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Player to Player: Preventing "Turf Toe"

May 25, 2008 12:04 PM

Real Tennis Players - Like You! - Asking For, and Offering, Advice on the Sport They Love

Player to Player is USTA.com’s bi-weekly feature in which everyday tennis players are given a forum to ask advice on the sport they love – and their fellow players will dish out advice. We’ll post a number of the best responses we receive to our question of the week.

Please send any questions you’d like answered, or responses to other player’s questions, to Player@USTA.com.


SEND YOUR TIPS TODAY
This week's question from Karl K. of Greene, NY


"I've been trying to wear contact lenses over the winter in preparation for those warm and humid days in the Northeast that are just around the corner. Many of the newer high H2O contacts are comfortable to wear around the house but on the tennis court it takes me a moment or two to regain focus after blinking, which, of course, is not a good thing when an 80 MPH serve is flying at you. I'd appreciate hearing about any good or bad experiences with contact lenses on the court. (By the way, I'm not at all interested in the Lasik solution)."

Please share your advice with Karl K. by e-mailing Player@USTA.com and include your name and hometown. Got a question of your own? Send that along, too.


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READ OTHER PLAYERS' ADVICE
Last week’s question from Mary S. of Chattanooga, TN
(Please note:
There's no need to send additional responses to this question)


I am a singles player at the 4.0 level. My only problem pain-wise is that I keep losing a toenail or two during my season. And it is painful! I usually wear New Balance and Nike shoes. Am I wearing the wrong shoe? Are my shoes too tight or loose? I don't see this problem addressed anywhere. I hope to hear from someone who has had this same problem.

PLAYER RESPONSES

From Jake L. of Memphis, TN
I understand your problem, and it can become quite painful. “Turf toe” is the common name for your condition. It is derived from athletes injuring their toes from ramming them either into the side or front of their shoes when playing sports on artificial turf. Having lost my toenail from doing that very thing, I learned a lot about footwear, in general, which now helps me in my tennis. More than likely you are hitting the end of your toe, or pulling the skin back form the nail by split-stepping or cutting on the court – hard surface, I imagine.

What I have done to prevent this is order a shoe a half-size larger than normal on my hard-court surface shoes. Also, I make sure that my width is correct, either by trying different shoes or thicker socks, to prevent my feet from slipping forward due to the shoe being too wide. And lastly, I lace the last portion of the laces (closest to the ankle) very tight to prevent my foot from sliding forward. Try this, and I think you’ll notice fewer “black” toenails and, hopefully, a more enjoyable time on the court!

From Bill K.
I have had similar problems. Several helpful hints:
Keep your toenails trimmed short so your sock and shoe aren’t constantly flexing the end of the nail. Constant pressure results in blistering and bruising under the nail and then the nail dies and releases.
• Make sure that your shoes fit properly and have a one-inch clearance between the end of the toes and the shoe. I like New Balance for better width fit.
• Leave a little slack in your socks at the end of your toes so the sock isn’t placing undue pressure on the ends of the toes and toenails.
Try playing on clay more – sliding instead of sudden stops.

From Carol of Marietta, GA
I am also a 4.0 singles player and have not lost a toenail in over five years. I buy my tennis shoes 1/2 a size larger than my “normal” size. This allows about ¾-inch extra room for your toes for all the quick starts, stops, pivots, etc. I test my shoes before purchasing by pushing my foot as far as I can into the ball of the shoe to make sure my big toe does not reach the front of the shoe. This practice has kept my feet in great shape.

From Neal P. of Denver, CO
If you are losing toenails regularly, you are wearing the wrong shoes or the wrong size shoe. All the brands fit a little bit differently, so keep trying different ones until you find a sneaker that doesn't cause you to lose nails. A problem that many women seem to have is that they wear tennis shoes that are too small. Just because you wear a certain size dress shoe doesn't mean that your tennis shoes are that size as well. You may need a larger size tennis shoe. Try a half or whole size larger, and see if your problem goes away. Also, sizing varies with the various brands. A size 8 Nike is not the same as a size 8 New Balance. Try on shoes without any preconceived notion of the size or width you need, and go with what feels the best.

From Joe Gerardi, certified tennis coach
What you have is commonly called "Turf Toe," and it can indeed be very painful. A telltale sign at the beginning of damage is a small black and blue mark across the top of the toenail. It's caused by your toe hitting up against the front of the shoe continually. You can try wearing two pairs of socks, which should help cushion the toe, and additionally, after you're done playing tennis, soak the toes in warm water to ease the stress to the digit, remove the dried blood under the toenail and keep the damage to a minimum.

