Posts for: March, 2011
Springtime is finally here, with its longer and warmer days. As people increasingly get out and expose their feet, fungal toenail infections might be more visible. Ubiquitous by nature, fungi cause an infection when they penetrate and spread in one or more of your toenails. Also known as onychomycosis, a fungal infection of your toenails may initially appear as a white or yellow spot under the tip of your nails and then spread deeper. Although the nail discoloration, thickening and crumbling edges that often result are not life-threatening, they are unsightly and may cause pain.
An ounce of prevention of toenail fungal infection is better than a pound of cure, for it often requires a lengthy and difficult treatment in order to clear. What’s more, infections commonly recur. The good news is that a bit of knowledge can go a long way in helping you avoid, control or cure a toenail fungal infection.
What Causes Fungal Nails?
Dermatophytes are a group of fungi responsible for more than 90% of cases of fungal toenail infections. You may know fungi as teeny, tiny organisms that don’t need sunlight to survive. Some are beneficial to humans, but many fungi can cause infection. Fungi love dark, moist and warm environments. It is therefore no wonder that shoes make excellent reservoirs for them….especially shoes that come in contact with sweaty feet every day. By crowding your toes, tight shoes can also promote fungal infection. In gyms, communal showers and locker rooms, the fungal organisms lurking around can spread rapidly from one individual to another, as people walk around with exposed feet, touch equipment, and so on. Truth is, fungi are everywhere and can live on the surface of your nail plate without causing a problem, as long as the protective barrier of cuticles remains intact. Repeated micro-trauma –such as during physical exercise—can break that protective barrier, giving fungi an opportunity to invade your nail plate and spread. Diseases that affect your immune system can also make you susceptible to fungal toenail infection. These include diabetes, peripheral ischemia and AIDS. Less common but possible causes of fungal toenails include yeasts and some bacteria.
Do You Have an Infection?
If you have a fungal infection, one or more of your nails may thicken, become distorted, brittle, crumbly or ragged. They may also lose their luster or shine. The most characteristic feature, however, is the change in color. Indeed, fungal infections often cause a build-up of debris under your toenails, which darkens their color. Sometimes, infected toenails separate from the nail bed, producing pain. You may also notice a foul foot odor. If you see any of these signs or symptoms, visit your physician to confirm if you have a fungal infection or not.
What to Do?
Over-the-counter antifungal creams are the first line of defense for many people, but they are not very effective for nails. However, if you have Athlete's foot in addition to your fungal toenail infection, topical medications should help treat the Athlete’s foot on your skin. Refrain from using topical steroids for fungal toenail infections, as they tend to make the problem worse.
Oral antifungal medications can help fungal toenails grow back free of infection, but you need patience in order to clear them up. The typical oral treatment lasts 6 to 12 weeks, and it may take 4 months to a year to get rid of a toenail fungal infection. The ultimate test of a drug’s effectiveness occurs when the affected nail grows back completely. The goal is a clear nail, and Terbinafine (Lamisil) and itraconazole (Sporanox) are viewed as some of the most effective oral treatments available, even though your podiatrist would likely take a sample of your infected toenail to help him or her choose the most effective treatment. Like most drugs, oral antifungal medications have side effects or interact with other medications. They may not be recommendable for you because of other medications you might be taking, allergies, a liver condition or congestive heart failure.
Antifungal lacquer can be a viable alternative to oral treatments if you have a mild to moderate case of fungal toenail infection. A classic antifungal lacquer is Penlac, or ciclopirox. The typical regimen involves applying it to your infected nails and surrounding skin once a day for about a year. Every seventh day, you remove the piled-on layers with alcohol and begin fresh applications. Antifungal nail polish does not usually clear your nails as well as oral treatments, but
In some cases, your podiatrist may recommend topical antifungal medications coupled with urea-containing creams to improve absorption. If your infected toenails are thick, he or she may file their surface to lessen the amount of nail to treat. Topical medications, however, do not usually cure fungal toenail infection unless they are coupled with oral medications.
A fungal toenail infection can be severe or painful enough to warrant the surgical removal of the affected nail. It may take up to a year for a new nail to grow in the place of the old one, since the average toenail grows at a rate of 1 millimeter per month. Your podiatrist may also opt to treat your nail bed with ciclopirox in addition to the nail removal.
