Of all of the conditions podiatrists treat, toenail fungus is among the most frustrating. Organisms called dermatophytes love dark, warm environments, which tend to be our shoes. These fungi are the same that cause the itchy rash of athlete's foot. Once they take root in the nail bed, they become very difficult to eradicate. The nails may become thick, yellow and either brittle or crumbly. Often they are impossibly difficult to cut. Patients may be hesitant to seek care because they're embarrassed about the condition of their feet. Often a spouse will insist the toes be evaluated, and commonly drag the mortified significant other in to the office to be seen. Believe me, podiatrists have seen it all, and it's nothing at all to be worried about.
How does this pervasive little fungus take hold? The fungus is found throughout our environment. It seems that resistance to developing the infection is, like many things, inherited. One person may be exposed and never develop and infection. Their roommate may share the same shower, bathroom floor, even slippers (ick!) and their toenails become yellow, thick and deformed after exposure. Different immune systems, different response. Exposure to the fungus may come from public showers or any place where public barefooted behavior is common. Most of us have likely been exposed, but because of our unique immune systems, we won't all become infected. To prevent infection, it's prudent to wear flip flops or shower shoes in the locker room at the gym, and make sure your nail salon is stringent in their sterilization techniques. If you have athlete's foot but your nails are normal, make sure you treat the skin condition before the fungus invades your nails.
Once our nails have started to look like the picture above, what do we do about it? Home remedies are always worth a try. Applying Vick's Vaporub or tea tree oil are popular and occasionally effective treatments. Since it takes a normal healthy toenail 6 months to a year to grow from base to end, improvement will be very slow.
If you've religiously tried the home remedies for 6 months without improvement, it's unlikely to work. Once you come in to our office, we have options available. No one treatment works 100% of the time. If cosmetic appearance isn't important to you, and especially if the nail has become too painful to wear shoes, we can permanently remove the nail. People worry that they'll lose some protection to their toe by removing the nail, but this really isn't the case. The toe might look "odd" without a toenail, but the goal is to alleviate pain. Temporarily removing the nail and allowing it to grow back isn't effective in eliminating the infection.
If the nail is painful but cosmetic appearance is important to you, we may recommend temporarily removing the nail while treating the underlying infection. The most successful treatment is an oral antifungal medication which is typically taken for three months. Some serious side effects, however, have made the use of these pills less than desirable. Anyone with even minor liver abnormalities may not take these drugs, nor should they be used with alcohol or any other medications (like Tylenol) that can be toxic to the liver.
Our other option is treating the nail with a laser that's designed to kill the fungus without the need for removing the nail. This procedure can be expensive and is not 100% successful. Our FDA-approved Noveon laser for toenail fungus tends to be our treatment of choice for patients who want to keep their nail and minimize their exposure to medications. While it's a remarkable technological advance, we're still awaiting the fool-proof panacea that will guarantee our patients an acceptable result.
Nail fungus is an embarrassing, frustrating condition. Like many problems, treat it when it's more minor, and our chances for success are better!
