If you have a fungal infection in the nail, is it your fault? No, not at all. Onychomycosis has nothing to do with hygiene. But unknowingly, we can contribute to the growth of onychomycosis. The environment inside the shoe is dark, damp and warm. This environment is wonderfully conducive to the growth of onychomycosis.

It is safe to say that 50% of folks over the age of 50 have some degree of onychomycosis. But this doesn't necessarily mean that onychomycosis is due to 'old age'. But we can imply that over the course of our lifetimes we would have more opportunities to acquire a fungal infection of the nail. The reason that onychomycosis becomes more prevalent with age is due to accumulated trauma to the nail over time. Trauma makes the nail much more susceptible to onychomycosis. It's also reasonable to assume that folks in professions or social activities where they may abuse their feet would tend to have a higher rate of onychomycosis. An example of activities that may abuse the feet and nails would included a mechanic dropping tools on their feet, horses or cattle stepping on the toes or runners who constantly injure their nails. An injury to the nail is a common precursor to onychomycosis. Trauma may be something abrupt or something as benign as a pair of ill-fitting shoes constantly rubbing on the nail.

The appearance of onychomycosis can vary but most cases begin at the distal tip of the nail and slowly progress into the nail over a period of months to years. The nail will thicken as the fungus continues to grow. The filaments of fungus take up space in the nail causing it to swell. The nail can be yellow, white or even green to black. The nail also begins to be chalky and flakey.

Treatment of toe nail fungus and onychomycosis

The single most important thing that you can do to protect the nail from onychomycosis is to protect the nail from injuries. A healthy nail acts as a protective barrier to fungal infections. Once the nail is injured, the door of susceptibility swings open, allowing entry of the fungus. Also, keep the feet dry. Keeping the feet dry will inhibit the ability of the fungus to thrive. Frequent changes of socks, the use of powder, such as baby powder and rotating shoes so that they are worn only every other day, can help tremendously.

Medications used to treat onychomycosis fall into two categories; topical and oral. There are any number of effective topical medications available over the counter. Topical medications are most helpful in treating early, small infections and for maintaining clear nails. Topical medications do have a limited ability to penetrate the nail to reach all of the fungal elements. Topical medication inhibit the growth of onychomycosis allowing for faster growth of the nail. Remember, fungus doesn't take a day off. Compliance is a big issue when using topical antifungals. A number of effective over the counter (OTC) antifungal medications are available including ClearZal Bac, Elon Dual Defense Antifungal and Tineacide.

Onychomycosis can reoccur if your shoes are not properly treated, therefore an antifungal shoe spray. Keeping the feet clean and dry is another important part of treating fungal infections of the skin and nail. The daily use of a drying solution will significantly decrease the ability of a fungal infection to thrive.

The newer generation of oral antifungals, including Sporanox and Lamisil have been received very well by the medical community. Patients with a history of liver disease should avoid the use of these medications due to their hepatotoxicity. The older generations of oral Rx antifungal medications, Fulvicin or Griseofulvin, have been used successfully for years and are making a comeback due to their economic value.

It's important to recognize that the use of a topical or oral antifungal may temporarily treat onychomycosis, but the literature does show that most cases of onychomycosis will recur without the use of a topical antifungal. Topical antifungals are commonly used on a prophylactic basis to inhibit the recurrence of onychomycosis.

Patients who use a topical or oral antifungal medication should realize that the medications may treat onychomycosis, but these medications cannot restore the normal shape of the nail. In long standing cases of onychomycosis, nails change in shape becoming thick. Nails also separate from the underlying nail bed. Oral and topical antifungals cannot restore the shape of the nail or re-attach the nail to the nail bed.

When all else fails, the fungal toe nail can be permanently removed. This procedure is not difficult to perform and most patients return to their normal shoes in just a Band-Aid in 24hrs. The removal of the nail is permanent.  The site once occupied by the nail heals with skin that can been painted with nail polish as seen at left.

