A very common condition of the toenail is nail fungus, also known as onychomycosis.  This can occur in people of all ages and at times can be seen in immunocompromised individuals, such as those with diabetes or vascular disease.

If severe enough, nail disease can lead to embarrassing moments during which patients attempt to hide their feet by burying them in the sand at the beach, covering their feet with closed toed shoes or by wearing socks all day long. This, in turn, often compounds the nail disease, allowing it to spread to more toes, making the condition worse.

In more advanced cases, if untreated, it can lead to abscesses (pockets of infection) under the nail or even ulcerations.  This is commonly seen in our older population when regular routine foot care (trimming of nails, corns and calluses) is not performed.

Similarly, in all ages, if untreated, nail fungus can lead to what appears to be skin peeling, itching, dryness on the bottom and sides of the feet, but is actually athlete’s foot.  In fact, it has been proven that nail fungus and athlete’s foot are caused by the same fungus.  Your podiatrist knows how to treat and prevent fungal infections that may compromise the skin barrier and potentially lead to secondary bacterial infections which can spread deeper into the foot posing amputation risks.

Over the years, many forms of nail fungus testing have been implemented with varying degrees of success. More recently, advanced testing has been developed that involves a simple painless skin scraping of the peeling skin or a simple nail clipping. This permits genetic analysis of the nail or scrapings, provides your podiatrist with precise information on the type of fungus that is present or not present, and provides valuable action steps in the report to guide quick diagnosis and treatment.

Nail fungus can be treated with topical or oral medications. In our experience, there are a limited number of topicals that have been effective in treating nail fungus. Our office has successfully used a practical and affordable solution known as Tolcylen (featured picture) which has a low molecular weight vehicle allowing penetration of the medication to penetrate into the nail plate and bed where the fungus resides. 

For cases unresponsive to topicals, oral medications can be used as well but require monitoring of both liver function and white blood cells which are measured and evaluated by monthly blood draws while on oral medication.

Regardless of treatment path chosen, the prevention of recurrence of fungus is very important in the patient’s treatment plan.  It is our clinical practice to educate patients about using ultraviolet shoe zappers to sanitize shoes to rid them of unwanted remaining fungus living in the shoe.  Additionally, for feet that perspire frequently and are prone to re-infection, our physicians often recommend bamboo socks.

In the end, both of our Board-Certified Podiatrists with over 25 years experience each, recommend that all cases of athlete’s foot and nail fungus be treated to avoid complications and embarrassing moments.