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%.
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.
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.
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.