Fungal Toenails | Onychomycosis
Fungal Toenails (Onychomycosis)
Onychomycosis (on-ih-koh-my-KOH-sis), also known as “tinea unguium,” is a fungal infection of the nail. It can cause fingernails or toenails to thicken, discolor, and disfigure.
There are five subtypes of Onychomycosis:
1) Distal lateral subungual (DLSO or DSO) the most common form of Onychomycosis.
2) White superficial onychomycosis (WSO),
3) Proximal subungual onychomycosis (PSO), the least common form of Onychomycosis.
4) Total Dystrophic Onychomycosis
5) Candida onychomycosis, outbreak of fungi on the fingernails.
Signs and symptoms:
The first sign/symptom would be thickening and discolouration of the nail. The nail may change to a white, brown or even black colour. As the condition progresses, the nail may become brittle. In fact little pieces of the nail may fall off. As the fungus spreads, the nail will thicken more, and may cause the tissue around the nail to become inflamed resulting in pain.
With delayed treatment, the fungus will destruct the nail plate, nail bed (skin under the nail), and nail matrix (where the nail grows from). This causes the nail to look disfigured. The disfigurement may be permanent if enough damage has been done to the nail bed and nail matrix. Therefore, although the fungus may be erradicated, the nail may still look deformed.
There are many risk factors for fungal toenails. Fungus loves warm, dark, wet places. Therefore, communal bathing places (eg: swimming pools, showers in gyms, etc.) are common places people are exposed to fungus. In a child we often see the fungus present on the skin. However, as we age we are more susceptible to onychomycosis. Age is the most common risk factor; decreased blood circulation, longer exposure to fungus, increased thickness of the nail plate, and slower growth of the nail plate increase and individuals susceptibility.
Other risk factors include: heavy perspiration, exposure to moist environments, psoriasis, socks and shoes that hinder ventilation (eg: safety boots), previous fungal infection of the skin (athletes foot), nail injury/damage, diabetes, arterial insufficiency, and those with weakened immune systems.
Diagnosis of a fungal infection of the nail can often be made on presentation. If the practitioner can not determine the cause, the practitioner may send the nail away for laboratory testing. This testing involves microscopic examination and culture of a nail scrapping or clipping.
The easiest way to treat onychomycosis is to take preventative measures early on. However, this is not always the case. Therefore, regular reduction of the nail with an ongoing prescription of an antifungal is the next best option. If the infection is severe, surgery may be required to remove the nail, topical antifungal will be required and the nail may take approx. 1 year to grow back.
Oral Antifungals are often not used, as oral antifungals can be hard/destructive to the liver. If oral antifungals are used the patient must undergo liver enzyme testing to make sure there is not any damage to the liver. Due to this problem Oral antifungals are not very commonly prescribed.
Laser treatment is also an option. The laser heats the fungus under the nail causing it to be fungicidal (Fungal – death). This is an available option, however can be very expensive.
If you are experiencing this, please contact Waterloo Foot Clinic. Trust your foot with a foot specialist.
Frequently Asked Questions
What is a Regulated Foot Specialist Called in Ontario?
A regulated foot specialist in Ontario can be one of two names. The member may be a Chiropodist or Podiatrist. Since July, 1993 no new podiatrists have been registered to practice in Ontario in order to promote the development of the chiropody profession.
The College of Chiropodists of Ontario made a request to the Minister of Health and Long-Term Care in January 2006 to ask the Health Professions Regulatory Advisory Council (HPRAC) to examine whether a reversion to the podiatry model would better respond to the demand for foot care services in Ontario than the current chiropody model.
HPRAC's review got underway in January, 2014 and is expected to be completed by March 31, 2015.
Do I need a medical referral?
NO you do not need a medical referral. If you or someone you know needs help with their foot concerns or pain – they are more then welcome to attend the Waterloo Foot Clinic. Often we are able to offer same day appointments.
Can a Chiropodist/ Podiatrist Prescribe Medication?
YES, Chiropodists and Podiatrists are allowed to prescribe a wide range of medications to help you with your foot concerns. The medications include: oral antibiotics, oral anti-inflammatorys, topical anti-fungals, topical corticosteroids, topical antibiotics, topical anti-inflammatory and many more. Chiropodists and Podiatrists are also allowed provide injections. Some of the more common injections are corticosteroid injections and local anesthetic injections.
