Nail Fungus (onychomycosis)

I have observed the following complaint on a runner, and it isn't a pretty
sight!

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Nail Fungus (onychomycosis)
by Dr Marc Mitnick

>Nail fungus or onychomycosis is an infection of the nails
occurring both on the hands and feet but certainly more
prevalent on the feet due to the environment that feet find
themselves in. Nail fungus generally thrive in dark, moist
environments, so when you consider wearing shoes and socks
all day along with perspiration that occurs, it ends up
being a perfect growth media for nail fungus.

The true, tough to get rid of nail fungus, actually grows
underneath the nail. As it grows, it forces the nail up
off the nail bed and the nail becomes thick, crumbly and
discolored ranging in color from yellow to brown. There
may also be an odor. It is not uncommon for these infected
nails to then spread to the remaining healthy nails on the
foot. It is also not uncommon for nails to fall off and
unfortunately, in most cases grow back the same way if not
properly treated.

Aside from the unsightly appearance of the nail fungus,
other problems can arise. Having nail fungus makes most
people more prone to developing athlete's foot of the skin.
(The opposite also holds true). Additionally, thick
fungal nails can be uncomfortable in closed shoes as they
feel like rocks underneath the top of the shoe. These
infections can make people more susceptible to secondary
bacterial infections as they exacerbate the formation of
ingrown nails, plus the sheer distortion of the nails tends
to irritate the healthy skin of the adjacent toes causing
abrasions that can become infected. This is especially
dangerous in people who suffer from diabetes or have poor
circulation.

Treatment can be difficult because of the fact that fungus
thrives in "dark moist environments". Eliminating those
factors can go a long way to reducing recurrence.

Many patients ask me if the infected nail has to be
removed. The only time I remove them is if they are
already partially loose. If the onychomycotic nail is
adhered to the nail bed I no longer advocate removal of the
nail because the simple truth is, just removing a nail all
the way back to its growth plate will cause the nail to
grow out with a degree of thickness even if there is no
fungus present.

>There are both oral and topical medication treatments. The
>gold standard for treating onychomycosis in an otherwise
healthy individual is the oral therapy. The most widely
prescribed medication today is Lamisil tablets (Novartis),
although there are certainly other oral antifungals that
can be used. The newer generation of oral antifungals is
very safe medications if properly used. Your doctor may
prescribe one or two blood tests during the course of
therapy to make sure there are no adverse effects.
Additionally, your doctor should take a sampling of the
nail and have it tested to confirm that it is true nail
fungus. Visual inspection is not the proper way to make a
diagnosis.

Although topical treatments are available, they tend to be
less effective. The main problem, as stated earlier, is
that fungus grows underneath the nail; so applying
medication to the top of the nail becomes an effort in
futility. Trying to force the medication underneath the
nail rarely works.

The best way to use topical medication is to see a foot
specialist who will grind down and cut away as much of the
diseased nail as possible (a painless procedure), so that
the topical medication will penetrate to the live fungus
more readily. This can become a tedious process as the
medication generally has to be applied twice a day by the
patient, (being lazy about it defeats the whole purpose)
and then the nail has to be ground down on a regular basis.
The other problem is that depending on the degree of
fungus this process can take upwards of a year. The other
problem is that the greater the number of nails that are
infected, the less the likelihood is of clearing them all
up with the topical medication. Having said that, I have
seen some very gratifying results with topical medication.


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A podiatrist with over 25 years experience discusses
various conditions of the foot, ankle and lower leg. This
discussion is in the same manner that he discusses various
problems on a day to day basis with his patients; people
just like you. Visit his web site for more information or
to ask a question.
http://www.foot-pain-explained.com