Achoo! The Common Cold of the Foot
Onychomycosis, also known as a fungal infection of the toenails, is the Common Cold of the foot, as it is easily seen 10 times per day in a Podiatrists office. It may not be the patient’s chief complaint, but it does make up about 50% of toenail related complaints that a podiatrist will see in a year. So, how does one contract it, what are signs to look for and how can it be treated?
Fungal infections of the toenails typically present as a gradual thickening and discoloration of the nails. The change in color and thickness may also be associated with a crumbly texture, noticed when the patient trims their toenails. Infection often goes unnoticed at first and will not appear on all toenails, leading patients to avoid seeking treatment until the thickening has markedly increased and they may or may not have pain with shoe wear. It is important that if you do notice such changes and suspect fungal infection, see your Podiatrist as soon as possible. The earlier the infection is identified and treated, the greater your chances of treatment success.
Most patients have difficulty understanding how they contracted toenail fungus, as they are “clean their feet and shower regularly!” Unfortunately, the fungus that infects the toenails is everywhere and often contraction of onychomycosis is luck of the draw; it is in no way a reflection of poor hygiene. It can be picked up from carpets, showers, or shoes harboring the organism. If you have had injury to the nail and expose the nail to a moist environment, you are also more likely to develop a fungal infection, as the injury provides a portal for the fungus to invade. Elderly, diabetics and men seem to have a greater predilection for onychomycosis, but it is not exclusive to them and can be seen in anyone, including children. Individuals susceptible to athlete’s foot and those who have previously been infected with toenail fungus also seem to have a greater chance of suffering.
To better decrease your chances of developing fungal toenail infections avoid re-wearing socks and do your best to keep feet clean and dry, especially after times when the foot has perspired. Do not apply moisturizers to the nails mistaking the fungus as dry skin and do not apply toenail polish in attempt to hide the color change. Both of those “treatments” tend to trap moisture into the nail and lead to an increase in growth of the fungus! It might also be helpful to carry an extra clean, dry pair of socks with you and to wear “shower-shoes” when using public showers, creating a barrier between your feet and the shower floor.
Treatment of onychomycosis can be tricky! Over the counter topicals generally are not successful, thus it is best to see your Podiatrist for treatment. Various treatment options include oral medications such as Lamisil and nail lacquers such as Penlac. Depending on the severity of infection it may be recommended that you combine a nail lacquer with an oral medication to attack the fungus systemically and topically, increasing chances of successful treatment. Other treatment options have been suggested including laser therapy, UV light therapy and several topicals that are all undergoing FDA trials. The effectiveness of these treatment methods has yet to be determined, but they do suggest promising evidence for success.
Onychomycosis is extremely difficult to treat and even after successful clearing of infection, reoccurrence rates are high. Be patient while your podiatrist works with you on an effective course of treatment!