Answers To Toenail Fungus Quiz!

Yesterday, I posted a short quiz on toenail fungus (onychomycosis).  As promised, here are today's answers (along with the questions in case you missed them yesterday):

1. Nail fungus is a sign of bad hygiene.

True or False

2. Nail fungus is commonly caused by the fungus that causes ringworm.

True or False

3. Failure to treat athlete’s foot will increase your chances of developing toenail fungus.

True or False

4. Common places to catch infections are locker rooms, pool sides, etc.

True or False

5. Fungal infection of the nail may destroy the nail.

True or False

Answers:

1. False---Nail fungus is an infective problem. It has no relation with nail hygiene. Nail fungus is caused by a fungus or a type of yeast.

2. True---The fungus of the dermatophyte family that causes ringworm, also causes nail fungus.

3. True---If you don't treat athlete's foot, the infection may reach the nails and infect them.

4. True---Common areas that are infected with fungus like locker rooms, pool sides, etc. are the places where you catch nail fungus infection. Wash your feet after visiting such places, dry them and if you are susceptible to fungal infections, apply an anti-fungal ointment. Wear footwear whenever possible.

5. True---If the infection spreads, the nail may get detached and may fall off.

Unlike when I first began to practice podiatry, there are treatment options for toenail fungus that actually work!  As a new podiatrist, the best options I had available for the treatment of toenail fungus included periodic trimming and grinding down of toenails (which did not resolve the infection) and permanent removal of the affected toenail(s) - not a very popular option. 

Today, however, I can offer three options for treating toenail fungus.  First, for mild cases, there are topical antifungal medications.  I prefer a medication called Formula 3.  It is applied twice daily for one year.  This does take some effort on the part of the patient, and for severe cases, the medication has a hard time penetrating the toenail deep enough to actually kill the fungus.  Formula 3 is available for sale in my office.

The second option available is an oral mediation called terbinafine.  This is the generic version of Lamisil.  Because it is taken internally, the medication becomes incorporated into the toenail, and over a period of several months, the toenail gradually grows out clear.  Over the years, I have seen a lot of success with terbinafine.  However, not everyone is able to take terbinafine.  Some patients cannot take terbinafine due to potential harmful interactions with other medications they are taking.  In addition, those with kidney or liver disease should avoid terbinafine. 

The final option that is now offered at Concord Foot and Ankle Clinic is the use of the PinPointe FootLaser.  This laser was specifically designed to treat toenail fungus, and is FDA approved for the treatment of the onychomycosis.  The PinPointe FootLaser works by gently heating the toenail bed, thereby killing the fungus.  Once the fungus is killed, the toenail gradually grows out clear.  This is a procedure that is done in the office, taking 30 to 60 minutes.  Some patients may experience temorary warmth during the procedure; however, anesthesia is not required.  Because of the gentle way the PinPointe FootLaser works, there are no known side effects, and is a treatment option open to almost everyone.  As with other treatments for onychomycosis, clearing of the toenail takes several months, and is seen first at the base of the nail as new, disease-free nail begins to grow out.  To learn more about the PinPointe FootLaser and to see if it is right for you, visit my website by clicking here.  While there, you can browse through the gallery of before and after pictures.  You may also wish to simply call my office at (574) 875-8698.  We would be happy to answer any questions you might have.

With all the treatments now available for onychomycosis, there is no reason for anyone to continue to suffer with this condition. 

Toenail Fungus Quiz

One of the most common conditions treated by podiatrists is toenail fungus (onychomycosis).  When infected, toenails become thickened and discolored (often yellow, white or brown).   While always unsightly, severe cases can cause considerable pain, especially when shoes are worn.  When I first started practicing podiatry, treatment options were limited.  However, there are now options available to successfully treat the condition.  First though, let’s take a quiz on toenail fungus. 

1. Nail fungus is a sign of bad hygiene.

True or False

2. Nail fungus is commonly caused by the fungus that causes ringworm.

True or False

3. Failure to treat athlete’s foot will increase your chances of developing toenail fungus.

True or False

4. Common places to catch infections are locker rooms, pool sides, etc.

True or False

5. Fungal infection of the nail may destroy the nail.

True or False

How do you think you did?  The answers to the quiz will be given tomorrow, along with a discussion of the exciting new treatment options available.

