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A single toenail or any number of nails can be affected. It can also occur on just one foot. Over time, the nail becomes thickened, crumbly, and distorted in appearance. Sweaty feet contribute to the initial infection process and contribute to its spread. The fungus prefers an environment that is moist, dark and warm, which is why it affects the toenails much more often than fingernails. It does not spread through the blood stream. The infection limits itself to the nails and skin. It is often found in association with areas of dry scaly skin on the bottom of the foot or between the toes. The dry scaling skin is frequently found to be chronic athletes’ foot. It is not highly contagious, and family members are almost as likely to contract it from some other source as they are from the family member who has the infection. Keeping common showering areas clean is recommended, and sharing shoes should be avoided.
Not all thicken or yellowed toenails are caused by a fungal infection. Injury to a toenail can cause the toenail to grow in a thickened or malformed fashion. This can be due to an established fungal infection or may be due to the damage caused to the nail root when it was injured. In these instances, treatment with anti-fungal medications will not correct the malformed nail. Other causes of thickened toenails are small bone spurs that can form under the toenail and psoriasis. Taking a scraping of the toenail and culturing it makes the diagnosis.
It is best to treat the condition as soon as it is noticed. In early cases, over the counter medications may be sufficient. It is also important to treat any concomitant athlete’s foot that may be present. In more advanced cases, a prescription medication may be needed. There are effective topical and oral medications available for the treatment of fungal toenails. Topical anti-fungals are usually liquids that can be painted on. However, the medicine often times has trouble penetrating the nail plate. The nail plate may require that it be ground with a rotary grinder prior to application of the medicine. This can be done with a “dremmel moto tool” with a sanding disk or sanding drum. This makes the nail plate porous allowing greater penetration of the medicine. Our office should do the first grinding. Follow-up grindings can be performed every 2-3 weeks using an Emory board or a dremel tool. The medicine must be used twice a day and compliance is very important. As the nail responds to treatment, sometimes a brownish discoloration is seen. This is just the medicine working and can be debrided off.
Oral Antifungals such as Sporanox and Lamisil are also effective in treating toenail fungus for a three to six month period. However, there are occasions when this treatment is not effective. The nail may grow out improved, but it will be attacked by existing spores due to a lack of original blood supply and ultimately yellows and dies.
If sweating feet are a problem, changing shoes and socks during the day is recommended. There are some topical medications available that help to reduce the sweating of the feet. On occasion, your doctor may recommend removing the toenail.
Feet For Life has raised the bar for the manicure/pedicure profession with CleanSpa – Feet for Life is addressing the concerns of infection due to less than ideal practices in the nail salon industry. “Many places do not realize they are putting their clients at risk for contracting these infections.” says Dr. Michael Horwitz, Medical Director of Feet for Life Podiatry and CleanSpa. “After seeing these issues in my podiatry practice for years, I realized the need in the market for a spa dedicated to health and beauty.”Dr. Horwitz, also owner of the AAAHC certified, MidCounty Surgery Center, has had decades of experience in managing optimum treatment environments. Every inch of CleanSpa was carefully planned out. The details are evident, from the sterilization room with its UV baceria detecting lights, to the custom built manicure tables designed for effective dust extraction and air purification.