Toenail Fungus Infection
Toenail fungus (Onychomycosis) is uncommon in children but the incidence increases with age. Nearly half of Americans age 70 and older are infected. Fungal infections occur when the organism finds it’s way into the nail through small cracks in the nail. Once in, the fungus spread through the nail and to adjacent nails in the dark, warm, moist environment that is the inside of our shoes.
Toenail fungus can cause swelling of the skin adjacent to the nail, yellowing, thickening or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail color can vary from brown or yellow to white with this condition.
Toenail fungus can be picked up in damp areas such as public gyms, showers, saunas, steam rooms or swimming pools. It can also be picked up in areas where people are barefoot such as dance and yoga studios, and fungus can be passed people who live in the same home. Athletes and people who wear tight-fitting shoes that causes trauma to the toes or keep the feet from drying out are at higher risk. The condition can also spread from one toe to another, or to other parts of the body.
In our practice where we work with a lot of athletes, early treatment in physical therapy is extremely beneficial and often shortens the duration and severity of the injury, getting folks back to their desired sports activities sooner and strong. That said, there are many patients who get to us too late in this process and despite our best efforts and interventions, there is not much that can be done, especially in cases where the tendon injury has already been longstanding before we commence treatment. In many of these cases where there is a partial tear and/or degeneration of the tendon tissue, surgery is the best option in order to remove the fibrous scar tissue, and repair any tears that persist in the tendon. Typically, our patients start walking around 6 weeks after this surgery, commence an aggressive program of physical therapy, and then get back to their normal activities, stronger than they were before, able to dance, bike/spin, cross-fit, and even run marathons.
Other factors that put you at risk for a fungal toenail infection include not drying off the feet thoroughly after bathing or exercise, having an abnormal pH level of the skin, and having a compromised immune system. Diabetics have an increased risk of contracting a toenail fungus because, by definition, their immune systems are compromised. This is one of the reasons that The American Podiatric Medical Association as well as the American Diabetes Association warns diabetics that they should have their nails cut and debrided by a podiatrist.
Most topical medications for onychomycosis fail to resolve the infection. The two most successful treatments are an oral anti-fungal medication, and an FDA approved laser that kills the fungus in the nails.
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