Tobacco and Your.... Feet?

Everyone is aware of the dangers of smoking to your lungs and heart. But the effects of smoking go far beyond your heart and lungs. Are you aware of what smoking can do to your feet? When I tell patients that smoking cigarettes can affect their feet, many are surprised. But the fact is that smoking can lead to serious problems with your feet.

First, when you smoke, levels of carbon monoxide become elevated in the bloodstream. Carbon monoxide displaces oxygen in red blood cells, and the result is that the blood is not able to carry as much oxygen. Since the tissues in your body (and feet) need oxygen, this is serious. Once oxygen is displaced from the blood cell by carbon monoxide, that blood cell can no longer carry oxygen for the rest of its lifespan (about 3 months).
Secondly, nicotine, which is found in cigarettes, causes the blood vessels to constrict and become narrower. This decreases the amount of blood (that’s the blood that already is carrying less oxygen) that can get to the tissues. The effects of nicotine diminish after two weeks, so quitting can improve circulation in a relatively short period of time.

Thirdly, smoking greatly increases the risk of PAD (peripheral arterial disease). This occurs when the arteries become clogged with plaques, further decreasing blood flow. Of the three main effects of tobacco smoking on circulation, this is the slowest to reverse itself after smoking is stopped (see www.padcoalition.org).

Why should you care if your feet are receiving adequate blood flow? Patients with poor circulation often will develop a condition called claudication, which manifests itself by causing severe pain in the legs when a person walks for short distances. In essense, the pain is a result of the muscles being starved of oxygen. When blood flow is poor, your body’s ability to heal itself (such as if you have an ulcer) is greatly diminished. Bones are also slower and more difficult to heal with a smoker who has poor circulation. In fact, when the circulation is bad enough, healing will not occur at all. This leads to tissue death (gangrene), and ultimately, amputation of a portion of the foot, or even the leg. This is very serious, because studies have shown that the 5-year mortality rate following a major amputation was 68%! This is higher than those diagnosed with colorectal cancer (39%), breast cancer (23%), Hodgkin’s disease (18%), and prostate cancer (8%). Losing a leg is not something to be taken lightly. Lung cancer, as it turns out, has a higher mortality rate (86%), but then again, tobacco is the major cause of that cancer too.

So what can be done? First, if you don’t smoke, please don’t start. I know very few people who are happy about the fact that they’re addicted to cigarettes. Secondly, if you do smoke, talk to your doctor about ways to quit. It probably will not be easy, but will most definitely be worth not only saving a foot, but saving your life!

Ingrown Toenails

One of the more common problems that causes patients to come see me is for the treatment of ingrown toenails. They are painful, persistent, and can really make life miserable. For some reason, I see a lot of fear on my patients when it comes to the treatment of this problem. I would like to explain what causes ingrown toenails, and what the preferred treatment is for most of my patients.

Ingrown toenails can affect people of all ages. I have seen infants with ingrown toenails, elderly patients, and everyone in between. What causes them to occur? Sometimes it is just the inherited shape of the toenail that predisposes people to develop ingrown toenails. Other times, it can be caused by wearing shoes that are too tight, or an injury to the toe that drives the nail into the surrounding skin. Fungal toenails, because they are often thicker, can also be a factor. Finally, if toenails are cut too short, especially long the sides of the toenail, they can become ingrown as they start to grow back out. Once the problem starts, the surrounding skin will often become infected and inflamed, As it does so, it will cause the entire area around the toenail to be painful.

Treatments at home can and probably should be tried first in mild cases. This includes putting a little bit of cotton under the nail, foot soaks, and avoiding wearing tight shoes. However, if you don’t see results after a week or so, it’s time to let your podiatrist take over. The treatments he can offer range from controlling the infection, to permanently correcting the problem so it does not happen again.