From Patricia E. of Reston, VA
I have suffered from jammed toes for several years. Doctors suggested that I was wearing my shoes too small, but that wasn’t the problem. In my case, there are two problems: My feet slip forward, jamming my toes, and I have a tendency to curl my toes causing "runners toe" or a bruised toe. I have solved the problem by finding a shoe that was tighter across the middle of my foot so I can lace it tighter to hold my foot. I also tape two of my toes together, preventing them from curling when I am running for a ball. I wear a Wilson shoe that has a narrow instep and wider toe box. I also wear an ankle brace on one leg that seems to prevent my foot from slipping forward. I don't even tape the toes on that foot. I believe that the brace’s thickness helps the laces to hold the shoe in place.

From Phil S. of GA
I had the same problem two years ago. My tennis outfitter measured my feet and discovered that I was wearing shoes that were a size too small for me. I switched up a size and haven't had a problem since. Get your feet measured by a professional, and wear proper tennis shoes, not athletic shoes.

From Michael B.
Is your nail getting yellow and discolored before it falls off? You could have a nail fungus infection. See a podiatrist for some medicine. If you need a cheap solution, try rubbing Selsun Blue shampoo (Selenium Sulfate) on and under the toenail. This should control the situation, but it will be several months before your nail gets back to looking close to normal. If your nail is just black and blue, then your shoes are probably too tight, and the nail is being damaged by constantly jamming into the front of the shoe. Also, you could try wearing a thicker sock for more cushioning in the toe area, as tennis shoes are notorious for having no cushion in the uppers in this area. I had both of those problems, and now my nail seems to be doing much better, as I have not lost one in years now and the color is almost normal.

Robert W. of TN, tennis player and podiatrist
My advice is to wear a larger shoe size and try an arch support that is fairly rigid. This will keep your foot from sliding forward into the toe box and causing the avulsion of your toenails. Good luck.

From Joel C. of Thornton, CO
Use a shoe size with an extra space for your toes. One way to select a good shoe size is to slide you feet in all the way to the end and then make sure you can insert a finger between your heel and the shoe. Then keep your shoe laces tied snug when playing.

Deborah Fitzgerald, M.D., of Coronado, CA
Trauma and or fungal infections are the two most common reasons for toenails cracking/falling off/breaking. This is extremely common in marathon runners due to the repetitive pounding, whether or not they wear the “right” shoes. However, athletes usually find that wearing a shoe that is too long will lessen the trauma and sometimes alleviate the toenail problems. One toenail fungus called Onchomycosis must be treated, or it will cause your toenail to split in layers or fall off without much trauma at all. In the meantime, I have found wonderful “cushions” for toes that get sores, calluses, blisters or damaged nails due to the simple trauma of athletic endeavors. Look for silicon “sleeves” that cap over the end of the involved toes. They work WONDERS! (Ask your podiatrists, look online at special foot-product stores or just Google them).

Mary P. of Duluth, GA
I have lost toenails, as well, and I do not think my two big toenails will ever recover. However, I have a lot less discomfort wearing a shoe 1/2 size larger, and I also put bag balm on the bottom of my feet before playing. Hope these tips help! I am too embarrassed to even get a pedicure anymore. My podiatrist said to keep them short and polish them dark!

From Joe B. of Oxford, MS
The problem that you are having is from impact of the toe with the toe box of the shoe. The cause could be a couple of things, including shoes too loose or too tight, and the length of your nail. New Balance tends to have a roomier toe box, while Nike’s toe box and shoe construction is a little narrower than others. If you are losing the big toenail, this is more than likely due to the foot sliding forward when you stop and hitting the toe box, which may be indicative of too much room in the shoe. If it is one of the smaller toes, then the toe box may be too tight. Asking for advice from a store that specializes in athletic footwear may be very helpful for you, as opposed to going to the local sporting goods store. Finally, if you feel that your feet are sliding in your shoes, use a second pair of socks. This will fill up the space and provide more cushioning.

From Sayoko of Redmond, WA
I have had the same problem for years also. Here are the few tips I can offer:
• Keep your toenails trimmed as short as you can – and trim them as often as reasonably possible.
Buy the custom heat moldable insoles to keep your feet from slipping forward when you play. These generally last for at least a year, so it’s not too expensive. Put them in your new shoes when you get them.
• Tie your shoes as tight as you can – though still comfortable – to keep your feet from slipping.
• Get a shoe that is a good fit for your particular foot shape. Often a good podiatrist will know the "lasts" or molds that different shoe manufacturers make. For example, if you have a wide front foot or a narrow front foot, you may need a different brand and model of shoe.