Although it has long been used for other foot conditions, laser, or photodynamic therapy, is an emerging treatment for fungal toenail infection. It involves using intense light to irradiate the infected toenail after it's been treated with an acid. However, its cost is fairly high and availability low.
How To Avoid Getting Fungal Nail Infections
Good hygiene practices can not only help you prevent nail fungus, but also reduce recurrent infections. Here are some guidelines:
- Rotate or change your shoes. Avoid wearing the same shoes every day. If at all possible, rotate your shoes. You may also alternate closed-toe shoes with open-toed shoes during the day, to allow your feet to “breathe.” If you just completed a successful treatment for toenail fungus, get new shoes to reduce your risk of relapse.
- Protect your feet. Avoid walking barefoot in public places. Wear shoes in communal shower facilities, public pools and locker rooms, especially if you’ve had fungal infection or athlete's foot in the past.
- Keep your feet dry and clean. Keeping your whole feet clean and dry –including between your toes—can go a long way in preventing nail fungus infection. An antifungal spray or powder applied to your shoes and socks would also help.
- Wear the right socks. Synthetic socks that wick away moisture are more likely to keep your feet dryer than cotton or wool socks. Change your socks daily or more frequently if you feet sweat excessively. Taking your shoes off from time to time during the day and after exercising can also help reduce the amount of moisture in your shoes.
- Don't break your protective skin barrier. Picking or cutting into the skin and cuticles around your toenail enables germs to penetrate both your skin and nails, leading to infection.
- Keep your toenails short. Maintain short toenails, making sure to cut them straight across and not in a curved path.
- Choose a reputable manicure and pedicure salon. Fungal toenail infections can spread from one customer to another via manicure and pedicure instruments as well as through polishes. Make sure that your salon of choice sterilizes its instruments in-between customer. If in doubt, bring your own.
- Avoid or limit the use of nail polish and artificial nails. Even though nail polish can help even infected toenails look pretty, the danger is that it worsens the infection by trapping moisture on your nails.
- Avoid cross-infection. Because fungus can spread from nail to nail –including finger nails to toenails, and vice versa—wash your hands after touching infected nails. This applies to infected household members. Using separate towels can also help avoid cross-infection within your household. If your hands must be in prolonged contact with water, wear rubber gloves to protect them, if you can.
Contact Your Physician!
The best time to consult your podiatrist regarding a fungal toenail infection is at its early stages. Watch out for early signs of nail fungus, such as tiny white or yellow spots under the tip of your toenails. Nail fungal infections take longer to clear once they spread. Left untreated, they can remain indefinitely.
“Life begins at 40,” as some would say. Yet, after this “magical age” comes a series of changes to your feet. These changes can be particularly unwelcome if you are a woman. Admittedly, people age more or less gracefully and at different speeds. Yet all will age, ultimately. What’s more, a number of factors can increase one’s chances of developing foot problems with ageing. These include: diabetes, arthritis, osteoporosis, peripheral neuropathy, flat feet, biomechanical abnormalities, obesity, shoe styles worn over the years and a history of foot injuries. Below are some of the changes your feet might go through as the wheel of time keeps turning.
Your skin is one of the first structures to reflect the aging process in your foot. That’s because, as you age, your skin cells divide more and more slowly and your body produces less sweat, oil and other fatty substances. A thinning of your skin results from this, leaving the top of your foot dry and looking like a parchment. Naturally, the severity of the dryness varies from person to person, but it’s not unusual for aging skin to become so dry that it cracks. Cracked skin in your foot is more vulnerable to both bacterial and fungal infections and may cause pain with walking. Additional skin problems that may arise with aging include flakiness, itchiness, and excessive skin thickness and hardness. The thick and hard skin typically develops around the edges of your heels and can be your body’s reaction to repetitive pressure, changes in the stress placed on your foot, or a thinning of the soft tissue that normally cushions your foot. With time, you may also notice a loss of hair below your knees and on the top of your feet and toes. Areas of yellowish-brown discolorations may appear on your skin as a result of an accumulation of hemosiderin, a breakdown product of red blood cells. To maintain or recover a supple, natural-looking skin, gently exfoliate dry dead skin and moisturize. A good moisturizer should hold the water in your skin, to help compensate for your body’s decreasing ability to do so. It should also protect your skin from further drying. The best time to apply a moisturizer is right after a shower or bath, while your skin is still damp. Adding some oil to your bathwater would have the dual benefit of soothing your dry, irritated skin and further helping it retain moisture. As you shop for socks, keep in mind that nylon and rayon socks tend to contribute to skin dryness.