Which choice is right for you? Consider the following two examples;

Case 1. Sandy is a 24 year old hairdresser who has intimate, hands-on contact with her clients on a daily basis. She has developed a fungal infection in several of her finger nails. She is concerned that the fungal infection will have a direct impact on her livelihood and does not want to spread the infection to others.

Case 2. Joe is a 62 year old farmer and has a long history of injuries to his hands and feet. His last visit to the doctor showed signs of an increase in his liver enzyme studies indicating an overall decrease in his liver function. Joe has developed onychomycosis in most of his toe nails.

I think the choices for Joe and Sandy are clear but in most cases the criteria to make recommendations for treatment of onychomycosis are not as obvious. In those cases, patients should consult their physician to discuss the pros and cons of treating onychomycosis.

Onychomycosis is a fungal infection that is unrelated to foot hygiene. No matter how clean you keep your feet, you are still at risk for a fungal infection of the skin and nail. There are several ways in which we contribute to the onset of onychomycosis. First, as a civilized society we wear shoes. Shoes create an environment that is wonderfully conducive to the growth of fungus. The environment inside a shoe is dark, warm and damp. That environment is perfect for the growth of fungus. Second, any form of trauma to the nail will enable fungus to enter the space beneath the nail and begin an infection.

It is safe to say that 50% of folks over the age of 50 show clinical signs of onychomycosis. But this doesn't necessarily mean that onychomycosis is due to 'old age'. This simply implies that with the passage of time there is a greater tendency to acquire a fungal infection of the nail. Trauma makes the nail much more susceptible to fungal infections. An injury to the nail is a common precursor to a fungal nail infection. It's also reasonable to assume that folks in professions that abuse their feet would tend to have a higher rate of onychomycosis. Trauma may be something abrupt such as a can of soup hitting the nail from the top shelf or something as benign as a pair of ill-fitting shoes constantly rubbing on the nail. Onychomycosis is also very common in runners.

The appearance of onychomycosis can vary but most cases begin at the distal tip of the nail and slowly progress into the nail over a period of months to years. This classic onset of onychomycosis is called distal subungual onychomycosis. The nail will thicken as the fungus continues to grow. The filaments of fungus take up space in the nail causing it to swell. The nail can be yellow, white or even green to black. The nail also begins to be chalky, flakey and will separate from the underlying nail bed.

Treatment of toe nail fungus and onychomycosis

Prevention of injuries to the nail is a very important aspect of preventing fungal nail infections. Preventative measures include:

• Avoid injuries to the nails. Protect the feet with enclosed shoes or steel toe boots.

• Keep the feet dry with frequent changes of socks and use of talc or baby powder. Rotate shoes to let them dry for 48 hours between use.

• Purchase shoes with a toe box the shape of your foot. When purchasing shoe, stand barefoot next to the new shoes and see how the shape of your foot compares to the toe box of the shoe. Try to match the shape of the toe box to the shape of your foot.

Medications for onychomycosis fall into two categories; topical and oral. There are any number of effective topical antifungal medications available over the counter. Topical medications are most helpful in treating early infections and for maintaining clear nails. Topical medications are fungistatic meaning that they inhibit the growth of the fungus. By limiting the growth rate of the fungus, the nail is then able to grow faster than the invading fungus infection. Remember, fungus doesn't take a day off. Compliance is a big issue when using topical antifungals. It can often take several months before results are seen.

The older generation of oral antifungal medications, which includes medications such as Fulvicin or Griseofulvin, have been used successfully for years and are making a comeback due to their economic value. The newer generation of oral antifungals, including Sporanox and Lamisil, have been received very well by the medical community. These medications should only be taken under the care of your doctor due to potential hepatic toxicity.