As mentioned above, the toe often becomes infected when the toenail is ingrown. The right antibiotic can treat the infection and greatly reduce the pain. But if that is all that’s done, your relief may be short-lived. Antibiotics do nothing to treat the underlying cause of the problem, namely, the toenail digging into the toe. Under local anesthesia (yes, that does mean a shot!), a portion of the toenail can be removed. Once this is done, the pain is dramatically reduced in most cases, and it also helps to clear the infection. I have found that when just a portion of the nail is removed (as little as 1/8”), the toe heals up within a week or so following the procedure. The one problem with this method is that while the pain is gone, the part of the toenail that was removed will grow back, and often will grow back ingrown.

So what do I do? I have found that for most of my patients, the best alternative is to remove the ingrown portion of the toenail permanently. Not the entire toenail, just the tiny portion along the side that is causing all the problems. Essentially, the same procedure is done as was described above, but I also use a medication to kill the root of the portion of the toenail that was removed. When done correctly, this will prevent the portion of the nail removed from growing back, thus solving the problem for good.

One of the first questions that people ask me is “how much does it hurt to have my ingrown toenail fixed?” Since I believe that it’s best to be straight with patients, I will admit that when the toe is made numb during the injection, there is discomfort. However, that does not last very long, and the rest of the procedure is painless. Afterwards, the biggest surprise most have is how little pain there is once the numbness wears off. Certainly, there is some tenderness, but by far the vast majority of patients tell me when they come back to see me one week later for their follow up appointment that they are happy, they feel much better, and they wish they had taken care of the problem sooner.

Once the toe is healed up completely, the toenail will be a little narrower. Other than the patient herself though, very few will be able to tell that anything had ever been done.

So, my advice is that if you have trouble with a painful ingrown toenail, decide to get it fixed and fixed for good. You’ll be glad you did!

What is a Podiatrist?

What is a Podiatrist?

As a practicing podiatrist for the last 20 years, this is a question that I am frequently asked - What is a podiatrist? Along with that question is the ever-popular "how can you stand looking at feet all day?" To answer these questions, let me start by explaining what it takes to become a podiatrist.

For a person coming out of high school with dreams of becoming a podiatrist, the first step is to go to college. Your major in college is not nearly as important as some might think. You will need to take several required classes regardless of your major though, with a heavy emphasis in the sciences (chemistry, physics, and the biological sciences). Once you near the end of your undergraduate career, it's time to start the application process to one of the 8 podiatry schools. Podiatry school is a 4-year curriculum, which when examined, closely resembles that of a typical medical school. This is especially true for the first two years. It is rigorous, and will test even the brightest of students. The further along students get into podiatry school, the more emphasis is placed on clinical training - as in actually seeing and treating patients. It would be a mistake, though, to think that today's podiatrist only learns about feet. To the contrary, the training is quite broad. In real life, it is impossible to treat foot problems without knowledge of what is going on with the rest of the body. For example, if a patient comes into my office with sudden onset of pain in his foot at the base of the big toe, I would include in my list of possible causes of the pain the diagnosis gout (see http://www.concordfootdr.com/library/1860/Gout.html). Treatment for this systemic disease that presents itself in the foot usually requires oral medication. Medication cannot be prescribed without knowledge of what other medication the patient is taking and how they all interact. Because of this, podiatrists have become experts in treating diseases, injuries and abnormalities of the foot and ankle, but are also able to tailor treatment plans that take the whole patient's situation into consideration.

Following the completion of podiatry school, the training is not yet complete. Podiatrists today must complete residency training that lasts up to 3 years. During this time, further training is received in the many areas podiatrists see in daily practice, including surgery, wound care, biomechanics, podiatric medicine, etc.

On a typical day in my office, I may see and treat any number of following conditions:
Ingrown toenails
Diabetic ulcers
Heel pain
Flat feet
Bunions
Hammertoes
Arthritis
Neuromas
Fungal toenails
Sprains
Fractures
Athlete's foot
Gout
Poor circulation
Neuropathy
Corns and calluses
And the list goes on and on.

So, the next time you think of your podiatrist, be grateful that such trained individuals are there to take care of all your foot care needs.

Oh, and as to the second question, how can I stand looking at feet all day? I look at it this way. If I can have a person come into my office with pain, and leave painfree, there is nothing I would rather do. I brings a great deal of satisfaction to get people back to normal activities... back to being able to walk, run, and work. In short, healthy feet go a long ways to making lives more fulfilling and productive. It's great to be play a part in improving the lives of my patients!