Dr. Vincent Giacalone
Podiatric Medicine & Surgery
466 Hook Rd., Suite 24D, Emerson, NJ 07630
Fungus Toe Nails
Fungal infection of toenails is a common foot health problem. A majority of patients don’t seek treatment, and may not even recognize they have the problem. Studies estimate that it afflicts three to five percent of the population; however, doctors of podiatric medicine think that percentage is low because so many cases go un-reported, the incidence is much higher. Podiatrists treat approximately 2.5 million people annually, but that’s less than a quarter of the cases estimated by medical studies. Probably one reason so many people ignore the infection is that it can be present for years without ever causing pain. The prevalence of fungal toenails rises sharply among older adults, 20 to 30 percent. Because older adults may be experiencing more serious medical problems, it is understandable that fungal nails can be passed over as very minor, though it is anything but.
Whatever the case, the disease, characterized by a change in a toenail’s color, is often considered nothing more than a mere blemish; ugly and embarrassing. It is apparently assumed that since white markings or a darkening of the nail are minor occurrences, the change represents something minor as well, even when the blemish spreads. It may be that cosmetologists see this condition as often as doctors. Nail polish is an easy solution for many women, rendering the problem “out of sight, out of mind.”
In most cases, however, the change in color is the start of an aggravating disease that ultimately could take months to control. Fungal infection of the nails are known to podiatrists and other physicians as onychomycosis. It is an infection underneath the surface of the nail, which can also penetrate through the nail. If this is ignored, its spread could impair one’s ability to work or even walk. That happens because it is frequently accompanied by thickening of the nails, which then cannot easily be trimmed and may cause pain while wearing shoes. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.
What is a Fungal toenail?
Onychomycosis is an infection of the toe nail, and is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms, such as molds and mildew, that lack chlorophyll and therefore do not require sunlight for growth. A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail’s protein substance. When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail and the infection is capable of spreading to other toenails, the skin, or even fingernails. Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail may make it more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of athlete’s foot and excessive perspiration.
Because fungi are everywhere, including the skin, they can be present months before finding opportunities to strike, and before signs of infection appear. By following precautions, including proper hygiene and regular inspection of the feet and toes, chances of the problem occurring can be sharply reduced.
Clean, dry feet resist disease; a strict regimen of washing your feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection. Shower shoes should be worn when possible in public areas. Shoes, socks, or hosiery should be changed daily. Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe. Use a quality foot powder, such as cornstarch, in conjunction with shoes that fit well and are made of materials that breathe. Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks, especially for those with more active life styles.
Artificial Nails and Polish
Moisture collecting underneath the surface of the toenail would ordinarily evaporate, passing through the porous structure of the nail. The presence of an artificial nail or a polish impedes that, and the water trapped below can become stagnant and unhealthy, ideal for fungi and similar organisms to thrive. Always use preventive measures when applying polishes. Disinfect home pedicure tools and don’t apply polish to nails suspected of infection or on toes that are red, discolored, or swollen.
Depending on the nature of the infection and the severity of each case, treatment may vary. A daily routine of cleansing, over a period of many months, may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter antifungal agent. However, even the best-over-the-counter treatments may not prevent a fungal infection from coming back. A fungus may work its way through the entire nail, penetrating both the nail plate and the nail bed. If an infection is not overcome, or continues to reappear, further medical attention is strongly recommended.
Podiatric Medical Care
Dr. Giacalone can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Indeed, debridement is one of the most common foot care procedures performed by podiatrists. Newer oral and topical antifungal medication approved by the Food and Drug Administration may be the most effective treatment. They offer a shorter treatment outlook (three to four months) and improved effectiveness, though podiatrists advise that lengthier treatments, up to 12 months, may still be required for some infections. Current studies show that, for a small percentage of the population, there are some unwanted side effects with any oral antifungal. Topical antifungal medications provide a reasonable alternative to oral medications. New laser treatment is also a reasonable option for the treatment of fungal toenails. In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail. Trying to solve the infection without the qualified help of a podiatric physician can lead to more problems. With new technological advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.
Foot Health Tips
- Washing your feet regularly with soap and water.
- Remember to dry your feet thoroughly after washing.
- Properly fitted shoes are essential. A shoe with a firm sole and soft upper is best for daily activities.
- Shower shoes should be worn when possible, in public areas.
- Shoes, socks, or hosiery should be changed daily.
- Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
- Use a quality foot powder, such as cornstarch
- Shoes should fit well and are made of materials that breathe.
- Avoid wearing excessively tight hosiery, which promotes moisture.
- Wear socks made of synthetic fiber, which tend to “wick” away moisture faster than cotton or wool socks.
Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone recently practiced at the Hospital for Joint Diseases in New York City. Dr. Giacalone performs surgery at Hackensack University Medical Center (HUMC) in Hackensack, HUMC @ Pascack Valley and Surgicare Surgical Center in Oradell.