Nail Conditions

About fungal toenails (Onychomycosis)

Toenail fungus is a condition that disfigures and sometimes destroys the nail. It is also called onychomycosis. Toenail fungus can be caused by several different types of fungi. Fungi are microscopic organisms related to mold and mildew. These fungi thrive in the dark, moist and stuffy environment inside shoes. As they grow, fungi feed on keratin. Keratin is the protein that makes up the hard surface of the toenails.

Causes

• Factors that increase the risk of developing toenail fungus include:
• Wearing tight-fitting shoes or tight hosiery
• Practicing poor foot hygiene
• Wearing layers of toenail polish, which doesn’t allow the nail to breathe
• Being a military personnel, athlete or miner.
• Having a chronic illnesses, such as diabetes or HIV Having a circulatory problem that decreases blood flow to the toes
• Being infected through direct contact such as pedicure salons that may not sterilize contaminated instruments between clients.

However, many people with toenail fungus have no clear risk factors. Toenails on the big toe and little toe are the most likely to develop a toenail fungus. This may be partly because the big toe and little toe are constantly exposed to friction from the sides of shoes.

Symptoms

When a toenail develops a fungal infection, it typically turns yellow or brown. It becomes thick and overgrown. Foul-smelling debris also may accumulate under the nail. As the infection continues, the nail may crumble gradually and fall off. Or, it may become so thick that the affected toe feels uncomfortable or painful inside shoes. A less common variety of toenail fungus is called white superficial onychomycosis. The nail turns white rather than yellow or brown. The surface becomes soft, dry and powdery.

Diagnosis

You will describe your foot symptoms to the podiatrist. He or she will ask about any factors that may increase your risk of toenail fungus. These include: A high-risk occupation; Sports participation; Tight-fitting shoes or hosiery; Poor foot hygiene; Use of heavy toenail polish; A history of illness that may decrease your resistance to infection or interfere with blood flow to your toes. These include: Poor circulation; Diabetes HIV; A skin disease called psoriasis sometimes can cause nail problems that look similar to a fungal infection. As a result, the podiatrist may ask whether you or a family member has psoriasis. It is possible for psoriasis and a fungal infection to affect the same toenail. The podiatrist will examine your affected toenail or toenails. Often the diagnosis can be made based on the appearance of toenails. The podiatrist may take small samples of the affected nails. These samples will be sent to a laboratory where they are tested for fungi and other infectious agents. Expected Duration Toenail fungus rarely heals on its own. It is usually a chronic (long-lasting) condition. It can gradually worsen to involve more and more of the nail. Even if the affected nail comes off, the new nail may be infected with fungus.

Prevention

To help to prevent toenail fungus:

• Wear comfortable shoes and hosiery that allow your feet some breathing space.
• Wear shoes, sandals or flip-flops in community showers or locker rooms.
• Wash your feet every day.
• Dry them thoroughly, and use a good-quality foot powder.
• Wear clean socks or stockings every day.
• Keep your toenails trimmed.
• Disinfect pedicure tools before you use them

Treatment

Treatment may begin with the podiatrist removing as much of the infected nail as possible. This is painless and helps to gain better results.

There are many options in treating fungal toenails. Treatment choice depends on the degree of infection, the type of infection, duration, previous treatment outcomes, age, lifestyle and cost. Treatment options are topical medicated products being solutions or lacquers; laser treatment ; oral medication; non-medicated products such tea tree oil. A podiatrist can assess and recommend which treatment is most suitable for you, thus saving you time and money trying to resolve it yourself.

What other conditions can be mistaken for fungal nails?

Here are some other conditions you may have instead of fungal nails:

1. Lines and ridges: These are common and may be considered normal.

2. Aging nails: As you age, the nails become brittle, develop ridges and separation of the nail layers at the end of the nail.

3. Whitish or yellowish nails due to onycholysis. This means separation of the nail from the nail bed.

4. Red or black nails due to a hematoma, or blood under the nail, usually occur from trauma (like whacking yourself on the thumb with a hammer).

5. Green nails can be caused by Pseudomonas bacteria, which grow under a nail that has partially separated from the nail bed, thereby producing a green pigment.

6. Pitted nails may be associated with psoriasis or other skin problems that affect the nail matrix, the area under the skin just behind the nail. This is the area from which the nail grows.

7. Swelling and redness of the skin around the nail is called paronychia. This is an infection of the skin at the bottom of the nail (cuticle). If the infection is acute (has a rapid onset), it is usually caused by bacteria.

8. Chronic nail trauma, such as repeatedly starting and stopping, kicking, and other athletic endeavors, can cause damage to the nails that can look a lot like fungal nails. This sort of repetitive trauma can also occur with certain types of employment or wearing tight-fitting shoes.

When to see a podiatrist?

If you suspect a fungal toenail infection, you must see a podiatrist. Often people attempt to treat it on their own with expensive chemist products for months and not see the results. In order to treat nail fungus effectively, the nail requires professional trimming and filing so any topical product used absorbs effectively and gets to the source of the problem.

Ingrown toenails refer to inflammation, pain and possibly infection of the skin on the edge of the nail. It is caused by the nail pushing into the skin causing too much pressure and inflammation. They commonly occur on the big toes.

Initially you may notice the skin surrounding your toenail become red, swollen or tender to press. Within a few days or couple of weeks it can become more inflammed, produce yellow discharge and be very painful to walk.

Causes of ingrown toenails

There are several things that can cause, or contribute to, an ingrown toenail.