Fat Pad Changes
Every step you take places the equivalent of your body weight on a single foot with walking, and up to five times your body weight on that same foot with running. The fat pads located at the bottom of your feet normally act as shock absorbers for the bones, joints and other soft tissue structures they cover. As you can imagine, however, these fat pads are subject to wear and tear, given the continual pressure exercised upon them. With age, they atrophy, or lose their thickness, leaving your bones, joints and other structures without proper cushioning. This leads to inflammation in the afore-mentioned structures, which explains the common complaint of pain in the ball of the foot. This lack of cushioning and shock absorption can also result in callus formation and pain in your metatarsals, the long bones that connect your toes to the rest of your foot. Given that walking barefoot increases the stress on your fat pad, try to wear shoes whenever you’re weight bearing. To help slow the loss of your fat pads or improve related pain, wear well-fitting, supportive shoes. In some cases, your doctor may recommend that you wear custom-made orthotics, for maximum effectiveness and comfort. Keeping the skin on the ball of your feet soft and supple would also help minimize any discomfort associated with fat pad loss. Again, try to develop the habit of gently exfoliating and moisturizing your skin.Arch Height Changes
Along with the fat pad, the normal arch acts as a shock absorber for your body when you are walking, running, or jumping. In the absence of any shock absorber, the continual stress from your body weight would such that the bones of your feet would ultimately fracture or dislocate. With age, the different structures that maintain your foot’s arch at its optimum height grow weaker and thinner. As a result, the arch progressively falls, causing the foot to flatten, or collapse. Because a collapsed foot does not work as a shock absorber, it is commonly associated with pain in the foot, knee, hip, and lower back. Not surprisingly, prevention and self-treatment for a fallen arch are similar to those for fat pad loss. Instead of walking barefoot, always support the arches of your feet with well-fitting shoes that provide stability. You may even prefer custom made orthotics, or your doctor may prescribe them, since they’re built to support the specific bones and joints which constitute your foot’s arch.
Your toenails undergo a series of changes as you age, often as a result of the age-related reduced blood circulation to the toes. Toenails may, for instance, thicken and/or develop ridges related to repeated minor trauma, disease or nutritional deficiencies. It’s not unusual for the shape of your toenails to change as you age. However, toenail deformities generally become more pronounced and complicated when dry, thick and hard skin develops in the nail folds and/or a fungal infection of the nail sets in. Toenail fungal infections and dry, hard skin are common, chronic complaints, especially among those aged 65 years or older.Fungi love dark, moist and warm environments. To help prevent nail fungus and other toenail problems, keep your feet clean, dry and moisturized. Ensure, however, that the spaces in-between your toes are dry but not moisturized. Rotating your shoes and changing your socks daily should also be beneficial. Another important aspect of prevention is to clip your toenails straight across, avoiding creating round edges. As you do so, keep your toenail cuticles intact, because they act as a barrier against germs.
Muscle & Soft Tissue Changes
With time, your lower extremity progressively loses muscle mass and soft tissue density. This leads to a decrease or lack of physical activity, which in turn increases the likelihood of foot injury. Indeed, as you age, even minor trauma can lead to a fracture and a significant limitation of activity. As an illustration, the loss of muscle mass of foot bones known as interossei is a triggering factor for the development of hammertoes, the falling down of metatarsal bones, as well as the thinning and displacement of the plantar fat pad. Peripheral vascular disease and arterial insufficiency can also cause toenail changes and lead to rest pain, calf pain with activity, coldness and skin color variations. There may, on occasion, be a loss of sensation and other changes related to neuropathy. As the muscles, ligaments and tendons in your foot lose strength and power, they are no longer able to maintain your bones and joints in their proper alignment. As a result, your feet increase in length and width. You may also develop crooked toes and fit. For the proper fit, have your feet measured whenever you shop for shoes and always make your purchase at the end of the day, when your feet tend to be most swollen. The right shoe for you should fit from the moment you try it on and should have a toe box wide enough to allow your toes to comfortably wiggle. To avoid aggravating such problems as hammertoes, corns, bunions or arthritis of the toes, opt for shoes with a deep and wide toe box, and which accommodate the shape of your foot.
