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Got Funky Toes? Maybe You've Got a Toenail Fungus!

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.


Medical Treatment
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.