Onychomycosis
(Fungal Infections of the Toenails)
What to look for: Thickened, yellowish or discolored toenails; toenails become difficult to cut. The toenail may separate from the nail bed, and may begin to crumble. Without treatment, the condition may continue without pain, or may progress over time, resulting in nails that become so thick that they cannot be cut using conventional pedicure equipment, or in the formation of abscesses under the nail, causing pain when the patient puts on footwear or attempts activities that put pressure on the toes.
Other notes: Condition is resistant to over-the-counter remedies, homeopathic methods, home remedies, treatments intended for athlete's foot or similar medications and remedies.
What it means to you:
If you've noticed a gradual thickening, yellowing or other discoloration of your toenails, particularly on the big toe, or hallux, be aware that these are classic symptoms of the fungal infection, onychomycosis. (Often, when people think of fungal infections of the foot, their mind jump automatically to athlete's foot. Onychomycosis is an fungal infection of the toenail itself, while athlete's foot fungus affects the skin of the foot, rather than the toenail itself. Information about athlete's foot is available in our website as well.)
One of the problems inherent in onychomycosis is the patient's delay in seeking professional treatment. In its earliest stages, a fungal infection of the nail manifests itself as a color and/or texture change, and may be viewed as merely a bothersome cosmetic problem. For that reason, affected individuals may not even consider it a condition about which they should seek a professional's help, preferring instead to try over the counter remedies, or to wait and see if the situation rectifies itself. Unfortunately, because having mycotic nails means an unsightly appearance of the feet, women will often cover the discoloration with toenail polish, and both sexes will wear heavy shoes and socks, rather than shoes which allow air to circulate. Other times, patients will mistake the condition as the result of dry skin, and will apply moisturizers to the toes and toenails. All these things actually aggravate the situation by increasing the moisture under the nail and accelerating the growth of the fungus. Eventually, without treatment, the nail will thicken to the point where shoes become uncomfortable, and where the infection may develop into an abscess, causing intense pressure and pain.
A change in nail color or texture, while seemingly only annoying at first, is something that should be immediately addressed by a doctor. Waiting only allows the infection to accelerate, and can add months to treatment time. Why? Onychomycosis is a particularly stubborn infection, and is not easily or quickly dispatched - something that is only aggravated by putting off treatment. It's also quite common - onychomycosis cases make up approximately 50% of all the toenail problems seen by podiatrists each year.
What causes it?
Unfortunately, the fungus that causes mycotic nails is found in the atmosphere, and therefore, is extremely difficult to control. It can be picked up in many ways - by wearing shoes that harbor the organism, by walking barefoot in areas where fungus is prevalent (showers, and locker rooms are often the culprits, but even carpets and floor surfaces in the household can harbor the fungus), by continuing to wear shoes and/or socks that have become wet, through previous injury to the toe or toenail that opens a path for the fungus, by wearing improperly fitted shoes, or shoes that are too tight, too narrow or too shallow - or in any number of other ways. One of the problems with treating onychomycosis is that the fungus that causes it is difficult - if not impossible - to eliminate from the environment.
What cures it?
Unfortunately, very little that is available over the counter will even be able to make a dent in the case of a fungal nail infection. As was previously mentioned, these are tough to cure, and won't respond to most methods. Rather than wasting time with drugstore solutions or home remedies, your best bet is to find a podiatrist with all due speed. Remember - the more quickly you get the jump on a fungal infection, the better the likelihood that it can be treated successfully. Prescription oral anti-fungal drugs, such as Sporanox or Lamisil can be used to fight the infection. Be aware, however, that because this is one tough infection, there is a high relapse rate, and many patients may require a second course of treatment. There is also a brush-on lacquer (Penlac) that can be used with success; however, doctors caution against relying solely on a topical medication, especially in the case of a tenacious infection such as onychomycosis. In extreme cases, surgery may be necessary to remove the infected nail.
Who is most susceptible?
Men and the elderly seem to be more prone to onychomycosis; however, it has been found to affect both genders of any age - even children. Also highly susceptible are individuals who have developed the infection previously. People who have, or are prone to, athlete's foot, those whose feet perspire heavily, and those affected by diabetes are also candidates, but they are by no means the only ones who can develop it. There isn't a "type" that develops onychomycosis. Nor is it a result of bad personal hygiene habits.
How can it be prevented?
Onychomycosis is an opportunistic infection. Fungus loves a warm, dark, damp environment, so promote dryness, light and air circulation instead. Keeping toenails trimmed straight across, and keeping feet clean and dry at all times, will reduce the chance of fungus getting a toehold. Wash and dry feet after athletic activity, or after anything that causes the foot to perspire. Do not work out in a pair of shoes, then wear them for the rest of the day, or even over the next several hours. It's an invitation to infection. See a doctor promptly in the event of injuries to toes, nails or feet.
Take precautions to insure you won't have to wear wet, damp or even perspiration-soaked socks and shoes. Carry an extra pair of each with you, keeping one at work, one in your car, etc. That way, should your shoes and socks become wet at any time (rainstorms, etc), slip them off, clean and dry your feet thoroughly, and change to a dry pair of shoes and socks. Wearing breathable shoes made of natural fabrics - canvas, leather, sandals, etc., rather than man-made materials - will assist, too. Avoid walking barefoot - even at home - as this directly exposes toenails to all manner of organisms on floors, carpeting, tiles, etc. Alternate shoes, too, so that you're not always wearing the same pair of dress, sport or casual footwear.
Athletes and/or health club members can cut their risk of infection (or re-infection) by wearing foot protection (flip-flops or other quick-drying sandals that provide separation between feet and the shower/locker room/rest room floor) when using public shower facilities, and by discarding heavily used sports shoes which may have a high density of fungal spores. Remember - even expensive running or workout shoes (and even dress shoes or casual footwear) can be a culprit, if they aren't changed often enough. Your podiatrist can advise you on how often various types of shoes should be discarded and new ones purchased.
Do these symptoms always mean mycotic toenails?
No - other disorders can have similar symptoms. Therefore, it's best to see a qualified podiatric physician who can evaluate your symptoms and give you a reliable diagnosis, as well as discuss your treatment options.
Who can help me?
The American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) stands ready to help you find a podiatric physician in your area. Simply click on our foot-help-finder link to find the professional who can help you the most.
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