From Shannon N. of Rome, GA
I was having some problems, too. Try Adidas tennis shoes, like Barricade or Feathers – they have a larger toe box. Also wear cushioning socks, such as Thorlos.

From Anne G., National 55 and over champion
Ouch! That sounds very painful. I used to get black tennis toes from slamming my foot into the front of my tennis shoes while playing on hard courts. Now I wear a shoe that is a 2/3-to ¾-high top and is a 1/2 size larger than I need. Then I tighten the shoe around my ankle to keep the foot from sliding forward. No tennis toe! I usually have to buy men's basketball shoes to get a shoe with a little higher cut around the ankle.

From Ken J. of Mt. Pleasant, SC, singles 4.0/4.5
Find a shoe with a nice tapered toe box, not a roomy boxy toe box. By doing this, you will keep your whole foot from moving forward into the nice "comfy roomy toe box" and then jamming your toes. The snugger fitting shoe grabs the edge of your foot and keeps it from sliding when you run down drop shots. I personally have found Nike shoes to be best, but the durability is worse. I pay extra to keep all my toenails.

From Robin T. of York, PA
I have lost a few toenails, too, and believe it was from slamming forward into the shoe. Finally after 12 years of playing singles and doubles, I happened upon the Wilson Phantom shoe. It is a snug fitting shoe, but with a wide toe box, so I have wiggle room. My toenails don’t become black anymore and no throbbing toes at night. That shoe is on sale now, so Wilson is probably close to changing the style. If you want to give them a try, you’d better hurry. If they work, order a bunch of pairs. With this shoe, however, I did have a little twinge in the Achilles area of my slightly smaller foot but have strengthened that area now to avoid injury.

From Dave R., Mid-Atlantic, 4.0
I also was losing my toenails playing tennis. And it can be very painful when the nail is holding on by a thread and you rub the nail against your bed sheet in your sleep. What I learned from my podiatrist is that there are two kinds of shoes: straight last and curve last. A shoe is straight last if you trace a straight line through the middle of the shoe and it is the same width on both sides (Nike has straight last). If your feet curve inward, I recommend getting curve last shoes where the shoe curves inward at the top (C-shaped at the top). If you draw a line in the middle of the shoe, there is more shoe on the inside half, at the top. These shoes work much better for me based on the curve of my feet. Wilson offers several models of curve last shoes.

From Patti of Briarcliff, NY
I have had the same problem, where both big toenails would break about half way down. After speaking to friends who play four or more times a week, many reported the same thing. I began to think that this was supposed to happen as I started to play more. Then I went to a running shop where they are really good at fitting sneakers to specific sports. I found out that after all these years, my sneaker size has increased by 1/2 a size. I have not had the toenails break again, and I've been playing more tennis!

From Diahann W. of De Soto, TX
I’ve also been losing toenails every season for the last few years, which included several painful days of swelling and bleeding under the nail. Many people I shared my plight with suggested doubling up on socks, wearing different shoes, and wearing padding used by ballet dancers. Recently, a veteran player told me losing toenails may be counteracted by better foot movement to prevent frequent jamming of the toes. This advice has proven effective. I still have sore toes after some matches but have experienced fewer incidents of actually losing a nail since working on my foot movement.

From Patti of Tampa, FL
I’ve also lost toenails several times. After discussing it with my doctor and nail tech, I found many helpful solutions and haven’t lost a nail in a year. It’s possible that your shoes are loose from use, causing your toes to jam up into the front especially when you volley. I go for pedicures once every other week and that actually was too much. They were buffing my nails so much that they became soft, therefore breaking off easier. I have them cut the nails pretty short for all those volleys and buff only once a month.

Also, if you play hard courts you may want to wear a sock that is thicker in the front (like the ones used for rollerblading). When you’re done playing, take those tennis sneakers off and put on a pair of flip flops so your toes can dry out. Leaving your shoes on will trap the moisture, causing softer nails and a breeding ground for fungus. I wear my flip flops before and after every match, no matter the weather. Buy some tea tree oil and put in on dry nails and around the cuticles before you put socks on. It will keep the moisture at bay.

From Kelly P. of Hoover, AL
The one shoe I have found that doesn’t cause blisters under my toenails (leading to my toenail falling off) is the Nike Air Max. I tighten my shoestrings before playing and loosen them when I’m done. My feet are really achy afterwards, but no lost toenails with those shoes.

