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Toes

Information on Fungus Nails

Onychomycosis, is a fungal infection of the toenails that affects approximately 3% of the U.S. population. Like any infection, it can spread from one toenail to another over time and is seen almost without exception with an athlete’s foot infection. Keep in mind that no physician can verify a fungus infection without a laboratory test of the affected toenails to confirm the diagnosis. Treatment options vary from observation (do nothing), treatment with medication, and/or surgical intervention. This may occur rapidly or slowly with a spontaneous resolution of no more than 6%.

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Topical medications have a low degree of success because they do not have an ability to penetrate to where the fungus lives and therefore has a success rate of approximately 10%. Oral medications have a much higher success rate as they have ability to reach the source of the fungal infection via circulation. The most successful oral medication is terbinafine. It is taken as a pill once a day, every day for 90 days once liver function tests are done to ensure no pre-existing liver disease is present. After one year, success rates are approximately 70%. If after one year, a second dosing is required, success rates are approximately 90%. Surgical intervention is at times recommended because the deformity of the nail caused by the fungus may cause it to “in-grow” and may be painful, cause bleeding, and/or develop a bacterial infection.

Laser treatment of the fungal nail has been approved by the FDA on October 10, 2010 “for use for the temporary increase of clear nail in patients with onychomycosis” (i.e. fungal nails) http://www.accessdata.fda.gov/cdrh docs/pdf9/K093545.pdf. I do not perform laser treatment for fungal nails within my practice because of the temporary nature of this treatment, as laser treatment does not effectively address the infectious component of this disease process when compared to other reliable methods of treatment.

Information on Ingrowing Nails

Ingrowing toenails occurs when one or both borders, and at times the entirety of the nail, become deformed and grow into the skin of the toe. The medical term for an ingrowing toenail is “onychocryptosis.” In addition to being painful, serious medical issues can arise should the nail cause an infection of the skin or underlying bone.

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An ingrowing toenail is a structural deformity of the toenail that arises from an injury to the nail root. At times, the injury can be relatively small (such as a pair of shoes that may be a little tight). This mechanism involves repetitively traumatizing the toenail each time a step is taken (10,000 steps/day on average). It can also be caused by a single event injury such as stubbing your toe on something immovable. Because of the structural nature of this problem and the fact that it typically occurs from an injury to the nail root (the area from which the toenail grows), simply trimming the nail back or doing “bathroom surgery” on it will fail to provide any type of long term relief. It can even cause worsening of the condition and increase pain and discomfort, cause bleeding, and possibly infection. Even if relief is obtained, usually the pain and discomfort return within one to two weeks. When the area around the toenail becomes tender, red, swollen, even if there is no pus or bleeding present, this nail has probably become infected. If there is bleeding and pus associated with the toenail in addition to being tender, red, and swollen it almost certainly is infected and requires medical and often surgical intervention. Medical intervention often times involves oral antibiotics, a dressing, soaking instructions, and if necessary, consideration of a surgical procedure to attempt to permanently correct this problem and to keep it from coming back. The procedure itself would be tailored to the needs of the patient and is typically well tolerated once pre-operative planning has been completed. If there any questions, please do not hesitate to contact our offices.

Information on Hammer Toes

Hammertoes are contractures of the lessers toes of the feet (the second, third, fourth and fifth toes). These contractures can occur and be benign in nature in the sense that they do not cause pain, blisters, nor shoe gear difficulty. Hammertoes can become worse with time and cause significant issues regarding one’s foot health.

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Hammertoes are structural deformities of the foot that occur typically based off of instability within the foot during the gait cycle. We take approximately 10,000 steps/day and in an unstable foot the toes may be required to “claw” at the ground to help stabilize the foot. With time the hammertoes may go from being “reducible” or “flexible” to “rigid” or “inflexible.” As the hammertoes become more significant, the amount of contracture typically increases and shoe gear issues may occur. Most shoes available “off the shelf” are unable to fit a significant hammertoe deformity. Pain from hammertoes can come from two areas in most cases. The top of the toe (the area over the “knuckle” of the toe). The top of the toe becomes painful because the knuckle area is rubbing against the top of the shoe and this can cause pain, blisters, calluses, and even wounds and infections on occasion. One can also have pain at the tip of the toe. This area becomes painful because it has been converted to the weight bearing surface of the toe. The bottom of the toe (like the bottom of your finger) has a cushioning fat pad. The tip of the toe does not, the repetitive striking of the ground with the tip of the toe (even while wearing a shoe) in addition to causing pain, blisters, calluses,wounds and infections, can also cause toenail issues such as ingrowing toenails. Treatment for hammertoes can vary. At times the symptoms of hammertoes may respond to conservative care such as shoe gear suggestions, prescriptive insoles, and/or prescriptive shoe gear. There are times, however, that the hammertoe has become so significant that it can not respond to conservative care. Surgical intervention may be considered at this time. The individual surgical procedure would be tailored to the individual patient’s needs during pre-operative planning. If there are any questions regarding hammertoes, we encourage you to contact our office directly.

Information on Bunions

Bunions or Hallux Abducto Valgus (HAV) deformities are one of the more common deformities encountered in the foot. There are several different types of bunions. Hallux Abducto Valgus refers to the first toe drifting toward the second toe. This deformity at times can be so significant that it may allow the first toe to lie on top or underneath the second toe.

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One in ten individuals in the United States suffers from some type of foot deformity or pathology. There are approximately 2.75 million people who suffer from bunions alone in the U.S. Bunions affect women at an approximate 4:1 ratio versus men. Patients usually seek treatment for their bunions when the bunion becomes painful, makes shoe fitting difficult and/or when it causes another structural problem such as a hammertoe (a deformity of the 2nd, 3rd, 4th or 5th toes). Non-treatment, conservative treatment as well as surgical treatment options are available for most patient’s bunions. People and their bunions are different and it is important to have your feet properly assessed so that a treatment plan tailored to your individual needs can be rendered. If you or someone you love suffers from painful bunions, I urge you to call me, Dr. Michael Wood at the Foot Health Institute.
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