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Foot Orthotics Seattle
 

Fungal Nails and other Thick and Discolored Toenails

Click here for our recommendations on self-treatment of fungal nails

Alternative names

Nails - fungal infection; Onychomycosis;

Fungal nail

Figure 1 - Potential nail fungus

Definition

Fungal nail infection is an infection of the nails by a fungus.

Causes, incidence, and risk factors

The body normally hosts a variety of microorganisms, including bacteria and fungi. Some of these are useful to the body. Others may multiply rapidly and form infections. Fungi can live on the dead tissues of the hair, nails, and outer skin layers and are also the cause of Athlete’s Foot.

Fungal nail infections are most often seen in adults. They often follow fungal infection of the feet. Fungal nail infections may be difficult to treat and may recur often. Toenails are affected more often than fingernails.

People who frequent public swimming pools, gyms, or shower rooms -- and people who perspire a great deal -- commonly have mold-like infections, because the fungi that cause them thrive in warm, moist areas.

The risk of getting a fungal infection is increased by closed-in footwear, prolonged moist skin, and minor skin or nail injuries.

Symptoms

Nail changes on one or more nails (usually toenails):

  • Brittleness
  • Discoloration
  • Loss of luster and shine
  • Thickening
  • Distortion of nail shape
  • Crumbling of the nail
  • Debris being trapped under the nail
  • Loosening (detaching) of the nail.

Signs and tests

Your doctor will suspect a fungal infection based on the appearance of the nails. The diagnosis can be confirmed by scraping the nail for a culture, or a microscopic examination to identify the type of fungus.

Treatment

Over-the-counter creams and ointments are generally are not very effective at completely eliminating the fungus, but according to some studies1, 2 some over-the-counter treatments can help the nail look better and reduce symptoms.

What you can do on your own

We have tried a number of products over the years and have found the use of a combination of two topical nail medications to be the most effective non-prescription method to improve the appearance of fungal nails and thickened nails. Most patients see anywhere from fair to very good improvement in nail appearance over a 6 month treatment.

The two medications are:

1. Tripod NailStat Anti-fugal Treatment. Unique cream formula for onychomycosis kills fungus, promotes growth of healthy new nail. Softens nail and increases permeability with grape seed extract, the most potent naturally-occuring antioxidant

2. Nonyx Nail Gel: Clears out discoloring keratin debris under the nail. Apply to dark or yellowed nails. Nail discoloration is actually keratin debris build-up under the nail. NonyX Nail Gel breaks down and removes this yellow or darkened build-up and keeps nails looking clearer and more attractive with regular use.

Both of these can be purchased at www.FootAnkleStore.com or at some local pharmacies.

INSTRUCTIONS – 6 month treatment plan:

1. Apply NailStat to the affected nails every morning as directed on the bottle.
2. Apply the Nonyx to the affected nails every night as directed on the bottle.
3. Once per week file the nails down using a nail file or a dremel tool. If the nail is thick use a high-quality nail cutter.

What we can do for you in our office

For more definitive treatment make an appointment to see us in our Seattle office. We will likely take a sample of the nail (no pain involved – just a little clipping) to send for a lab test to see if the nail has a fungal infection and if so, what kind of fungus. This information will help us decide the most appropriate treatment for your condition. We’ll review in detail with you the available prescription treatments for fungal nails including details on the advantages and disadvantages of each. Once your lab tests are back, we’ll provide information on the treatment most likely to provide the best outcome.

Prescription anti-fungal medicines taken by mouth may help clear the fungus in about 50% of patients. However, such medicines can cause side effects or may interfere with other health medicines the patient is taking.

In some cases, the nail may be removed by the doctor. Nails grow slowly, so even if treatment is successful, a new, clearer nail may take up to a year to grow in.

Expectations (prognosis)

Fungal nail infections may be difficult to treat and may become a reservoir for fungal organisms, causing them to return in the skin or nails. The fungal nail infection is cured by the growth of new, non-infected nails. Even with successful treatment, a relapse is common.

Complications

• Permanent damage to the nails
• Secondary skin infections, including infections associated with ingrown nails.
• Recurrent fungal infections of the nails or other parts of the body

Making an Appointment

Make an appointment to see us in our Seattle office if you are not happy with the results of the home treatment explained above, if you experience persistent fungal nail infections, or if the fingers become painful, red, or drain pus.

Prevention

Good general health and hygiene help to prevent fungal infections. Keep the skin clean and dry. Take proper care of the nails (see treatment). Wash and dry the hands thoroughly after contact with any fungal infection.

It is possible to pick up a nail infection in a nail salon. If you ever go to a nail salon or otherwise have pedicures, you can help prevent infection by taking your own instruments. We recommend the Dr. Siegel’s Savvy Nail Kit or the SOS Safe Salon Pedicure kit. In addition, take your own tub liners, such as the Dr. Siegel’s Savvy Nail Tub Liners.

References:
1. Syed, TA; Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Trop Med Int Health. 1999 Apr;4(4):284-7

2. Buck DS; Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. Dermatology, 2001

Healthy feet allow for regular exercise and a happy healthy feet. If you have nail problems not relieved by the suggestions above, make an appointment to see us in our Seattle office. We can provide you with conservative treatment options that will relieve your pain.
 


All pages on this website © 2008
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.