Cropped shot of a young man holding his ankle in pain while running.
(Photo: Getty Images)

Dealing With Injuries That Aren’t Really Injuries

Chances are pretty good that you've experienced at least one of these "injuries." Yes, you can run through them.

Cropped shot of a young man holding his ankle in pain while running.
Getty Images
Jeff Gaudette

Heading out the door? Read this article on the new Outside+ app available now on iOS devices for members! Download the app.

Running is difficult enough when you consider the very real threat of prolonged injuries that keep you off the roads for weeks or months at a time. But what do you do about those more frequent — and extremely painful — annoyances like black toenails and cramps that, while not classified as injuries, can be very difficult to run through?

In addition to treatment and prevention, how do you decide whether you can or should run with one of these very painful annoyances?

To make the decision more confusing is that more serious injuries, like Achilles tendonitis and plantar fasciitis, often begin with pain that is very slight and easy to run through. These “smaller annoyances” are often extremely painful from the start but typically don’t last long. You certainly don’t want to take unnecessary days off, especially if complete rest won’t speed up the healing process.

To help you make sense of these smaller, yet very painful “injuries,” I am going to outline the three most common injuries that aren’t really injuries. More importantly, I am going to detail treatment and prevention methods and help you decide when it’s safe to keep training and when it’s not.

Black And Dead Toenails

Black toenails are the bane of sandal-loving runners everywhere. However, in addition to looking hideous, they can also be very painful, especially in the first few days after the blood blister is formed.

Generally, black toenails are caused when your toe rubs up against the front of your shoe or your sock. When the nail tissue gets damaged, fluid builds up behind or below the existing nail, which creates a great deal of pressure. This pressure is what causes black toenails to be very painful. The black color is due to the blood capillaries breaking underneath this pressure.

Almost every runner gets a black toenail at some point in their career. In my opinion, having your first black toenail is the mark that you’ve really begun training hard.


Generally, it is best to leave the toenail as is and not try to release the pressure. The pain should subside in a few days without intervention. Attempting to release the pressure could result in infection.

If you decide that you can’t bear the pain and need to release the pressure, consider visiting a doctor to be safe. However, if you are determined to do this at home, you certainly can.

First, sterilize a paper clip by putting it over a flame and heating the tip. While it is hot, place the hot end on the nail, where it will quickly melt through and create a hole by which the fluid can escape. To be safe, after the fluid is drained, put some antibiotic ointment in the hole and on the nail.


The most effective way to prevent black toenails is to run in shoes that fit properly. You should have a thumbnail’s width of room between your big toe and the front of your shoe while standing, not sitting. You should also wear moisture thin, moisture-wicking socks to prevent increased heat build-up.

You should be able to run through this “injury,” provided the pain does not cause you to limp or modify your form. Generally, the pain will be extreme the first few hundred meters or even the first mile, but it will often go away. If your toe hitting the front of the shoe is causing the pain, you can try running barefoot in the grass. Unless you’re well-conditioned to run barefoot, you’ll only be able to run a few miles, but you’ll still be able to run and you’ll strengthen your feet in the process.

Pain On The Top Of Your Foot

Generally, pain on the top of the foot is an inflammation of the tendons that straighten the toes, which run along the top of the foot and are called extensor tendons. Thus, the clinical name for this injury is extensor tendonitis.

Extensor tendonitis is most often caused by lacing your shoes too tightly or having an ill-fitting shoe, in which case the lace creates a pressure point along the top of the foot. Swelling can often occur and it’s very likely you see a large bump or nodule somewhere on the tendon itself.

As with black toenails, extensor tendonitis can be extremely painful as the tendon will rub against the shoe with almost every step. Luckily, despite the presence of a nodule and swelling, this “injury” is not very serious.

Treatment And Prevention

The most effective treatment is to change your shoe lacing pattern and loosen your laces slightly, especially while you’re bothered by the pain. Arthur Lydiard developed a lacing pattern called ladder lacing, which reduces pressure on the top of the foot by not allowing the laces to cross over the middle of the metatarsals. Click here for detailed instructions on how to lace your shoes this way.

You can also ice the top of your foot frequently to reduce inflammation. Once the tendon is no longer inflamed or tender to the touch, you’ll be relatively pain-free.

This is an “injury” that you can run through if the pain is not impacting your gait. If you do find running in shoes to be too painful, even after switching up your lacing, you can try running barefoot in the grass. Just be sure not to overdo it if your feet aren’t accustomed to barefoot running. You don’t want to develop a more serious injury.

Cramps And Side Stitches

Cramps and side stitches are “injuries” that every runner will experience at least once, if not multiple times, in training. Researchers believe side stitches are actually spasms in the diaphragm or the ligaments that support the diaphragm.

The exact cause of this spasm could be general tiredness or overuse, just like any other muscle used while running; or there could be increased demand on the diaphragm, like when you eat a large meal before your workout.

Treatment And Prevention

Most conventional wisdom says slow down, stretch, and wait until the ache subsides. Great advice when you’re not in the middle of a race or an important workout. Luckily, here’s a great way to eliminate cramps while running — force your stomach to do the opposite of what it naturally wants to do, which is expand when you breathe in and contract when you breathe out.

To visualize this, place your hand on your stomach while you take deep breaths. You’ll notice your stomach expand (press against your hand) when you breathe in and contract when you breathe out. Simply reverse this process and contract your stomach when you breathe in and try to press your stomach against your hand when you breathe out.

It’s a little difficult to get the hang of at first, but practice a few times and it will become easier. Once you’ve got the rhythm down, make your breaths deep and forceful, taking all the air in that you can and then letting it out forcefully. You’ll still have to slow a little at first because of the change in breathing rhythm, but you won’t have to stop completely. The more you do it, the better you’ll get and the more efficient at relieving cramps you’ll become.

From PodiumRunner Lead Photo: Getty Images

Trending on Outside Online