Blisters Under Your Toenail

blister under toenail

These blisters are caused by pressure, a bit like the the end of the toe blisters and since you have four nerve endings at the end of each toe, they are so receptive to pain. Sadly these blisters can cause problems long after the initial blister. They can result in the loss of your nail with damage to the nail bed that produces the next nail, which can often be misshapen, the remnants of the damage can still be seen a year later!!

How to prevent toenail blisters

Routine nail care– if your toe nails are long or thicker than usual, then they need to be cut short or thinned down by a podiatrist to reduce the amount of pressure on that area. It is a simple solution that is often over looked

Footwear – Use shoes and boots with more depth and that are long enough at the front of the shoe

Lace locking– keeps the foot from moving around in the shoe and creating more repetition in slipping which makes the foot unstable and then the toes want to grip, increasing the pressure, then shear- and then blisters.

Toe props- these are custom made to prop the toes from underneath and reduce the pressure on the ends of the toes. They are made by a podiatrist as they will be a custom made fit to your feet

Biomechanical assessment with a prescription of orthotics or simple insoles by a Podiatrist. This will establish the cause of the retracted toes or the hyper-extension (toe sticks up onto the top of the shoe) of the big toe. Hoka oneone running shoes would be useful here as the same biomechanical issue is going on as getting blisters under the toe section. These would help to offload the pressure on the big toe joint

Running technique– be aware of how you run, especially downhill as this is the time when you are likely to develop these blisters. The pressure at the end of the shoe can be huge and the repetition of impact can be relentless. Longer strides will make it worse, so adapting a shorter stride length going downhill would help a lot but like with any adaptation to your technique it will take time to change safely without incurring injuries. Talk to a running specialist or a physiotherapist on how to help you do this.

How to treat toenail blisters

These are difficult to treat and carry on with your activities as the blisters could be affecting all of the toes at the same time, which would increase the bulk in the shoes but on the flipside the dressings are going to be more comfortable than the blisters! If you are no longer continuing the activity then wearing open fronted sandals will be more comfortable as there will be no pressure on the end of the toes.

What is a blister “hot spot”?

Hotspot – If you have recognised a hotspot on the skin in time before a blister has developed then a simple island dressing will be enough to reduce the shear on the skin and hence reduce the blister from forming further and if you have them, apply an engo patch on the insole as explained in the prevention of blisters. Deflective padding works really well here to reduce the pressure on the joints.

Treating Bubble blisters

Bubble Blister – If the roof is still on then treat it in a similar way to a hotspot on the skin, by applying a sterile island dressing, if the blister bursts (pops) when the dressing is on, then you know the dressing is already sterile and will prevent an infection from getting into the open sore. If you decide to pop the blister, then follow the instruction on “how to pop your blister” and treat it as a roof torn blister. Use an Engo patch applied to the insole with deflective padding applied to the feet.

Treating broken blisters

Roof torn blister – now this type needs its roof (skin) to stay in place, the roof may be broken but your own skin is still important for healing, so use a sterile saline swab to clean the wound first, then apply the povidone iodine stick over the torn area as an antibacterial action and apply a sterile island dressing. A deflective pressure relieving padding as shown in the video to prevent any further pressure and friction.

Treating “popped” blisters

Roof off blister – Hydrocolloid dressing is the only option for this stage of blister, swab the area with saline to make sure the wound is clean and dry before applying the hydrocolloid, add extra hyper fix tape to anchor it down and apply deflective padding if continuing an event or activity. Hydrocolloid dressings are great wound healers and Podiatrists have been using them for a long time in the management of ulcers, with great success. They are not used at any other stage of the blister treatment and can cause blisters if not applied at the correct stage. I like to use some fleecy foam padding over the dressing as it just gives a bit of cushioning to the blister area, which is always very painful.

Treating infected blisters

Infected blister this is the stage of blister that you need to recognise quickly, a bacterial infection has invaded the blister and it could look red, swollen, there may be yellow or green pus in the blister and it could smell? Extending into the skin around the blister might be red and hot with red lines tracking away from the blister. You may feel unwell in yourself and swing from having the chills or feeling quite feverish. This is the time to get medical help as the infection can easily travel into the blood stream causing the infection to move into the leg and cause sepsis.