Do you suffer from toenail fungus (update)?

Advice from a Toenail Fungus Podiatrist: Yellow and thick toenails are usually note even caused by the fungus, but by the skin under the nail bed!

Kill your toenail fungus infection

Causes of a severe toenail fungus infection?

Yellow and thick toenails are not always caused by a problem with the cells that are responsible for growing the nail. Yellow and thick nails are actually caused by what is happening in the nail bed!
Dr. Bradley Bakotic , THE leading foot dermatology-pathologist (backed by cutting edge publications),  states that the toenail itself is rarely even thickened. He states that it is the skin under the toenail becomes thick and spongy; it then causes the nail to lift and the callus makes the toenail appear yellow. The thick skin under the toenail is really what is making the nail look yellow and deformed!
Over time the nails lose their blood flow from the skin underneath them and become dry, brittle and detach from the skin underneath it. The nails lose their pink appearance because the blood vessels underneath the nail plate are no longer visible. This also means that the immune cells don’t have access to the area under the nail because they are blocked off by the spongy and thick tissue. This leaves the area ripe for fungal invasion.

A less pink nail bed makes the nail yellow, not the fungus!

Only now does fungus get under the toenail

Once this process begins to happen, it creates a space for fungus to enter underneath the nail. This is why nail fungus is so hard to cure! Toenail fungus is not really the cause of ugly nails, but an inevitable progression from the callus formation under the nail states Dr. Bakotic and recent literature. The fungus is not what is causing your nail to look bad. Your nail looking bad is what is allowing the fungus to get underneath it! My mind was absolutely blown the first time I heard this!

Ask yourself these questions before kill or remove the fungus:

It is a good idea to skim over these commonly encountered problems. Otherwise you could spend months and huge $$$ attempting to treat the wrong problem!

1) How to fix severe toenail fungus?

**No need to read this if you read the stuff above, but make sure to understand that the fungus is not the only thing to fix!**

Read this before attempting any home cure!
You must understand that the fungus is not what is causing your toenail fungus. If you attempt to treat only the fungus your nails will never look better! There is something predisposing you to being able to catch the nail fungus. Read point #2 to find out why you are susceptible and if it is even worth pursuing a cure.

2)Who is most susceptible to toenail fungus

First there must be some type of trauma causing

Systemic Factors

• Old Age.
• Immunosuppression.
• Poor peripheral circulation.
• Nail psoriasis.
• Onychomycosis susceptibility genetics (very rare).

Agent Factors

• Exotic non-responsive organisms (<10%)
• This is very unlikely

Environmental Factors

• Occupational factors- excessive sweat
• Occlusive footwear
• Prolonged contact with water or sugary food

3) Is toenail fungus contagious?

Toenail fungus is not contagious unless you are susceptible to it. There is fungus everywhere, but not everyone gets it. It is only usually systemically compromised people. The people listed in #2  are more contagious and susceptible for toenail fungus because of their systemic problems. You also need to be experiencing some microtrauma and irritation; this allows the fungus a route to get under the nail.

4) Does nail polish cause toenail fungus?

It is very common to remove your nail polish and see white chalky nails. But don’t panic, it is probably not nail fungus! This is a condition known as keratin granulations almost all of the time; unless you are already susceptible for fungus and the nail polish was just masking it. There is still a chance it may be a type of nail fungus called white superficial onychomycosis; if you are worried go see your toenail fungus podiatrist because running a lab test is the only way to know for sure.

5) Black toenail fungus?

If you have black toenail fungus, then this is likely not even toenail fungus. If you suspect black toenail fungus then look at these options first:

• Bleeding under the toenail - Heavy running, traumatic injury or new shoes can cause this.
• A mole underneath the toenail – If it is a black streak or a linear smudge.
• Pseudomonas infection- if it is black and green.

What should you use to clear and eliminate your toenail fungus:

Should you try a  Natural Home Cure? Or go straight to the podiatrist for heavy duty treatment? If you meet the criteria for option number 1 – you should try using home, natural or topical treatment first. There is no guarantee that it will work, but there is no harm in trying it out. Going to a good toenail fungus podiatrist will  boost your chances from about 0% in severe toenail fungus to above 90% according to published medical studies.

