What it is
Onychomycosis is an infection of the bed and plate underlying the surface of the nail, and is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms, such as molds and mildew, that lack chlorophyll and therefore do not require sunlight for growth. A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail’s protein substance.
When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.
Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot — swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of athlete’s foot and excessive perspiration.
Because fungi are everywhere, including the skin, they can be present months before they find opportunities to strike, and before signs of infection appear. By following precautions, including proper hygiene and regular inspection of the feet and toes, chances of the problem occurring can be sharply reduced, or even put to a halt. Clean, dry feet resist disease; a strict regimen of washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection. Shower shoes should be worn when possible, in public areas. Shoes, socks, or hosiery should be changed daily. Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe. Use a quality foot powder — talcum, not cornstarch — in conjunction with shoes that fit well and are made of materials that breathe. Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks, especially for those with more active lifestyles.
Depending on the nature of the infection and the severity of each case, treatment may vary. A daily routine of cleansing, over a period of many months, may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent.
However, even the best-over-the-counter treatments may not prevent a fungal infection from coming back. A fungus may work its way through the entire nail, penetrating both the nail plate and the nail bed. If an infection is not overcome, or continues to reappear, further medical attention is strongly recommended.
A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Indeed, debridement is one of the most common foot care procedures performed by DPMs.
Newer oral antifungals approved by the Food and Drug Administration may be the most effective treatment. They offer a shorter treatment outlook (three to four months) and improved effectiveness, though DPMs advise that lengthier treatments, up to 12 months, may still be required for some infections. Current studies show that, for a small percentage of the population, there are some unwanted side effects with any oral antifungal.
In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.
Trying to solve the infection without the qualified help of a podiatric physician can lead to more problems. With new technological advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.