Fungal Toenails

 

Understanding Fungal Toenails And How To Treat Them Effectively. 

Fungal toenail or onychomycosis is an infection affecting the nail plate and surrounding tissue, most commonly caused by fungi (dermatophytes), yeasts or moulds. This type of infection can affect both the fingernails and toenails, though it is more commonly seen in toes due to dark, humid environment (eg. enclosed footwear). Such infection is often ignored as the infection can be present for years without causing any pain.


How do I know if I have fungal toenails? What are the signs and symptoms?
Fungal toenail is characterized by a progressive change in a toenail quality and colour, which is often ugly and embarrassing. The condition is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in colour and foul smelling. The debris may collect beneath the nail plate, white marks may frequently appear in the nail plate and the infection is capable of spreading to the other toenails, the skin or even the fingernails. Separation of the nail from the nail bed is often noted.

The clinical appearance of a discoloured (yellow, brown or white) nail would usually indicate a fungal infection. Other conditions that can cause thickened toenails that may look similar to that of fungal nails are psoriasis, eczema, and lichen planus. Not every thickened, discoloured toenail is a fungal infection, so it is crucial to have the nail assessed and examined. A microscopy and/or culture of nail specimens can be carried out as required.


Why do I get fungal nails?
There are several factors that may put you at higher risk of developing fungal toenails.

  • Poor hygiene - not drying off the feet thoroughly especially after shower or exercise - Toenails are vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, lockers rooms, and showers.

  • Having sweaty or constantly moist feet - Fungi thrive in a warm and moist environment. This is made worse with warm, wet work environment and wearing shoes with poor ventilation or of synthetic materials.

  • Trauma to the nail. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. These include acute or repetitive micro-trauma such as rubbing against footwear. Fungal toenails are found to be particularly common amongst those who are actively involved in sports and suffered from nail injuries.  

  • Chronic diseases such as diabetes, circulatory problems, or immune-deficiency conditions

Fungal toenails are rare in children but the incidence increases as we age. These seemed to correlate with age-related increase in disease and difficulty (or inability) to maintain proper nail hygiene.

Should I do anything about fungal nails, what will happen if I just ignore the problem?
Fungal nail is often ignored as the infection can be present for years without causing any pain. However, the effects of fungal nails are not simply cosmetic. Fungal infections can cause the nails to thicken, discolour, deform, crumble and split. If ignored, the infection can spread and possibly impair one’s ability to work or even walk. This happens because the resulting thicker nails are difficult to trim and make walking painful when wearing shoes. The infected nails may press on the inside of the footwear, causing great discomfort and pain. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate. Shame may preclude people from acting in social and occupational circumstances where they feel unwilling to show their feet. Therefore, even if considered a cosmetic problem, this is an infection that is often worth treating.


What can I do to treat fungal nails?
As always, prevention is better than cure. Below are the few things you can do yourself to prevent fungal toenails in the first place.

  • Proper hygiene and regular inspection of the feet and toes are the first lines of defence against fungal nails.

  • Clean and dry feet after shower or exercise.

  • Washing the feet with soap and water daily and to dry thoroughly after.

  • Shower shoes should be worn when possible in public areas.

  • Shoes, socks, hosiery should be changed more than once daily.

  • Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.

  • Wear shoes that fit well and are made of materials that breathe.

  • Avoid wearing excessively tight hosiery, which promote moisture.

  • Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks.

  • Disinfect instruments used to cut nails, including home pedicure tools.

  • Don’t apply polish to nails suspected of infection - those that are red, discolored or swollen.


Is there any home remedies for fungal toenails?
Everyone seems to have a story about how their aunt or grandma once soaked her nails in vinegar, baking soda or tea tree oil and cured the condition. All of the home remedies seem to have one thing in common: lots of attention to local nail hygiene. Those home remedies may or may not help. There are many alternative home treatment strategies that are used by patients with only anecdotal evidence of any success.

How can a podiatrist helps with my fungal nails?
Treatments may vary, depending on the nature and severity of the infection. If you suspect you have developed a fungal toenail infection, it is recommended that you see a podiatrist who can professionally diagnose and manage the condition. The treatment options for fungal nail infection include topical antifungals, oral antifungals, laser therapy and surgical procedures.

Topical antifungals
Treatment for fungal toenails can be a slow process as the nails generally take as long as 12 months to grow from the base to the tip. Most treatments generally work by preventing the spread of fungus while encouraging and waiting for the nail to grow out. If the fungal infection is superficial or only affecting the distal portion of the nail, topical antifungals are generally indicated. It is crucial to note that topical antifungals alone in general are not effective for the treatment of fungal toenail as the nail itself provides a protective covering that allows the fungi to grow underneath on the nail bed unimpeded. Most topical antifungal solutions and creams that are applied to the nail do not work well simply because of the lack of penetration into the hard nail unit. The treatment is generally required until the infected area has completely grown out. Some simple nail preparation is essential and the podiatrist can assist to drill the nail down to aid penetration of topical antifungals. Your podiatrist can also be helpful in assisting you in selecting the type of topical antifungals that is appropriate for your nail condition. During the treatment period, nail polish or artificial nails are generally avoided.

Oral antifungals
If larger or majority portions of the nails are infected, oral antibiotics are generally indicated.

Laser therapy
This is one of the recent major advancement in the treatment of fungal nails. A laser light is used to penetrate the skin and nail plate to destroy the fungi.

Surgery
Nail surgery is generally not performed as a routine procedure for the treatment of fungal nail infection. It is generally reserved for chronic cases or those that did not respond well to the conservative treatments.

 

Trying to solve the infection without the help from podiatrist can be frustrating. If you suspect you may suffer from fungal toenail or uncertain if you need any treatments for your nails, it is best to visit your podiatrist today.

 

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