Runners often encounter various challenges during their training, and toe pain is a common issue that can disrupt their routine. 

In this discussion, we explore the potential causes of pain on the middle toenail after running and provide expert guidance on addressing this discomfort.

Identifying the Root Cause

When experiencing pain specifically on the toenail, several factors may contribute to this discomfort. One primary indicator is the blackening of the toenail or toenail bed, signalling underlying issues that require attention. 

The following scenarios may elucidate the root cause of the pain:

Long Nails: If the toenails are too long, particularly the middle toe, they may repeatedly impact the front of the shoe or catch on the sock, leading to trauma and subsequent bruising or blackening of the toe.

Ill-Fitting Shoes: Wearing shoes that are either too small or too big can exacerbate toe pain. Shoes that are too small exert constant pressure on the toes, while oversized shoes allow excessive movement, increasing the likelihood of toenail irritation.

Practical Solutions for Relief Of Toenail Pain While Running

To alleviate toe pain and prevent recurrence, implementing practical measures is essential:

Proper Nail Maintenance: Keep toenails trimmed short, especially before long training runs, to minimize the risk of irritation and trauma.

Shoe Selection: Ensure proper shoe fit by assessing space around the toes. The thumb test—wherein you should be able to snugly fit your thumb between your heel and the shoe—can help determine the correct shoe size.

Customized Shoe Modifications: If toenail catching persists despite proper nail care and shoe fitting, consider making targeted adjustments to the shoe. Cutting a hole in the top of the shoe where the toe is located can prevent nail-related discomfort.

Exploring Neuroma as a Potential Factor

In some cases, toe pain may stem from neuroma—a condition characterized by nerve entrapment in the toe joints. Symptoms may manifest as localized discomfort, particularly during and immediately after running. Neuroma-related pain typically subsides quickly following activity cessation.

Treatment Options for Neuroma

Addressing neuroma-related toe pain requires tailored interventions:

Cortisone Infiltration: For recent injuries, cortisone injections directly into the affected nerve can provide relief and mitigate irritation. Additionally, specialized strapping techniques may be employed to stabilize the joint and prevent further nerve aggravation.

Surgical Intervention: Persistent or chronic cases of neuroma-related pain may necessitate surgical intervention. While surgery may entail a brief recovery period, it offers a lasting solution to alleviate discomfort and restore mobility.

By understanding the underlying causes of toe pain after running and implementing targeted strategies for relief, runners can mitigate discomfort and optimize their training experience.


With a passion for high performance sport – Lindsey Parry is one of South Africa’s most widely recognised coaches. Having led a team to the London, Rio and Tokyo Olympic Games as well as the Commonwealth Games in Edinburgh, the Gold Coast & Birmingham, and coached both triathletes and runners onto podiums of some of the world’s most illustrious races, Lindsey has a unique ability to understand what it takes to succeed at any level and thrives on coaching, motivating and inspiring others to do the same – whether it’s on the track, on stage or behind a mic.

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