Toe trouble.

? I'm training for a marathon and my second toe keeps getting bruised beneath the nail. It's extremely tender. What causes this? I didn't notice it during my lower mileage weeks, but now the end of the toe is also getting severely blistered. My second toe is shorter than my big toe, so it shouldn't be hitting the end of the shoe. How can I relieve the pressure?

Linda Bell, New Albany, IN

You may have adequate room at the end of the shoe, but not at the top. Make sure you're running in shoes with a high toe box. If your toe is overextending and rubbing on the top of the toe box, you can try increased Achilles tendon stretching. You might also experiment with taping down the toe.

If the problem is due to excessive flexing or gripping of the toes, it would be generating from the bottom of the shoe. In this case, you may be hyperpronating and require an orthotic.

A company called PediFix (www.pedifix.com) makes a silicone sleeve that fits over the toe and may help to reduce the friction, regardless of the cause.

Robert Hallivis, DPM, Annandale, VA

An alternative to a toe sleeve or gel innersole is a forefoot posted orthotic with a Morton's extension. A cut-out for the second metatarsal head should decrease the pressure on the second toe.

Mitch Goldflies, MD, Chicago, IL

I believe you're experiencing recurrent subungual hematomas beneath the toenail. I suggest you apply petroleum jelly to the toe and then cover the foot with one or two pairs of socks. This will help lubricate and reduce friction in the area. Then have your shoes stretched by a shoemaker, or purchase shoes with a larger toe box. Taping the toe to a neighboring toe is a good idea. You may also reduce the thickness of the insole to allow more space for the effected toe. As a last resort you could have the toenail removed permanently.

Alex Kor, DPM, MS, Temple Hills, MD