While many of these changes are not always welcome, they are normal. But if the changes you experience are causing you any pain or discomfort, by all means, visit your physician to have a complete foot exam.
Ingrown toenails are a universal problem--anyone can suffer from them! The term "ingrown toenail" refers to the way the edge of your toenail curves down and pokes into your skin. Any toe can be affected, although big toes are the most susceptible to develop ingrown nails. Left untreated, ingrown toenails can lead to potentially serious complications, such as skin and bone infections.
Poorly fitting shoes are often held responsible for ingrown toenails, particularly if the toe box is too tight. In teenagers, ingrown toenails sometimes occur because their feet sweat more. This abundant sweat causes their skin and nails to become soft and easier to split. The split pieces of nail can in turn easily puncturethe skin on the nail edges. In older individuals, ingrown toenails often result from their inability to properly take care of their feet. Improper nail trimming can also lead to ingrown toenails, particularly in people who habitually "round off" the cornersof their toenails. Traumatic toe injuries and infection can also cause ingrown toenails. In some cases, ingrown toenails run in families.
Signs & Symptoms
Ingrown toenails often cause pain and can therefore limit your activities, particularly physical exercise. You may also notice hardness, swelling and redness in the skin around the affected ingrown toenail. Typically, the pain and redness are proportional to an ingrown toenail's severity. If the area becomes infected or turns black, consult a doctor as soon as possible. Possible signs of an infected ingrown toenail include fever, fluid or pus formation in the affected area.The change of color to black could indicate necrosis, which is the death of cells or tissues in the affected area.
A doctor typically assesses and diagnoses ingrown toenails by examining your nails and toes. If there are signs of infection, he or she may takea sample of pus or fluid and request a laboratory study to determine the specific organisms that are causing the infection. Knowing this would help select the most effective antibiotic. The amount of swelling, redness, drainage and pain generally determines the severity of your case. However, even if you're not in severe pain, an infected ingrown toenail will usually be considered as severe.
Mild to moderate ingrown toenails respond well to conservative care. You may treat them with10 to 20 minute-long foot soaks in warm, soapy water. After each soak, applya topical antibiotic ointment, such aspolymyxin/neomycin (Neosporin). An alternative to the antibiotic ointment would be a mid- to high-potency steroid cream or ointment applied to the affected area several times daily for a few days until the symptoms resolve. Another conservative approach consists in gently lifting the nail edge and placing wisps of cotton under it. In the office, your doctor may also opt for a gutter splint affixed to the ingrownnail edge with either adhesive tape or a formableacrylic resin.In some cases, a sculptured acrylic artificial nail can also be used. Treatment duration generally ranges from two weeks to three months, which is the time required for normal nail to grow.
Severely infected or recurrent ingrown toenails may require nail removal. Your doctor will usually remove part of nail, but in some cases, total nail removal may be recommended. He or she will typically numb the affected toe and use surgical instruments to cut away the ingrown part of the toenail. If you have an infected toe with an ingrown toenail, you will also need prescription-strength antibiotics. Promptly seeking care is especially important for diabetics who have ingrown toenails, because they can lead to serious complications, such as foot ulcers.
Management &Prevention Guidelines
- Always wear clean socks.
- If you're currently undergoing conservative treatment or recently surgical treatment, wear open-toed shoes while your toeheals.
- Maintain clean feet and make sure to clean the areas around your nails after a bath or shower.
- Only wear well-fitting shoes. For a more accurate fit, have your feet measured and shop for shoes in the evening, when your feet are more swollen.
- Cut your toenails properly, straight across withno rounded corners
- Do not leave sharp edges when cut your nails, as they could grow into the toe around thenail.
- Do not tear your toenails off.
- Call your doctor if you develop a fever or notice a red streak going from your foot up your leg.