From Emmy P.
Both my husband and I also lose toenails all the time. I don't believe it matters which shoe you wear because I've used K-Swiss, New Balance and Nike shoes. The only thing my husband and I believe is to be more aware of stops and starts. As we get older, we're trying to stay in better shape but not go for balls that are impossible to get. I don't know of any serious singles tennis player who doesn’t have some type of toenail problem. It goes with playing serious competitive tennis. Sorry I couldn't be of more help, but know you're not alone.

From JA of San Diego, CA
I play singles, as well, and have had the same problem! I have the edges of my toenail rounded just a bit. I wear two pairs of socks and the New Balance WCT1001 (bigger toe box on this shoe). This seems to have solved my problem. Good luck!

From Chas S. of Baltimore, MD
A friend of mine knocked off his big toenail in a tournament. Ouch! The way he had his shoes tied you could slip a finger under his shoe laces above his toes. My experience is that loose shoe strings, especially at the bottom near the toes, can cause the nail to catch. Maybe the entire foot slips forward? Tighten shoe laces carefully, starting with the bottom ones. Of course, the toenail should also be trimmed, and you should check that the shoe is free of inner ridges above the toe that might catch the nail.

From Peter of Forth Worth, TX
I have had problems for years with trauma to my big toenails. I started cutting out the part of my tennis shoe overlying the nail with a sharp knife. This left a hole in the top of my tennis shoe over my first toe but has cured my toenail problems. I think it works because it prevents my toenail from slamming against the inside of my tennis shoe when I stop and start.

From Kristin S. of Severna Park, MD
Mary, boy can I relate to your problem! After four seasons in a row of losing my big toenails, I finally went to an expert shoe salesperson and learned that I was playing in shoes that were almost a full size too small. With his help, I both upsized and switched brands (K-Swiss 7.0 to New Balance 1001). It’s great to be able to play pain free again.

From Janet L. of Siders, GA
More than likely you have a nail fungus. This is an occupational hazard for athletes, especially runners and tennis players because your toes are constantly smashing into the front of your shoe. I have the same problem, and my daughter, who is a runner, does as well. It's hard to treat, so I would suggest you see a dermatologist and consider purchasing the new running socks that have cushioning at the toe.

From Eliza C.
I had this same toenail problem and was actually losing six toenails in a summer. I used to wear Nike and Fila shoes until my doctor recommended Prince sneakers, which are roomier. I did, and it worked! I have not had anywhere near the amount of problems I had previously. Hope that you have the same results.

From Laura of Maui, HI
I have found Head tennis shoes are the best for me as far as toenail breakage. Since I have changed to a shoe with a bigger toe box, I am cracking less big toenails. I keep my nails very short and polished with nail strengthener. I also noticed since I switched to "Jox Sox" brand tennis socks my feet are not sliding around in my shoe. They absorb the sweat and grip the insole. I found that other brands of socks had nylon in them and made my feet slip inside my shoes. Good Luck!

From Carolyn of Louisville, KY
What you are experiencing is sometimes called turf toe. Players in other sports have the same thing happen to them. It used to happen to me a lot when I played softball. I lost my toenail several times from the sudden starting and stopping in the outfield. It is caused in part by the sudden stopping of your movement forward, causing your feet to slide forward in your shoe and hit the end of your toe to the tip of the shoe. It creates stress on your toenail causing it to "lift" eventually from the bed. It can help to make sure your shoe has the softer toe, versus some of the very stiff toes on some shoes. Also, wear your shoes as tight as you can, obviously without it being painful, to stop the forward "slide" of your foot in the shoe. But once your toenail falls off – it is hard to keep it from doing it again because the grip of the nail bed on your nail is weakened. You might also consider taping your big toe to the next one. Good luck with the toe deal – I know what you are going through!

From Jennifer B. of Los Angeles, CA
I’ve had similar toenail problems, which seem to be caused by my toes repeatedly slamming into the end of the shoe when I stop hard. You could get your shoes a half-size larger (but you could trip), or tie your laces so your foot doesn’t slide forward when you stop (and risk putting your foot to sleep). But the best and easiest way I found to attack this problem is to make sure your toenails are cut as short as possible so they don’t hang over the end of your toes. That way, even if your toes find their way to the end of your shoe (which they will in almost every tennis match you play), the toenails don’t catch, jam or tear loose. Voila! No more pain. Good luck.

*Please note that any advice given out in this forum should in no way be confused with actual medical advice. Before starting any new exercise regimen or altering your existing one, we strongly urge you to consult with your regular physician.


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