. THANK the volunteers at every chance you get, from registration through the finish chute.

Swim:

1. The far outside/inside sound like the best place, but they may not be, because everyone else is thinking the same thing.

2. Wear your goggles under your swim cap or double cap so they won't get kicked off. It can be hard to get them sealed like this though, so have someone check to make sure the cap isn't interfering with the seal.

3. Sight regularly. After you get out of the scrum it's tempting to put your head down and swim. Keep sighting or you'll swim extra yards.

4. You will likely be very lightheaded and loopy coming out of the swim. Be ready for it and ask volunteers to help with your wetsuit if you are wearing one. Don't get into a wresting match with it. (IM TX is probably speedsuit not wetsuit so practice getting out of it!)

Bike:

1. Don't forget sunscreen in T1. Trust me. Again the tuna thing!

2. Be steady with your cals. Just do water for the first 30-60 minutes out. A good nutritional system on the bike is using the “super fuel” system. Take one or two water bottles and super concentrate it with salt tablets and mix so when getting a “hand up” the only thing needed is water. Poor the water into the front aero bottle and mix in a small ratio of “super fuel” to make a drink until the next “hand up”. This is handy in that if you get caught in between aide stations in a dehydrated state you have a highly concentrated mix that can help you out fast if you need it. This also keeps you away from having to drink something provided by the race that you are unfamiliar with and may upset your stomach.

3. STAY AWAY from other riders as much as you can. First you'll avoid drafting penalties, and triathletes are often horrible bike handlers, especially when they get tired. Be especially careful around aid stations. Try to stay upright as much as possible.

4. Stay aero as much as you possibly can, except steep hills and corners. Riding out of aero is just wasted time.

5. At about 90 miles you'll probably want off your bike like you can't imagine. Stay focused, you're almost done. Keep your attention on your nutrition and pacing.

Run:

1. Just run aid station to aid station. Don't let the total distance scare you, you'll get through it. Break it into small segments in your mind.

2. Be steady with your nutrition, but keep it simple. Do the same thing at every aid station if you can.

3. Most likely when you get to the marathon you start to feel the day getting to be very long and this is the most critical time to focus on getting to the finish line. The day’s workout starts to compound and it might be time to give yourself a treat. On the marathon the volunteers in the aid stations will have two very important items. DRINK THE COKE! Straight shot of solid carbs and tastes heavenly also because most likely you have been drinking Gatorade until your blue in the face. The volunteers will also offer warm chicken broth. TAKE SOME CHICKEN BROTH! It is heavenly as well. The salty taste is something a little different as well and will give you a boost to the finish line.

4. Do your best to smile and wave to your family and friends. They want to see you having a good time. Fake it if you have to until mile 18 or 20. At that point, they'll probably understand.

5. And remember, a Shiner at the finish is the best recovery drink (or a 12 pack) ha ha.

If you have any other tips for us, the race is in a week! Please comment!

The Race In Your Head

Ryan Hall said about running a marathon, “It's a long, hard road and it's going to have its bumps; there are going to be times when you fall and times when you don't feel like going on anymore, times when you're just crazy tired but it takes focusing on that one step you're taking. That's what I'm trying to do with the marathon; I don't think about the miles that are coming down the road, I don't think about the mile I'm on right now, I don't think about the miles I've already covered. I think about what I'm doing right now, just being lost in the moment.”

I feel this is even truer about endurance triathlon and Ironman. Focus on the moment and don’t think about the miles and hours to come. Most of the battle in the race is going on in your head!

Disregard the negative self talk! Remember your mantras. It's all about the finish line. Pain is temporary and quitting is forever!

The Ironman Taper: Art or Science?

It’s two weeks to Ironman Texas and I can tell you that all my peeps are ready for tapering or are already in taper mode! Is there a science to Ironman tapering? Or is it really an art? I combed the internet looking for guidance, called all my veteran friends and coaches, and guess what? No one agrees - as usual. It seems that tapering is as much art as science and there is no one plan that works for everyone.