It's important to note that one of the characteristic findings of fungal nail infections is the separation of the nail from the underlying nail bed. Topical and oral medications are in part limited in their efficacy in that they can treat the fungal infection of the nail but they are not able to reattach the nail to the nail bed. Separation of the nail from the nail bed occurs in advanced cases of onychomycosis. Therefore, the success or failure of these medications in their ability to return the appearance of the nail to 'normal', can be limited by how advanced the nail infection is at the onset of treatment.

When all else fails, the fungal toe nail can be permanently removed. This procedure is an office based procedure and most patients return to their normal shoes in just a Band-Aid within 24hrs. The removal of the fungal to nail is permanent. Following permanent avulsion of the nail, the operative site heals over with skin that can be painted with nail polish as seen at left.

Which treatment choice is right for you? Consider the following two examples;

Case 1. Sandy is a 24 year old hairdresser who has intimate hands on contact with her clients on a daily basis. She has developed a fungal infection in several of her finger nails. She is concerned that the fungal infection will have a direct impact on her livelihood and does not want to spread the infection to others. In this case, Sandy's fungal infection may directly affect her job. In this case, the use of an oral antifungal may be indicated.

Case 2. Joe is a 62 year old farmer and has a long history of injuries to his hands and feet. His last visit to the doctor showed signs of an increase in his liver enzyme studies indicating an overall decrease in his liver function. Joe has developed onychomycosis in most of his toe nails. Joe would not be a candidate for oral antifungal medications. In fact, Joe may not be a candidate for treatment at all. Periodic debridement of the nail may be all that is necessary.

Case 3. Irene is a 42 y/o single mom who works in an office setting. Recently she has noticed a yellow discoloration of several of her toenails. Irene is beginning to see the onset of onychomycosis. Irene would be a great candidate for topical antifungal nail medications.

If you have a fungal infection in the nail, is it your fault? No, not at all. Onychomycosis has nothing to do with hygiene. One of the few ways we contribute to this toe nail fungus is that we create an environment that is wonderfully conducive to the growth of fungus. We jump out of the shower in the morning, put on our socks and shoes for 18 hours and create a greenhouse that promotes the growth of toe nail fungus.

It is safe to say that 50% of folks over the age of 50 have a fungal toe nail infection to some degree. But this doesn't necessarily mean that onychomycosis is due to 'old age'. But we can imply that over the course of our lifetimes we will have more opportunities to acquire a fungal infection of the nail. The reason that onychomycosis and age seem to travel hand in hand is due to accumulated trauma to the nail that occurs over time. Trauma makes the nail much more susceptible to fungal infections. People in professions or social activities where they may abuse their feet would tend to have a higher rate of onychomycosis. An example of activities that may abuse the feet and nails would included a mechanic dropping tools on their feet, horses or cattle stepping on the toes or runners who constantly injure their nails. An injury to the nail is a common precursor to a fungal nail infection. Trauma may be something abrupt such as a can of beans hitting the nail from the top shelf or something as benign as a pair of ill-fitting shoes constantly rubbing on the nail.

The appearance of onychomycosis can vary but most cases begin at the distal tip of the nail and slowly progress into the nail over a period of months to years. The nail will thicken as the fungus continues to grow. The filaments of fungus take up space in the nail causing it to swell. The nail can be yellow, white or even green to black. The nail also begins to be chalky and flakey.

Treatment of toe nail fungus and onychomycosis

The single most important thing that you can do to protect the nail from fungal infections is to protect the nail from injuries. A healthy nail acts as a protective barrier to fungal infections. Once the nail is injured, the door of susceptibility swings open, allowing entry of the fungus. Also, keep the feet dry. Keeping the feet dry will inhibit the ability of the fungus to thrive. Frequent changes of socks, the use of powder, such as baby powder and rotating shoes so that they are worn only every other day, can help tremendously.