1) Natural, Homeopathic Home Remedies or Topical Creams:

The home remedies and topical creams are not very effective on their own. They normally work under 40% when the conditions are right. If the conditions are not right, then there is virtually a 0% chance of them working. This does not mean that they are bad, you can combine for greater effect with strategies I will show you. There is also no harm in trying the easy solution first and seeing what happens. So see if you qualify for these home remedies:

Use Home Treatment or Over The Counter Medication if:

• Area of nail involvement is under 50% of the total nail surface.
• There is no ingrowing of the nails into the skin edges.
• The nail is not painful.
• The skin under and around the nail still looks normal and has not yet become thick.
• No White, yellow, orange, brown streaks in the nail exist.

2) Go see your toenail fungus podiatrist:

**Unfortunately if your nail is over 50% involved, it will be very difficult (but still possible) to cure your nail fungus at home**
A toenail fungus podiatrist can provide you with many services such as evaluating why you are predisposed to toenail fungus in the first place. They can correct these problems and make sure you are not susceptible for further toenail fungus. They can also place you on systemic medications, which when combined with dremeling and topical medications can produce an 90%+ cure rate.
You need a Podiatrist if:

• If you have trouble walking or have toe pain.
• If you have never been evaluated for why you have space under your toenail.
• If this is all very overwhelming to you.
• If all toenails are 100% involved, thick or crumbling.
• Immunosuppression (Diabetes, Rheumatoid arthritis or any systemic disease).
• Diminished peripheral circulation (Peripheral vascular disease, smoking, high blood pressure or more).
• Poor nail growth (nail has detached before, loose edges).
• If you are over 65 years of age.
• If you are a child under 18 years of age.

How to get cured: the home treatment review guide

Note #1: Be careful using any of these methods at home- this guide is for educational use only and should never be attempted without a toenail fungus podiatrist for supervision.
Note #2: Remember that any home treatment or topical medication will only give you a 40% cure rate. And that is if you qualify for home treatment. Home Treatment or Over the Counter Medications will not work if you have any of the following:

• >50% nail involvement.
• An entire hand or foot involved.
• Any systemic abnormalities that will depress your immune system: Smoking, PVD, Diabetes etc.
• Any of the criteria listed above.

Note #3: If you still want to try these- your toenail fungus won’t get any worse. It may even be advised that these be combined with the more advanced systemic medications. Check with your toenail fungus podiatrist.

Home treatment reviews (in progress- check back again!)

Before you get started, get one of the following tools:

• Emery Board.
• Nail File.
• Pumice Stone

Thinning your nails makes treatment 25%+ more effective!

Studies show that using an emery board to file your nails down in thickness increase the effectiveness of all of the following treatments by 15-25%. This is especially impressive when they only had a 40% chance of working in the first place!

A thick layer of fungal biofilm needs to be removed to allow treatment penetration.

The toenail fungus can create a thick impenetrable layer of biofilm that prevents treatment agents from entering into the nail bed. This lack of penetration under the nail plate is the #1 cause of treatment failure!
Research states that as you thin down your nails with an emery board or a pumice stone as described in treatment, you gain a 15-25% increased chance of the following treatments in working for you. So trim and thin your nails before the following treatments are tried!

A)Vick’s vapor rub treatment

• A Spanish study states that Vick’s Vapor rub is very effective.
• The Mayo Clinic states that while many people vouch for this treatment method, it is difficult to prove that the Vick’s Vapor Rub is effective.

Vick’s Vapor Rub contains ingredients which have been independently proven to have anti-fungal properties in studies.

• Camphor (4.8%).
• Thymol (1.2%).
• Menthol (2.6%).

What to do:

1. For this to work, you must fix whatever is allowing you to be infected with toenail fungus in the 1st place.
2. Rub it onto your nail every night before you go to bed.
3. Put some socks over it so it does not get onto your sheets.
4. It is essential that you do this for at least 6 weeks to 3 months to eradicate the fungus from your nails.
5. The nails then need 6-9 months to grow out.

B)Apple cider vinegar soak treatment

• A Michigan State University (MSU) study shows that Vinegar has anti-fungal properties.
• The MSU study has specifically to reduce nail fungus symptoms and even cure the fungus, but it was in very superficial fungus in completely healthy people.
• Apple Cider Vinegar provides a inhospitable acidic environment for the fungus. It is common to hear stories about how pouring just a little bit on foot skin fungus has made people almost instantaneously better!