Here are some tips on Ironman tapering. (And no, doing nothing for two or three weeks before the race and drinking beer to carbo load is not one of the tips!)

I did read some great advice in an article by the legendary Dave Scott wrote on tapering and then he was instantly contradicted by another, more scientific article, by Alun Woodward. Here are some of their thoughts and my personal commentary (can’t disappoint the fans of my pathetic humor).

Despite clear evidence that a shorter taper is most beneficial for endurance athletes, many Ironman training plans today include a full three-week taper. This is actually due to looking at marathoners and their habitual over training. If you are over trained, and on the brink of exhaustion, then a three week taper is for you. If you are more like an ultramarathoner and bounce back from your long rides and long runs quickly, your taper may only be a week or so. The hardest part about giving an answer to the question, “How long should I taper before an Ironman”, is that each athlete is so different. Some athletes repeatedly bounce back from 6+ hour rides and 2+ hour runs as if they were nothing (these folks can taper less, not me - and I hate those people), whereas others are sidelined for 2-3 days in a haze as they recover (these folks can taper more - more like me). So the first place I suggest you start is with your own athletic history. How have you recovered from you longer efforts in training? That will give you an idea of how much time you need. (Guess I need a month, oh no! I only have two more weeks….)

Everyone agrees that no matter how long your taper, it should be a fine balance between these 10 components:
1. Reducing volume (Yea!)
2. Maintaining intensity while reducing the length or volume of the workload (That means don’t turn into a turtle)
3. Allowing the body to rebuild quickly (one to two days) after higher intensity workloads (Sleep more, rest more)
4. Reducing the stress hormones that affect muscle performance; ultimately eliminating muscle soreness and heaviness (Rest, stretch, massages)
5. Maximizing muscle and liver glycogen stores (Eat, Eat and Eat)
6. Allowing the body to repair and rebuild so the power output is maximal on race day (That’s more sleep again)
7. Performing recovery workouts (Active rest, not couch potato)
8. Maintaining "normal" number of training sessions per week (Please, no…)
9. Fueling properly (More eating)
10. Preparing mentally (Stop freaking out!, find your zen)

Every individual taper is unique. Your age, preparation and personal history of your previous tapers should all play into the final formulation. Rest is key, but not too much rest. I recommend that you do something every day and just maintain your schedule. I have gone into a marathon too rested and bonked. I’ve also gone in exhausted and bonked (lots of bonking history) I have learned to listen to my body. Do regular self check every morning and rest as needed. Better to be 15% under-trained than 1% over-trained. Be confident that your body will rejuvenate and respond to resting.

The Gods of Ironman have conflicting stories about tapering, but the truth is in your own history of recovery. If you listen to your body, and are honest about your bonk history; you will know how long of a taper you need. Keep these tips in mind and be ready to rock your next Ironman!

See you all in Houston Texas May 21st!

Next article series is on recovery!

You Know You Are A Triathlete When?

I have a running gag going for the last few years on and off on my website and it makes up the last chapter of my book. “You know you are a runner when….” Lots of my friends contributed to the list from 2008 to late 2009, when we published the first book…. I felt it was fitting to add this year, especially since Janet and I are less than three weeks away from Ironman Texas, “You know you are a triathlete when…” Feel free to send comments back and I will add them to the list. This inaugural list was compiled by Janet and I emailing each other and drinking wine at the same time. Please do not be offended and you are required to laugh. If you do not get it, you need to ask a triathlete……

You know you are a triathlete when…

1. You think it’s normal to wear spandex 24/7.


2. You can blow your nose while on the bike without using tissue. (runners call this a snot rocket)


3. You know the psi needed for your tires, yet can’t remember the garage door code.


4. You have found even more areas to apply body glide you didn’t think were possible.


5. You have no problem loaning body glide or chapstick to a triathlete you don’t even know.


6. You come to the realization there is justification for public nudity in transition, and you are OK with it.


7. You feel that receiving a drafting penalty hurts worse than a tax bill.


8. You think swimming through pee is not so bad, and you pee often in your wetsuit and/or in the lake.


9. You contemplate how to pee on the bike when riding, and you are a girl.


10. You can speed on your bike, eat a gel and yell “on your left” to a pedestrian or other cyclist, all at the same time.


