Here’s a question I get pretty often: why feet? And I answer, because I love feet. And usually I’ll add a comment about how it’s a good thing I’m not a gastroenterologist or a urologist or something along those lines.
Look no further than your own toenails, or perhaps your loved one or roommate. And if not them, pay your grandparents a visit, because it’s more than likely that the veritable talons perched at the end of their toes have been thoroughly digested and processed by a petri dish of fungal organisms, thus leading to the characteristic appearance of yellow, thick nails in the elderly that give us one more reason to fear the golden years. In any case, continuing our previous themes of gross foot maladies, it’s time to discuss the feared toenail fungal infection.
Fungal toenail infections, or onychomycosis as any first year NYC podiatry student calls it in doctor speak, is a very common invasion of fungal organisms into the toenails. As previously mentioned when we discussed athlete’s foot, fungus likes warm and wet places, and eats protein, so the nails are a great environment where the fungi have a nice place to live and plenty to eat. As the fungus grows within the nail plate, the nail will appear yellow, brittle, thick, and may even fall off.
So how is this infection managed? First of all it’s important to note that this is a localized infection that stays localized. The fungi are quite content to remain within the nail plate, or more specifically, the skin under the nail plate, and do not cause systemic infection. Therefore, this is not a dangerous condition. It is, however, unsightly, painful, and as this is the age of modern medicine, treatable.
The most effective and proven treatment is an oral medication, taken for three months, that kills the fungi from within the nail, and a new nail then grows in the space. And if you’ll ask, “Won’t that kill my liver”? I’ll answer, “Probably not.” As most patients seem to know, the medications are metabolized through the liver, so a patient with a history of liver disease, even if it’s cured and stable, cannot take this medication. Sorry, Bob Weir and David Crosby. And in my NYC podiatry office, all patients who are considering oral therapy must start with a simple test to confirm the diagnosis of toenail fungus, as well as a blood test to check the liver function.
There are, of course, other medications, such as a topical medication, applied to the nail, which is designed to kill the fungus. This medication, while devoid of any major side effects, carries a low cure rate as it may not penetrate to where the fungus lives under the nail. And there are lasers available in my NYC podiatry office for the infection as well. So far, the cure rates are very positive, and there are no side effects, other than a loss of some money due to the fact that as of now, fungal laser treatment is not covered by insurance.
And no matter the treatment, the infection can always recur. So just remember to keep the feet dry, especially in the summer, and if you suspect a fungal nail infection, see your NYC podiatrist.
See you in the office.
Dr. Ernest L. Isaacson
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