Including Blood Blisters
I’ve drilled a lot of holes in a lot of toenails over the years. As a podiatrist, I have a piece of equipment called a nail drill. I use it every day to file and thin toenails, and it works a treat for drilling holes. It’s not a painful procedure at all. Very little pressure is required for the rotating bit to grind its way through the nail at 25,000 rpm.
At races, I don’t have the luxury of my clinical nail drill with me. It’s far too big to be lugged around and needs to be plugged into the electricity to work.
This year for Big Red Run, I bought a Cordless Dremel Micro as my race drill. It has a rechargeable battery, is light weight, low bulk and rotates at 18,000 rpm.
I took care of a few thick or long nails with it (pictured below).
But I didn’t drill any holes with it.
Why? Because I learned a new technique (it’s not new, just new to me). A technique I’ve known about for some time. A technique I’ve seen on YouTube. But one I’ve never tried before. It uses a hypodermic needle. You twist it back and forth, gently, until you get all the way through the nail.
This has become my treatment of choice for blisters (and blood blisters) under the toenail
I mean, I’ve seen it done on YouTube (often badly). But I watched BRR’s doctor Adam Brownhill do one and it looked easy. So I tried it myself on the next black nail that came through the medical tent. I anticipated having to press firmly while twisting the needle, but only light pressure is needed. I also expected it to hurt the patient when we got through the nail. To my surprise, it was dead easy and comfortable for the patient. Blood oozes from the hole before you (or your patient) realises you’re through it, thanks to the angle on the pointy end. This allows you to tread carefully for that last little bit as you create a hole big enough to allow the blood and blister fluid to keep exiting.
Until I get the opportunity to video one of these myself, here's the best video of the technique that I could find on YouTube (below).
Do It Yourself?
I think an athlete could (and should) learn to do this themselves. These black toenails can be the most painful of all blisters because there’s no room for the fluid to go – it’s stuck between a rock (the toe bone) and a hard place (the nail) with no room for expansion. The extra liquid volume actually separates the nail from the tender nail bed skin. That’s why it hurts! As soon as you release even a little bit of fluid, there is significant relief. If you find yourself stuck in the middle of nowhere with a toe like this, you'll be glad you watched this video and pakced the gear you need to put a hole in a nail, painlessly! A couple of holes may be necessary; and they may need to be reopened from one day to the next to allow the ongoing release of fluid. And don't forget about being clean and using your infection control procedures!
So I recommend you put a couple of hypodermic needles in your blister kit. Not sewing needles – I’m talking about the needles they give you injections with. They’re sterile; you should only ever use it once; and they’re easy to store safely back in its sheath before disposing of it into a sharps container.
Of course, try to figure out what has caused blister / bleeding and address this ASAP. Otherwise the problem will persist.
Is firmer lacing needed to keep the toes away from the end of the shoe?
Is a toeprop required to stop the toes from bending over and becoming weightbearing – pressing forcefully into the insole of the shoe? These can be custom-made. Or you can make your own short-term version with orthopaedic felt.
To wrap up, consider what you'll do about a blister (or blood blister) under your toenail. How will you treat it? How will you'll try and prevent it? What gear are you going to need?
If you need help, check out the Ultra Blister Kit.
Written by Rebecca Rushton
Rebecca is an Australian podiatrist with over 20 years experience. She has spent a lifetime dealing with her own blister prone feet in her sporting and everyday life. Rebecca specialises in helping athletes and sports medicine professionals figure out how to manage foot blisters with ease. And for kicks, she enjoys providing blister care at multiday ultramarathon events.