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 of a bruised nail:
- 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
Treatment:
- When bruising is seen, apply an ice bag for 10 minutes three times daily.
- Apply tape such as Microfoam tape over the base of the nail in order to apply compression and keep the nail intact.
- Keep the nail clean with applying alcohol at least twice daily.
- Do not attempt self treatment to evacuate the area of bleeding as the problem can worsen.
In-Office Medical Treatment:
- Evacuate the blood under the nail, subungual hematoma, via a small needle through the nail plate. This usually does not require local anesthesia.
- If a portion of the nail has been lost, the thick calloused tissue on the nail bed will need to be trimmed to allow healthy regrowth of the nail. Toenails grow at a rate of 1 mm/ month. This trimming may have to be performed periodically. Again, local anesthesia is not necessary.
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
BIO: Frank Sinkoe, DPM is a native of Atlanta, Georgia who has been practicing podiatry in Atlanta for 23 years. He has a general practice in podiatry and a subspeciality in dance medicine. Dr. Sinkoe serves as the podiatrist for the Atlanta Ballet and is a member of the International Association for Dance Medicine and Science (IADMS). He is married with two children. Reach him at 404-329-5050 or by e-mail at doctorfrank (at) bellsouth.net
