An Underreported Health Problem
Fungal infection of
toenails is a common foot health problem cause largely by the lack of
healthy footwear. A majority of victims
don't seek treatment, maybe don't even recognize the existence
of a problem. Studies estimate that it afflicts three to five
percent of the population; however, doctors of podiatric medicine
think that because so many cases go unreported, the incidence
is much higher than that (they treat perhaps 2.5 million people
annually, but that's less than a quarter of the cases estimated
by the studies).
Probably one reason
that so many people ignore the infection is that it can be present
for years without ever causing pain. Its prevalence rises sharply
among older adults (20 to 30 percent, the studies say, though
podiatric physicians think it's much higher). Because the older
adults may be experiencing much more serious medical problems,
it is understandable that fungal nails can be passed over as
very minor, though it is anything but that.
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 many cases,
however, that change in color is the start of an aggravating
disease that ultimately could take months to control. Fungal
infection of the nails is known to podiatrists and other physicians
as onychomycosis. It is an infection underneath the surface of
the nail, which can also penetrate the nail. If it 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
What is a Fungal Nail?
Onychomycosis is an
infection of the bed and plate underlying the surface of the
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 plate,
and the infection is capable of spreading to other toenails,
the skin, or even the 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 -- swimming pools, locker
rooms, and showers, for example. Injury to the nail bed 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
they find 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, or even put to a halt.
Clean, dry feet
resist disease; a strict regimen of washing the 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
-- talcum, not cornstarch -- in conjunction with shoes that fit
well and are made of materials that breathe.
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
Artificial Nails and Polish
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 ñ
those on toes that are red, discolored, or swollen, for example.
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 liquid antifungal agent.
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
A podiatric physician
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
Newer oral antifungals
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 DPMs 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.
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.