Thick nails, Black nails, Ingrowns, Oh My!

September is traditionally the start of running race season here in Austin, Texas. From the Zilker Relays to various 5K and 10K charity runs, Austinites are sure to hit the pavements racing across the city this fall and into winter. 

But even if you aren’t a runner, as cooler weather sets in and Texans lose the open toed sandals for close-toed shoes, we start to see more and more ingrown toenails and nail related injuries  across all ages during this time. Today, we dive into the the “how and why” of these issues and what you can do to prevent or treat these common nail issues. 

Ingrown Nails

Perhaps one of the most common toenail issues we see and treat here at Bluebonnet, ingrown toenails are often caused by either excessive pressure from tight socks and shoes or from repetitive pressure and push off of the toe against the ground in flexible shoes or impact from long-distance running. 

Although there can be a genetic disposition for the development of ingrown toenails, other factors can contribute, including excessively cutting nails short, causing the surrounding skin to overlap the slow growing nail plate. This in turn, eventually results in the nail plate growing directly into and pushing up against the skin causing pain, irritation, and sometimes infection. 

Old fashion remedies such as “cutting a V” into the center of the nail plate or stuffing tissue or cotton into the edge of the nail typically fail or result in more pain. 

You can prevent ingrown with effective trimming straight across the nail and leaving the nail edge just slightly above the skin. If you do have discomfort, effective home treatment options should start with warm Epsom salt soaks, antibiotic ointments, anti-inflammatories and relieving any pressure to the toe and nail. However, when there are signs and symptoms of infection such as redness, swelling, and drainage, it’s important to seek proper medical attention as soon as possible to prevent complications that can require surgical intervention.

Treatment from your Podiatrist may include oral antibiotics if necessary, as well as an in-office procedure that can immediately relieve your pain, or a permanent procedure that can prevent your ingrowns from ever coming back, especially if you suffer from chronic ingrowns. 

Runner’s Toes (Black toenails) or Subungual Hematomas

Repetitive trauma against toenails either from your toes hitting the front of your shoes, running or hiking down hills, or even from walking in tight fitting shoes, can cause blood to pool underneath your nail plate causing internal pressure and pain, and giving it a dark red, almost black appearance.

You can avoid this with proper fitted shoes that have a thumbs breadth in front of your longest toe and avoid excessively flexible, narrow, or tight shoes. 

Treatment by your Podiatrist, depending on severity can range from monitoring the nail to a painless procedure called trephination which involves drilling holes to drain the blood and relieve pressure and pain, and if severe, may need removal of the nail plate. 

Thickened Nails

As with anything, repeated trauma to any area including your toenails can cause a change in its shape and structure. Nails can become thickened or discolored and can often resemble fungal nail infections. Repetitive trauma can cause loosening of the nail plate from the nail bed, thereby making it easier for fungal nail infections to set in. 

A sample of your nail can be tested to rule out  trauma versus fungal nail infection to determine the appropriate  treatment that can range from topical medications to laser nail treatment. 

Prevention & Early Treatment is Key

Treatment for any of the above nail conditions start first with prevention and early detection.

Wearing shoes that are neither too tight or too loose, moisturizing nails with lotion or tea tree oil, and maintaining your nails so they are neither too short or too long. Avoid self treatment of digging out your toenails that can result in injury or worsening an infection that could require surgical intervention. 

Fungal nail infections are more easily treated in its early stages, so don’t delay in getting an evaluation. 

At Bluebonnet Foot and Ankle Institute, our board certified physicians can evaluate and assess the best treatment recommendations and are equipped with prescription topical treatment options to laser nail care and if needed, a quick and easy in office procedure can be performed to permanently address your ingrown toenails. 

Schedule your toenail and foot evaluation today so we can help you continue moving and running pain free this fall! 

Call us at (512) 394-5108 or schedule an online appointment at


Dr. Babak Kaviani

Dr. Babak Kaviani is a board certified podiatrist and founder of Bluebonnet Foot and Ankle Institute. He demonstrates his love of podiatric medicine in his continued charity work and mission trips to Latin America. When he is not practicing medicine, you can find Dr. Kaviani spending time with his wife and two kids, cooking, swimming, or enjoying a good book.