Dermatology

WHAT IS FUNGAL NAIL INFECTION?

Definition

It’s not just a cosmetic problem. It’s an infection of the bed and plate underlying the surface of a nail. Fungal nail infection, a condition called onychomycosis (ON-i-ko-my-KOsis), is caused primarily by organisms called dermatophytes. It’s an extraordinarily common, afflicting more than 35 million people in the United States alone. However, some 90% of them have yet to see a doctor for treatment.

Once these tiny organisms find their way under a nail, they begin to multiply. Ironically, when the fungus finds its way under the nail, the nail itself provides a protective environment for the fungus to thrive. %e toenails are most vulnerable to infection, since they spend much of their day surrounded by dark, warm and often moist shoes and socks.

Symptoms

When fungal nail infection begins to take hold, it can cause the nail to change colour, often to a yellow/green or darker colour. Debris may collect under the nail, causing a foul smell.

The nail may thicken and become flaky. Thick toenails, in particular, may cause discomfort in shoes and may even make standing and walking uncomfortable for some people. Moreover, because fungal nail infection is an infection, it can spread to other nails, and possibly to other people. Something as ordinary as emery board can carry the fungal organisms from an infected nail to an uninfected one. Your doctor may wish to take clippings of your nail before he/she starts treating you, to make sure that the problem is caused by a fungus.

How Do You Get It?

Fungal nail infection has little to do with personal cleanliness. Something as simple as banging a toe or finger, trimming your nails too closely, or wearing tight shoes is enough to weaken the nail and expose the underlying nail bed to infection.

The fungus that causes the infection resides in many common places: locker rooms, swimming pools, showers, even your garden. You can also contract the infection while getting a manicure or pedicure, from unsterilized instruments that have been used on others with the infection.

Some people have chronic disorders that make them more susceptible to fungal nail infection. People with diabetes, circulatory problems and immunological deficiencies (such as AIDS/ HIV infection) are at increased risk, as are the elderly. Moreover, fungal nail infection appears to be more prevalent in those with a history of athlete’s foot (a fungal infection of the skin) and people whose feet perspire a lot.

How Do You Treat It?

Fungal nail infection won’t go away by itself. The most effective treatments are only available from your doctor.

What Can You Do?

There are also steps you can take during and after your treatment to take better care of your nails:

  • Keep your feet as clean and dry as possible; you may want to use a talcum foot powder.
  • Use shower shoes when walking in public swimming and shower areas.
  • Clip your toenails straight across so that the nail does not extend beyond the tip of the toe.
  • Wear comfortable shoes that fit properly.

WHAT ARE WARTS?

Definition

Warts are one of several soft tissue conditions of the foot that can be quite painful. they are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but, technically, only those on the sole are properly called plantar warts. Children, especially teenagers, are often more susceptible to warts than adults; some people seem to be immune.

Identification Problems

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses – which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

It is also possible for a variety of more serious lesions to appear on the foot, including melanomas. Although rare, these conditions can sometime be misidentified as a wart.

It is wise to consult a podiatrist when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.

Plantar warts tend to be hard and  flat with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a centre that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to re-occur.

Sources of Virus

The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch (2.5 cm) or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching or even by contact with skin shed from another wart. The wart may also bleed – another route for spreading.

Occasionally, warts can spontaneously disappear after a short time and, just as frequently, they can re-occur in the same location.

When plantar warts develop on the weight bearing areas of the foot – the ball of the foot or the heel, for example – they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

What Can You Do?
  • Avoid walking barefoot, except on sandy beaches.
  • Change shoes and socks daily.
  • Keep feet clean and dry.
  • Check children’s feet periodically.
  • Avoid direct contact with warts – from other people or from other parts of the body.
  • Do not ignore growths on, or changes in, your skin.
  • Visit your podiatric physician as part of your annual health checkup.
Self treatment is generally not advisable.

Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. NEVER use them in the presence of an active infection.

What Might A Podiatrist Do?

It is possible that your podiatrist will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.

Lasers have become a common and effective treatment. A procedure known as C02 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

WHAT IS AN INGROWN TOENAIL?

Definition

An ingrown toenail is a painful condition characterized by the nail digging into the surrounding skin, leading to inflammation and possible infection of the toe. This is a serious condition for people with impaired circulation, diabetes or other systemic diseases.

Causes
  • Heredity
  • Improper nail trimming
  • Trauma
  • Shoe pressure
What Can You Do?

Trim nails straight across as a preventive measure.

What Might A Podiatrist Do?
  • Perform a physical examination.
  • Perform x-ray evaluation when necessary.
  • Remove the ingrown portion of the nail
  • Use nail braces.
  • Culture the nail.
  • Prescribe appropriate medications, such as antibiotics.
  • Perform surgical correction of the nail when indicated.

 WHAT IS ATHLETE’S FOOT?

Definition

Athlete’s foot is a common infection of the skin characterized by itching, scaling, redness and the formation of small blisters. In general, the lesions start between the toes and can extend to the borders and bottom of the foot. The fungus has the potential to spread to the toenails, causing them to become thickened, discolored and painful. In this case, the infection is called onychomycosis (see page 23 of this section for more details). While this infection is common among athletes, keep in mind that it can affect athletes and nonathletes alike.

Causes

The feet are vulnerable because shoes commonly create a warm, dark and humid environment that encourages fungal growth.

Athlete’s foot can also be contracted in dressing rooms, hotel and locker room showers and swimming pool locker rooms where bare feet may come in contact with the fungus.

What Can You Do?
  • Keep shoes and socks dry as a preventive measure.
  • Practice good foot hygiene, including daily washing of the feet with soap and water and drying feet carefully, especially between the toes.
  • Change shoes regularly and wear acrylic or cotton socks.
What Might The Podiatrist Do?
  • Prescribe topical anti-fungal medications.
  • Prescribe oral anti-fungal medications (only available by prescription).
  • Surgically remove the nail and its root.