What to do:

1. Pour some apple vinegar or some white vinegar (either is fine) into a tub of warm water.
2. The mixture can be 50/50 or 33/66 if your skin becomes irritated.
3. If the skin becomes irritated, then slow the treatment down; do it every second day instead of every day.
4. It is essential that you do this for at least 6 weeks to 3 months to eradicate the fungus from your nails.
5. The nails then need 6-9 months to grow out.
6. Put lemon or orange peels into the vinegar while you are storing it within the fridge, this will help eliminate the vinegar smell.

C) Listerine treatment

There is much less research behind using Listerine for toenail fungus. But like vick’s vapor rub, there is a good amount of testimonials stating it works, and the ingredients are anti-fungal. Thus there has to be something behind it.
Listerine contains the ingredients which have been independently proven to have anti-fungal properties in studies.

• Camphor.
• Thymol.
• Menthol.

What to do:

• The goal is to rub it onto your nail every night before you go to bed for six weeks.
• Pour some Listerine into a tub of warm water.
• The mixture can be 50/50 or 33/66 if your skin becomes irritated.
• If skin is irritated do it every second day instead of every day.
• It is essential that you do this for at least 6 weeks to 3 months to eradicate the fungus from your nails.
• The nails then need 6-9 months to grow out.

Prevent toenail fungus from coming back!

It is amazing how difficult it is to treat your fungal nails, but then people jump right back into the situations that caused it in the first place. It is essential that you start to control your sweating, correct your footwear (and throw out the disgusting gym shoes!), use anti-sweat powders and use lysol to spray down your old shoes.

The prevent toenail fungus from coming back guide 

 

For more information and updates about treatment of toenail fungus see this link.

Do you have foot warts (Verruca)?

A foot wart, verruca or plantar wart is no different than a wart on any other part of the body. These warts eventually go away by themselves, but they are potentially contagious and could stay around for a couple years; treatment is usually recommended to decrease the length of pain, the duration of pain and to decrease the chance of transferring it to other parts of the body.

Cause of a foot wart or verruca

• HPV (Human Papilloma Virus) is the cause of warts.
• The virus can stay alive for many weeks without a host ,especially in the shower!
• The wart enters through microscopic cracks in the skin of the foot or the fingers.
• If a cluster of warts forms, it is called a Mosaic wart which can create extremely large surface areas.
• It is completely normal to get a wart – most warts occur in 12-16 year old children, but are very rare in older age.

Symptoms of a  foot wart or verruca

• Not usually painful although may be tender when pressed, especially from the sides.
• The verruca may feel like a small stone under the foot.
• It looks different from a callus because of little red pin like dots- a callus looks like normal but thicker skin.
• There is usually a callus that forms around the wart.

Diagnosis of a foot wart or verruca

• Verrucas vary in size from a 1mm to over 1 cm and may vary in shape too.
• The surface of the verruca is usually covered with small black dots (blood vessels).
• They are usually surrounded by hard skin.
• There is usually nothing ever really tricky about diagnosing a wart.
• If the wart is really large then it is a more resistant mosaic wart that needs more attention.

Prevention of a foot wart or verruca

• Warts and verrucas are very common and nothing to get worked up about (especially ages 12-16 years old), although they should be treated as they are mildly contagious.
• They are only passed on via direct skin to skin contact and can be passed to other people or to other areas of your body (although this is more common when warts appear on the fingers).
• There is a higher risk of passing a verruca  if the skin is damaged or wet.
• Swimming pools are common infection area for verrucas.
• To avoid passing on a verruca, make sure it is covered when you go swimming (either buy a waterproof plaster, duct tape or special verruca sock), wear flip flops when walking barefoot and in the shower and don’t share towels.

Home treatment of a foot wart or verruca

There are many available treatment methods without a clear winner, because even doing nothing after a little while will make the wart go away! Studies show that you can make them go away a little bit faster and some of the best treatments achieve 70-90% cure rates within a couple weeks. If you have a mosaic wart then the chemical treatment approaches are recommended.

1st line therapy of a foot wart or verruca

- Duct Tape is my favorite method to try first!

A) Duct tape treatment

This is a controversial treatment method, some scientific literature states that it works great and it can resolve the majority of warts over a couple weeks, but then other papers say it does not work at all. I say whats the harm in trying it! This method has always worked for me, and if it didn’t work in the future- you can always move on to the other treatments!

B) Apple cider vinegar treatment

- Theoretically this should work, there will be some pain! Compare this to the duct tape method which is slower, safer and has no pain.

