The mysterious case of the cracked little toe…

This is the story of a rather curious process which befell my little toe over the course of last summer and autumn.  Although I wouldn’t normally afflict the online ethers with such an intimate affair, I do know that many people come to this website with questions of cracked toes.  If the story and pictures below contribute to identifying your own problem, then I’m glad to be able to help.

It all started in June or July, when I was increasing my barefoot mileage up to about 30 miles (50km.) per week: the amount I had always been accustomed to during the years I had run in shoes.  I was feeling strong and healthy, and so for the first time had also reintroduced hill runs.  At some point during this period, I began to notice a small, innocous looking crack beginning to develop in the crease under my little toe.  I didn’t think much of it.  It didn’t hurt.  The skin was soft and alive, not dead and dried out.  I assumed it was just the epidermis stretching as a result of the extra mileage and perhaps also as a consequence of the hills.  Actually, a similar thing had happened between my big toe and first smaller toe a couple of years earlier, when I had first started running barefoot.  The area became a little tender for a while, probably as the muscles underneath also stretched, but nothing ever developed out of it.  The skin began to heal from underneath, and it all cleared up over a few weeks.

But this time it didn’t clear up.  The crack began to deepen, until it had created a fissure several millimetres thick.  By late August, I had drawn a clear correlation between hills, distance, and the degree to which the crack was worsening.  Most likely, running downhill was the main culprit.

When running downhill with any momentum, there’s no time to lift your foot before your body weight has already carried you forward to some degree, driven ahead by gravity.  Given that the sole of your foot is fixed, planted on the ground, this means that the rest of your foot wants to slide forward slightly.  In other words, for a split-second the structure of muscle and bone, carried by gravity, slides forward over the epidermis, stretching it.  Yes, I know: purists will always cry: ‘bad form, bad form!’  Theoretically, I should have been lifting my feet faster with a faster turnover, but there does come a point beyond which you can’t raise the RPM any higher.  Yes, I know: I should have paid heed to the warning signs, but by now it was too late.

By the beginning of September, a half-centimetre hole had opened up in the epidermis, allowing a clear view to the flesh beneath:

It didn’t bleed, but the flesh beneath did offer itself up as a bright, happy red…  The problem now was that with the epidermis fully compromised, the wound didn’t want to heal.  It would close over for a day or two then reopen again.  Again and again…  I cut the hills out from my runs, and this did seem to help a little bit, but anything longer than half an hour or so would be sure to return me back to square one.

And so it lasted for over a month with no improvement whatsoever.  I began to worry that perhaps I’d contracted some kind of strange fungus / athlete’s foot.  Medication didn’t help, though, and creams only stung like hell.  They even seemed to prevent the wound from beginning to stitch back over.  So instead I began to spray antiseptic (Dettol) over it a couple of times a day, in order to minimise the risk of infection.  I figured that nature would eventually take its course.  The skin down there was still very much alive, so it was just a matter of time before my body adapted to the new circumstances, and new tissue began to stretch over the gaping hole in my foot.  Well, that was my theory at least…

In the meantime, though, when open, the flesh was very sensitive.  Plain water entering the crack was bad enough.  But Dettol?…  Ooooh, that was cruel!

Things did begin to heal, though, after the beginning of October, so that by the middle of the month the crack looked like this:

By now, the fissure was permanently closed.  The skin to either side was drying up and dying off, as visible in the photo.  I was hoping that this meant new skin was growing underneath, and would replace the old.  Nevertheless, it didn’t feel good to stretch my toe backwards.  If I so much as began to force it, it immediately hurt, suggesting that the wound might reopen if I continued.

I kept taking it easy while things healed, so that by the beginning of November the areas of dead skin on either side of the crack were beginning to peel off:

In this picture, the dead skin below the crack has just peeled off.  You can see the healthy pink new skin, not just along the line where the fissure had originally sliced into me, but to either side as well.  The epidermis has fully stitched together.  Although there is still a trough along the line of the original crack (especially on the left-hand side of the picture where the fissure was deepest), this subsequently smoothed and thickened out.

A few days later, the strip of dead skin above the original crack also peeled off (pictured above).  By this point, I was able to stretch my little toe back normally again.  It’s never bothered me since.  I run bigger hills than every before and my feet are happy.  All’s well that ends well.

As subjective as it must remain, I suspect that I do have slightly more flexibility in my little toe now.  Or more precisely, it doesn’t feel so tight if I pull back on it.  Before this whole incident began, a thick layer of leathery skin bound the toe to the metatarsals.  No wonder: shoes prevent us from bending our feet in the way that nature originally intended.  Without ever being fully stretched, the skin – along with the connective tissue underneath – will tighten to whatever extent we use it.  Running barefoot downhill is probably the most stress you can ever put on the underside of your foot.  If you give your body enough time to adapt (which I obviously didn’t…), then there’s no reason not to be able to gradually stretch this tissue out without causing an injury.

Interestingly, there hasn’t been any sign of a similar crack developing in my left foot.  We do all use our feet slightly differently from one another, so perhaps this is reason enough.  Who knows.  The main thing is that, for whatever reason, the connective skin under my left little toe isn’t quite so thick as it used to be under my right.  Perhaps as a result it can more easily stretch without tearing.

ADDENDUM, Nov. 2015:
Guess what?  Now the whole process is repeating itself on my left little toe.  I just returned from a run and noticed a strange sensation while walking the last few steps back home… I looked down and to my disbelief saw something that looked very much like the first photo on this page.  So it’s opened up too.  Maybe it’s no coincidence.  I’ve been putting in more hill miles than ever before, as preparation for my first ultra.  Just hope it doesn’t knock training back!  We’ll see, and I’ll post updates as to how things progress.