Day Two from www.racingtheplanet.com and I'm still practicing emergency medicine. Today's topic is the subungual hematoma. Another way to describe that is a bruise under the toenail. You might not have seen it if you haven't dropped a rock on your foot or ran two back-to-back marathons with five more to come.
To highlight this affliction of long-distance runners, a particular, sweaty Englishman comes to mind. He reached my checkpoint in the white sand after six hours and 30 kilometers, and his toes hurt. When I looked at them they were black under the nail and at the tips. I could see the agony in his face, hidden under the salt-caked cheeks.
With his feet propped up, I went to work in our tent. It was only 38 degrees in the tent and better than the 42 degrees celsius in the desert outside. I washed his feet with betadine, then put a large needle into the nail top and pushed until he could feel the tip. It seemed to relieve his pain more than hurt...and blood rushed out. After repeating that several times, I put bandages around his feet and sent him out to abuse his toes some more.
Lesson learned: Always bring a needle and betadine to a race, particularly a long race.