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Toenail Fungus (Onychomycosis)

Updated: Jan 11

In this section Cypress Foot and Ankle specialist Dr. Christopher Correa discusses fungal infections of the nails known as Onychomycosis or Mycotic Nails. Onychomycosis is a condition where a fungus infects the nail leading to discoloration, thickening and disfiguration of the nail. This condition is estimated to affect between 10-12% of the population and is transmissible between members of the same household. Fungal nails can be a source of pain, ingrown toenails, and self-consciousness regarding the look of the nail. Let's take a closer look at what causes toenail fungus and how it can be treated.

The class of fungus which is responsible for skin and nail infections is known as Dermatophytes (Dermato – relating to skin, phytes - to live upon). The species of fungi that most often associated with these infections are T. mentagrophytes, E. floccosum, and T. rubrum. These species of fungus are ubiquitous with the most common places humans come into contact with them being locker rooms, gyms, hotels rooms, nail salons and swimming pools. Factors that increase your risk of developing nail fungus specifically are repeated low level damage to the nails such as with steel toed boots, traumatic loss of the nail, prolonged exposure of feet in soaked shoes or boots, exposure to fungus via small scrapes or injuries immediately around the nail bed. Symptoms include yellow or darkish discoloration of the nail typical starting at one of the end corners as working it ways back towards the base of the nail. In some cases, an unpleasant odor may be associated with the nail that is particularly noticeable after toenail trimming. As the infection worsens the nail with start to separate from the nail bed, thickened and disfiguration of the nail known as “nail dystrophy”. This disfiguration of the nail can lead brittle sometimes painful nails which can develop ingrown toenails. Many patients who suffer from toenail fungus also suffer from repeated bouts of peeling, itching, and burning between their toes and on the arches of their feet. This condition is known as athlete’s feet and is typically caused by the same fungi that causes toenail fungus. While athlete’s foot is typically easily treated with topical antifungal creams, fungal toenails are less easily treated. Untreated fungal nails provide a source for recurrent athlete’s feet infections making it paramount to treat both conditions when present. In addition, all shoes and surfaces where your feet may have direct skin contact also need to be treated to prevent reinfection. In general fungus prefers dark, damp and moist environments making shoes and socks the ideal place for them to survive and thrive. Avoiding fungal toenail is mostly about preventing exposure and creating an inhospitable environment for the organism.

Measures you can take to reduce your risk of athlete’s foot and nail fungus include:

  • After washing your feet, be sure to dry them completely. Especially between the toes and before dawning socks and shoes.

  • Avoid wearing the same pair of shoes two days in a row. Remove the insoles and allow them to completely dry out for 24 hours. Antifungal powders are excellent adjuncts for shoes.

  • Clean showers with disinfectant after use.

  • After showering, do not reuse the same towel without putting it through the laundry.

  • Wash all bathmats weekly during treatment.

  • Monitor other family members for similar symptoms of fungal infections.

  • Avoid using lotions or creams between your toes.

  • Avoid cotton socks and socks made of non-wicking materials such as nylon. Instead use acrylic, wool, Drymax, Coolmax, Under Armour, or other athletic socks designed to wick moisture away from the foot. These socks also reduce the amount your feet sweat by keeping them cool.

  • If your feet sweat excessively consider changing socks mid-day or more if necessary and use over the counter anti perspirants such as B-Drier or Certain-Dri. Consider talking to your podiatrist about prescription antiperspirants such as Sweat Stop.

Treatment of Toenail Fungus

Treating toenail fungus has proven to be challenging with multiple different treatments available including topicals, oral medications, and class IV laser nail therapy such as The Remy. Each treatment has its own pros and cons. Topical medications have minimal side effects but are usually required to be used twice daily for at least 3 months. The addition of nail softeners have improved effectiveness and penetration in recent years. Oral medications have the highest fungal clear rate but do little to remodel look of the nail. Class IV laser FDA cleared for temporary nail clearing and can be effective at clearing improving the look of the nail and is effective in 60-80% of cases in killing the nail fungus, but it is not currently covered by insurance. Taking all of this in one can infer that a combination therapy provides to most ideal long-term results. It is important to remember that treatment of nail fungus is not a quick process. Even if the fungus can be eradicated from the nail in a single instance, restoration of a more normal looking nail requires a new nail to grow and replace the existing nail. Therapies including urea and nail laser can speed this process up. Total nail removal is sometimes helpful in cases where the nail is very disfigured and hold a lot of fungus however simply removing the nail and following up with no antifungal treatment will result in recurrence. Early diagnosis and treatment is paramount because the longer standing the infection is the more difficult it is to restore normal appearance of the nail. Like any other infection reinfection following successful treatment of fungal nails is common and patient should continue to be vigilant and expect to have to retreat their condition in the future. Your podiatrist can evaluate the severity of your fungal infection and discussed treatment options including the pros and cons of each therapy to find what treatment course is right for you! If you think you are suffering from nail fungus, give the experts at Select Foot and Ankle Specialists a call today and take the first step towards recovery!

Foot spa, nail salon, foot fungus, onychomycosis, toenail fungus

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