11. You put your helmet on backwards leaving transition and don’t want to stop and fix it because it takes too much time.


12. You think it’s sexy to have your race number sun burnt into your calf and show it off like a badge of honor.


13. You have worse tan lines than a farmer’s tan.


14. Your cycling race wheels are worth more than your neighbor’s car….or your car.


15. You realize flatulance is pretty funny in a wetsuit and warm on cold swim days.


16. You plan for your first Ironman tattoo before you even sign up for the race.


17. You press your race bibs with an iron and file or display for future admiration.


18. You find yourself yelling “on your left” as you pass other carts in the grocery store.


19. You find that a six hour bike ride is a warm up.


20. You wash your bike more than you wash the dog.


21. You look forward to aging as this will be your only way to stand on the podium in an older age group or qualify for Kona.


22. You realize you look like a squid or a sperm in your aero helmet and kinda like it.


23. You realize salt tablets on hot race days are like crack for triathletes.


24. You conveniently happen to have your race medal on you at work for “show and tell”.


25. New tri gear websites make you salivate.


26. You’ve been known to check your Training peaks log even more often then your email on your IPhone.


27. When you start to think it is normal to go to bed before 9pm and get up at 5am.


28. You can’t remember the last time you slept in past 6 am on a Saturday.


29. You rationalize that somehow it’s not completely crazy to try the first open water swim of the season when the lake water is only 58 degrees.


30. You own at least ten swim suits, five pair of goggles, a dozen bathing caps, swim fins, a pool buoy and at least a wet suit and speed suit if not two.


31. You have an entire chest of drawers full of running and biking clothing; but still shop for more practically weekly or even daily.


32. You have more pair of athletic socks with “wicking action” then you have pantyhose or dress socks.


33. You own more than a dozen pairs of running shoes and can justify why you need each and every one.


34. Your inventory of hats and visors equals your running shoes or greater.


35. You have at one time documented and tallied everything you eat or put in your mouth, even a tic-tac, in order to evaluate your nutrition even though you are at least 20 pounds under your “ideal weight”.


36. You have a plan “A”, plan “B”’, and a “try not to die” race plan.


37. You start to think an Ironman is not such an insurmountable challenge and start figuring out how you can qualify for Kona.


38. You regularly have to explain that you are not a victim of domestic violence, those are just your “crash bruises”.


39. Your biggest fear is skin cancer even though you practically bathe in sunscreen.


40. Even your kids start to think they have to swim, bike or run just to spend quality time with Mommy.


41. You have more water bottles than wine glasses in your cupboards.


42. Your refrigerator has more protein shakes and Gatorade in it than milk or soda.


43. You have a following on Facebook that lives vicariously through your training and racing ups and downs.


44. You have peeps that you feel like you have known forever through training, but they may not even know your last name (or your first, come to think of it).


45. Blisters, chaffing, road rash and sunburn (an the occasional broken toe) are just a minor annoyance.


46. You show off your peeling sunburn and chip holder tan line on your ankle with pride on the Monday after a race.


47. All of your t-shirts say things like 70.3, 140.6, etc…and you have at least 100+ you can’t part with.


48. When you wake up in the morning with every muscle and joint in your entire body hurting and think, “I had a great work out yesterday”.


49. When you know the exact distances that make up a sprint, Olympic, Half-ironman, and ironman race segments by heart and keep explaining to your friends that they are not all an Ironman and not all in Hawaii.


50. When your workouts have taken the pace of any kind of social life.


51. When you cross the finish line of your first triathlon.
    
    Smile…..and add to the list!