C) Salicylic acid

- This medication is known as a keratolytic agent which works by “loosening” the surface of the wart. Use this medication as directed by your pharmacist or your podiatrist.

2nd line therapy

- All of these have shown to be effective, but it is unclear which is the best (which means none of them are clearly better than any other). Canthardin and Cryosurgery are the most commonly used in podiatrist offices.
- Canthardin- This is a more painful but more effective agent than salicylic avid. It causes a blister to form within a day or so of application to your blister.
- Cryosurgery- The wart is touched by a liquid nitrogen swab. This freezes the cells of the wart destroying the tissue and stimulating new tissue to come up behind it. This sounds a lot more intense then it really is!
- Immunotherapy- This is a fairly new treatment that involves injecting something (any dead foreign particles that are not dangerous) that irritate your immune system to attack this area. As a “coincidence” the immune system cells wipe out the HPV virus that is causing the wart.

3rd line therapy

- The most common method is to cut the wart out and then use electricity to singe the underlying tissue under anesthesia.
- If the wart is extremely resistant consult a podiatrist about invasive treatment. These treatments are usually reserved for warts that have survived the first and second lines of treatment.
- Surgery- This can be done inside the office if the foot is not massive, but if it is a large mosaic wart- then the OR is usually necessary. The foot is numbed with anesthetic, then then the wart is simply cut out down to bleeding. The tissue is then heated to close it up; don’t worry, you won’t see whats happening! The wart can be considered as good as gone at this point and while there will be a scar, it should not be something that ever bothers you.
- Electrocautery- this is combined with surgery to burn the area where the wart used to be.
- Laser Surgery- It is a choice, but from what I have heard and seen it is more expensive than practical.

To learn more about foot warts visit this link.

Do you experience allergic reactions (dermatitis) on your feet?

There are two types of dermatitis caused by substances coming in contact with the skin: primary irritant dermatitis and allergic contact dermatitis. The primary irritant dermatitis is due to a non-allergic reaction of the skin resulting from exposure to an irritating substance. Allergic contact dermatitis is the allergic sensitization to various substances.

Primary irritant Dermatitis
People who work in areas where their feet are exposed to repeated or prolonged contact to chemicals, oils, or wet cement can develop primary irritant dermatitis. There are certain solutions that people soak their feet in as home remedies. Some of these solutions are safe if used properly, but their improper use can cause a significant contact dermatitis. This can result in skin break down and infection. This is particularly dangerous in people with diabetes; the result can be devastating and limb threatening. A common misconception is the value of soaking in hot water. Some people believe that the hotter the water the better. Quite to the contrary, hot water can cause damage to the skin and result in first or second-degree burns. People will soak their feet in all sorts of solutions. Common solutions are bleach, vinegar, salt water and iodine-based solutions such as betadine. If used properly and under the guidance of a doctor, these solutions can be beneficial. A common mistake that is made is to create solutions that are too strong. Should this occur, irritation to the skin and the development of a rash can develop. The dermatitis that results can also become secondarily infected.

Allergic contact Dermatitis
Allergic contact dermatitis is the result of exposure to substances that sensitize the skin, so that each time one becomes exposed to it again, an inflammatory reaction will occur. Some people are allergic to the substances in the dyes of socks or the materials used to make shoes. The rash that develops is in a pattern that reflects the exposure to the substance. Adhesive tapes can cause an allergic reaction with blisters or a rash developing beneath the tape. Not all blistering or rashes from tape on the feet however are an allergic reaction. Because of the heat and the accumulation of moisture beneath the tape an acute athlete’s foot infection may occur.

Treatment
Treatment should be directed at the cause of the dermatitis. Burns should not be treated with ointments because ointments are too occlusive and can trap the heat in the burned tissues resulting in further tissue damage. Cool compresses are soothing and can limit the damage caused by the burn. The dermatitis caused by the soaking of the feet in concentrated solutions act like chemical burns and cool compresses are also useful in this instance. Dermatitis caused by an allergic reaction will respond well to topical steroid compounds like hydrocortisone cream. Steroid creams should not be used unless you are certain that the condition is caused by an allergy. Cortisone creams will mask infection and allow infections to get worse while reducing the normal inflammatory reaction associated with infections. Anti-fungal creams are useful in the treatment of athlete’s foot that may be caused by occlusion under adhesive tape.

To learn more about thi9s conditions visit this link!