Fungal toenails were the main concern of everyone seen by McDermott Footcare this week. Everyone from the 30-year-old professional to the octogenarian needed help with toenail fungus, a.k.a. onychomycosis. Toenail fungus doesn’t discriminate against age and there are many causes for it.
Anatomy of a nail:
To understand how a nail becomes fungal, we need to know the structure of a nail. Anatomically, a toenail and a fingernail are the same. The nail plate is the part that needs clipping every 6 weeks or so. Underneath is the nail bed which is protected by the nail plate. The cuticle (eponychium) is the narrow band of skin at the base of the nail plate; it is a protective barrier, preventing fungus and bacteria from entering the nail bed. The nail root (matrix), at the base of the nail bed underneath the cuticle, is where nail cells form. The end of the matrix is the white, half-moon shaped area (lunula) at the base of the nail.
How nails become fungal:
Onychomycosis is caused by the same dermatophyte as Athlete’s Foot. Athlete’s Foot and Onychomycosis can be caused by the same factors (read here).
Anyone with poor circulation to the feet, including diabetics and people with heart and vascular conditions are more susceptible. People with weakened immune systems because of illness or medication use are at a greater risk.
Anyone who has regular pedicures may be at risk. During a pedicure, the cuticle is pushed back. This damages the cuticle and makes it easier for fungus and bacteria to infect the matrix where new nail cells form. Are the pedicure and manicure instruments sterilized (read here) by autoclave? Nail fungus is very contagious. The Ontario Ministry of Health and Long-Term Care mandates that these instruments be autoclaved. Ask the salon if they autoclave – buyer beware.
What does toenail fungus look like?
Onychomycosis starts off as a small area of whitish or yellowish discolouration in one corner of the toenail. This picture shows mild toenail fungus. As it spreads, the area of discolouration becomes larger and the nail becomes rough and thickened. You may notice a darker colour under the nail because of debris that has collected. The nail plate may separate from the nail bed. If bacteria are involved in the infection, there will be a slight odour.
Over-the-counter topical medications may or may not work. Your doctor may prescribe a stronger topical medication but even that will take months of regular use. Oral medications may be prescribed for diabetics or those with other medical conditions.
The vinegar – water soak I talked about in (this) previous blog is a home remedy that has been shown to work if used constantly over many months. Eating a healthy diet will boost immunity and help to fight the infection. Probiotics which are added to certain foods such as yogurt may help.
Tea tree oil applied to a piece of cotton and used to clean under the nail plate may show results over time.
As a certified foot care nurse, I treat fungal nails by clipping away as much of the infected nail as possible. For thickened nails, I use a special file that thins out and removes pieces of the damaged nails. Regular nursing foot care halts the spread of infection. A McDermott Footcare client is looking forward to being able to wear sandals this summer for the first time in years since I have treated her fungal toenails for the past 6 months and we are now seeing favourable results.
Preventing fungal toenails:
- The measures used to prevent Athlete’s Foot (here) will also prevent fungal toenails.
- Try to avoid wearing shoes that are tight in the toe box. Squashing the toes together damages the matrix and increases the likelihood of infection.
- If you get regular pedicures, do not let the esthetician push back the nail cuticle. Find a salon that will honour your request to leave your cuticles alone. It may be tempting to cover fungal nails with nail polish but this will trap moisture and worsen an existing infection.
- A fungal toenail infection is contagious. Again, use the same prevention measures as with Athlete’s Foot.
Toenail fungus, or onychomycosis, may be frustrating and embarrassing. Diligence and patience are needed to end the problem and prevent it from recurring.