Fungal Infection of Toenails
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 nail plate.
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
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.
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
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 those on toes that are red, discolored, or swollen, for
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
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
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 by DPMs.
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
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.