Toenail Injuries in the Dancer

Bruised Nails

Toenail problems become a source of concern and agony for the dancer, particularly the ballerina on pointe. Toenails function to improve our tactile (pressure) sensation and to act as a support structure for the toe. This can be helpful for the dancer on pointe.  However, because there is a lot of pressure on the nail while on pointe, bruising of the nail can result. The underlying nail bed is highly vascularized. The nail plate is adhered to the nail bed via small ligaments.  Repetitive microtrauma to the nail plate can injure the ligaments resulting in shear stress to the nail bed.  A small amount of bleeding occurs under the nail.  As the bleeding continues, the nail plate can elevate, producing calloused tissue and making the nail appear thick. A portion of or the entire nail plate can be lost.  This cycle usually repeats itself over a period of time.  Many ballerinas accept the fact that they have chronically bruised nails. Long-term consequences of a chronically bruised nail can be chronic ingrown nail borders, a deformed nail or a fungal infection of the nail.

Causes:

• Pointe shoes:  “dead” platform and/or wide box  can allow the toes to fall into the pointe shoe creating microtrauma to the nail
• Knuckling on pointe- will result in microtrauma to the nail plate
• Nails left too long will produce shear stress to the nail bed from micromovement of the nail plate

 Prevention:

• Do not allow nails to grow too long—cut at the free edge
• Evaluate pointe shoes and avoid dancing in “dead” shoes
• Access the cause of any toenail discomfort when first feeling the discomfort

Ingrown Nails/Infection:

An ingrown nail is usually referred to any condition whereby inflammation of the surrounding skin of the toenail is present. A “true” ingrown nail occurs when the nail does ingrow into the surrounding nail fold. This may result after the individual has lost the nail and the nail regrows abnormal. A chronically bruised and lost nail may result in an ingrown nail. This occurs because the root of the nail (nail matrix) has been injured and the nail is now “programmed” to ingrow abnormally.

However, the majority of the time, the “ingrown nail” results after the nail is cut too short within the nail grooves. Bleeding will occur resulting in a granuloma. A granuloma appears as reddish tissue within the nail groove. Granulomas attracts bacteria and thus a bacterial infection can develop. The granuloma grows and covers the nail border, thus appearing as an “ingrown nail”.

Signs and Symptoms:

• The nail folds which normally covers and protects the nail is red and swollen
• The granuloma is present and will bleed easily when manipulated
• Bleeding and/ or pus is noted

Prevention:

• Keep the nail trimmed to the free edge with a slight curve at the corners
• Do not push back the cuticle nor the nail folds as these protect the nail
• Keep toenails clean and apply alcohol daily on potentially problematic nails
• Evaluate pointe shoes for “dead platforms”
• Access the cause of any toenail discomfort

For more information, contact us at Olympic Foot and Ankle at 916.244.7630.