Medications for onychomycosis fall into two categories; topical and oral. There are any number of effective topical medications available over the counter. Topical medications are most helpful in treating early, small infections and for maintaining clear nails. Topical medications do have a limited ability to penetrate the nail to reach all of the fungal elements. Topical medication inhibit the growth of the fungus allowing for faster growth of the nail. Remember, the fungus doesn't take a day off. Compliance is a big issue when using topical antifungals. A number of effective over the counter (OTC) medications are available including ClearZal Bac, Elon Dual Defense Antifungal and Tineacide.

Fungus can reoccur if your shoes are not properly treated, therefore an antifungal shoe spray. Keeping the feet clean and dry is another important part of treating fungal infections of the skin and nail. The daily use of a drying solution will significantly decrease the ability of a fungal infection to thrive.

The FDA approved a new prescription strength topical medication for treating onychomycosis in 1999 called Penlac. (Dermik Laboratories, Collegeville, PA). Penlac is manufactured in Frankfurt, Germany by Aventis Pharma Deutschland GmbH. Penlac doesn't carry the side effects of the oral medications but the jury is still out on the efficacy of this medication.

The older generations of oral antifungal medications, such as Fulvicin or Griseofulvin, have been used successfully for years and are making a comeback due to their economic value. The newer generation of oral antifungals, including Sporanox and Lamisil have been received very well by the medical community. Care should be taken when using Sporanox due to its' potential liver toxicity. Both Sporanox and Lamisil are expensive medications costing several hundred dollars for the recommended three month course of treatment.

When all else fails, the fungal toe nail can be permanently removed. This procedure is not difficult to perform and most patients return to their normal shoes in just a Band-Aid in 24hrs. The removal of the nail is permanent.

Which choice is right for you? Consider the following two examples;

Case 1. Sandy is a 24 year old hairdresser who has intimate hands on contact with her clients on a daily basis. She has developed a fungal infection in several of her finger nails. She is concerned that the fungal infection will have a direct impact on her livelihood and does not want to spread the infection to others.

Case 2. Joe is a 62 year old farmer and has a long history of injuries to his hands and feet. His last visit to the doctor showed signs of an increase in his liver enzyme studies indicating an overall decrease in his liver function. Joe has developed onychomycosis in most of his toe nails.

I think the choices for Joe and Sandy are clear but in most cases the criteria to make recommendations for treatment of onychomycosis are not as obvious. In those cases, patients should consult their physician to discuss the pros and cons of oral antifungal treatment.

Improper trimming of the nail can result in a number of foot problems, first and foremost ingrown nails. Most ingrown nails (paronychia) result from partial or incomplete trimming of the nail. A common mistake is to trim the nail to the corner and tear the nail away. Tearing the nail often leaves a small spike of nail along the outer margin of the nail. Slowly the nail continues to grow and push the spike forward. The spike begins to act like a foreign object, just like a splinter. As the nail grows the splinter becomes increasingly imbedded in the skin resulting in an infection. Surgical correction of an ingrown nail is usually a matter of removing the little spike that's causing pain and a foreign body reaction (infection).

Who gets ingrown nails and why? You have to wonder why the most common ingrown nail patients are teenage boys and pregnant women. Teenage boys aren't particularly concerned about hygiene. They're also prone to more trauma to the nail from sports. Pregnant woman find that with each month of their pregnancy their arms get shorter and their legs get longer resulting an an inability to care for their feet. Additional contributing factors to ingrown nails include a tight toe box on the shoe, trauma to the nail, diseases of the nail and a host of other causes.

The key to successful nail trimming is to be sure you trim the nail regularly and completely. Use a nail cutter with a curved, pointed tip.  Be sure to round the edges using a double ended nail file, checking for the little spikes. Smooth the edges of the nail to prevent the nail from catching on hose or socks. The rate of growth of the nail is very slow so that once every 4-6 weeks should be sufficient to keep the nails well trimmed and healthy. When trimming the nails, take the opportunity to check between the toes for fungal infections. Fungal infections of the skin will slowly infect the nail resulting in toe nail fungus.