• Wearing shoes that don’t fit you properly. If your shoes are too tight, they can force the skin surrounding your toenail against the nail.
• Cutting your toenails incorrectly. Cutting them too short, or leaving a sharp corner makes the nail pierce the skin as its growing out.
• An injury to your toenail. A recent or past trauma can alter the shape of the nail causing difficulty in growing out smoothly.
• Fungal infections. These can cause your nail to become thickened, widened, or curved making it more likely to grow into your skin.
• If you’re sporty or active, you’re more likely to get an ingrown toenail. This is because your feet will sweat more, making your skin softer and easier for your nails to grow into. Also, the extra pressure on the toes within the shoe can cause the nail to push against the skin. Tight sport shoes, such as soccer shoes can make it worse.
• If you have inherited fan-shaped, curved, thick or wide shaped nail, you’re more likely to get an ingrown toenail.

Complications of ingrown toenails

It’s possible your ingrown toenail may become infected. Your symptoms may get worse and the area may:

• become more painful
• become swollen
• develop proud flesh
• become infected
• bleed

The infection may spread to the rest of your toe if it isn’t treated early and cause further complications.

Diagnosis of ingrown toenails

A podiatrist will diagnose an ingrown toenail from the first visit and most often resolve most of the pain immediately. In some cases, ingrown toenails can be mistaken with the pain of a corn (hard skin) on the side of the toenail. The causes and treatment is similar.

Treatment of ingrown toenails – (Self-help)

Initial treatment of an ingrown toenail is soaking it in salty water to cleanse the area and attempt to reduce the inflammation. Then application of a topical antiseptic cream. In cases, where the infection and inflammation is severe, a visit to the doctor for antibiotics may be required.

It’s important to wear comfortable shoes with enough space for your toes so you don’t make your ingrown toenail worse. So the use of thongs is most suitable.

Do not try and fix an ingrown toenail yourself by cutting the corners. It will make it worse. A podiatrist has special instruments and skills to trim the nail professionally.

Podiatry treatment

Podiatrist treat ingrown toenails often, and are experts at it. They attempt to avoid causing pain where possible during the treatment. Most people fear that treatment of an ingrown toenail is so painful that they avoid treatment. But in fact, its far less painful then the ingrown itself. In cases where the ingrown is very painful, a local anaesthetic can be given to numb the area.

The treatment involves cutting away a small edge of the nail that is pressing against the skin causing the problem. So the skin itself is not cut. Then the area is cleansed and an antiseptic is applied. You will notice relief immediately and within a few days see the area healed.

In severe cases, a few periodical treatments may be required before its completely healed. In cases where ingrown toenails re-occur frequently, the podiatrist will discuss other options such as nail surgery that permanently stop the ingrown occurring.

Prevention of ingrown toenails

There are a number of things you can do to prevent an ingrown toenail.

• Cut your toenails straight across rather than as a curve with short edges or cutting down the corners of the nail.
• Use clean, sharp nail trimmers and file the corners for a smooth finish.
• Wear shoes that are wide enough for your feet and that don’t apply pressure on your toes.
• Try not to wear narrow, pointed shoes.
• Keep your feet clean and dry. Wash your feet every day and change your socks and tights every day.
• See your podiatrist soon after the ingrown occurs. The treatment and healing time becomes far less easier.
• Do not try and fix the ingrown toenail yourself by cutting the nail. More often, this makes it worse. A podiatrist has special instruments and skills to trim the nail professionally.

The toenails are constantly sujected to pressure, especially in shoes. So it is very easy to traumatise them. Nails are thin and very fragile, so they will change in appearnce very easily.

Signs

• Red, purple, black discoloration
• Thickening
• Loose and lifted nail
• Ridges or splits in the nail

Causes

If you stub your toe, drop something heavy on your feet, you may develop a nail bruise, which is blood trapped beneath the toenail that appears as a red, black or purple discoloration. It is usually caused by blunt trauma from a heavy object or chronic friction from rubbing against the shoe.

But acute trauma isn’t necessarily a cause , even people who do a lot of walking or running are more prone to nail bruises because of increased shoe friction.

A nail bruise can range from a small spot under the nail to a large area of discoloration. Depending on the amount of blood beneath the nail, the nail may come loose. But often the nail does stay intact, and the blood fades as the nail grows out. If the nail bruise is large and causing pain, podiatry treatment will be needed to relieve pressure under the nail.

Nail trauma may not always lead to bleeding beneath the nail but to other predictable changes. These changes may occur due to chronic rubbing against the shoe or in response to irritation from a fungual or bacterial infection. Some of the most common changes are:

• Nail thickening- caused by damage to the nail’s growth center, or matrix
• Nail dystrophy- permanent nail changes such as splitting or a decrease in size
• Nail avulsion- entire nail or a portion of it becomes loose or falls off
• Permanent nail loss- due to damage to the nail matrix

When to Seek Treatment for nail bruise or any other nail trauma:

• If there is blunt trauma to the toenail, for example if a heavy object has been dropped on the toe, it is best to seek treatment to rule out a fracture and treat any wound beneath the nail bed.
• If toenail trauma leads to severe swelling, pain or redness of the toe.
• If there is any discharge from under the toenail.
• If the nail becomes loose.
• If you have neuropathy or any condition that affects healing or circulation such as diabetes or peripheral arterial disease.
• If the discolouration appears as a linear streak, or a stripe going with the length of the nail. Although a streak of pigment is often normal, in some cases it may be a sign of the skin cancer melanoma.

When the nail looks worse due to trauma, fungus infection, or for other medical reasons and the appearance is causing you to avoid exposure, cause embarrassment ,cause low confidence, and lower self-esteem, then you should consider having it cosmetically repaired to lift your mood and confidence.

We use a product called keryflex imported from the USA, that is  a professional medical grade product and applied in a hygenic manner , using sterilized instruments. This ensures you dont develop any secondary infections that you may get from pedicure salons.

This site provides more information on its use and results http://keryflex.com/  .