Are Chiropody Services covered by OHIP?
Most extended health insurance benefits cover Chiropody services. However, OHIP currently does not cover Chiropody treatments. We recommend that you contact your coverage provider prior to your appointment. If you are unable to, not a problem - one of our staff members can help identify your coverage. Our fee schedule is based on guidelines set by our professional association. We take the following forms of payment: cash, debit, cheque, VISA, and MasterCard – Depending on your insurance provider, we may be able to do direct billing.
Will my appointment be painful?
We will try our best to use our expertise and evidence based approach to assure your treatment is not painful. It is not uncommon for our patients to come in with pain, and leave stating they feel as though they are “Walking on a Cloud”. By using different modalities of treatment, and different methods we will help to make sure you are always comfortable.
What should I bring to my first appointment?
Your first appointment will include a thorough medical history and physical exam of your legs and feet. If you are a diabetic, this will include a complete diabetic foot assessment. We ask you to bring a list of your current medications and your most common worn footwear. If you have more then one pair, please bring them in.
If you have any other questions you would like us to answer, please don't hesitate to contact us.
Tips on taking care of your feet
Most of the time your feet take a beating without you even realizing it. Often, it's not until you feel pain that you begin to consider the health of your feet.
Did you know up to four times your body weight gets placed on the joints in your feet during every step?
With all that weight, it’s a good idea to give your feet a little extra attention. Here are a few tips to help take care of your feet and prevent foot conditions:
1. Be shoe smart.
Too many smart people often wear not-so-smart shoes. It's important to take a few things into consideration when you're buying a shoe. The first is to go shopping in the evening. Late in the day, your feet are tired and most relaxed/stretched. By doing your shopping in the evening, you'll be able to get the right fit for the whole day.
Next, be extra sure that you're buying the right size. If you shoe length or width is too small, it can cause a number of conditions like hammer toes, corns, ingrown toenails etc. With that said, overly large shoes can cause problems like calluses and blisters. As you can see, finding the right fit is very important. If you'd like more detail on selecting the right size shoe, check out our previous post.
Finally, pick a style of shoe that has the right support for you. A comfortable every day shoe that breathes well and doesn't trap your toes is a smart style choice. Most high heels do not provide support and can be extremely damaging to your foot's structure. Pick a round toe shoe so that each of your digits has enough room to be stretched out fully, with no cramping or pinching inwards.
2. Get daily foot exercise.
Each foot is made up of 26 bones and a collection of ligaments, tendons, nerves, and muscles. It's important to get your foot muscles the exercise they need to stay strong. Go out for a walk every day if you can. The length of the walk isn't as important as just getting out there and doing it. Keep your ligaments, tendons, and joints flexible and loose while strengthening the muscles in your feet!
3. Wash your feet thoroughly.
Make sure you give your feet an extra scrub every day. Your feet tend to be a hotspot for bacteria and fungus. No special foot washes or scrubbers are needed, just some good old-fashioned h2o and soap. If you are diabetic make sure your washing with the correct temperature water and soap that does not irritate your skin
For those of you who have dry and cracking skin, it's important to put on lotion. We recommend 2x/day. It doesn't have top be a specific brand, but try to get a colourless, non-scented lotion. REMEMBER: do not put lotion in between your toes!
5. Wear socks.
Wearing socks gives your feet an extra layer of protection. Calluses and blisters form much easier when you don't wear socks regularly. Additionally, if you are over-weight, are prone to varicose veins, or have bad circulation it is important to wear compression stockings. Compression stockings will assist with blood flow and alleviate added stress on your veins. Compression stockings are recommended for:
6. Avoid immediate skin contact in public areas.
Children, teenagers, and adults alike should all bring personal footwear when you're around a public pool, shower, change room, etc. These areas are common breeding grounds for bacteria, viruses, fungus and other pathogens. By bringing and wearing your own footwear, you will decrease direct contact and prevent spreading. Likewise, if you do have any foot condition it is important that you always wear shoes in public area's to avoid passing it along to others.
Please contact us at the Waterloo Foot Clinic if you have any questions about any material mentioned in this blog post or any of our other posts.
The Waterloo Foot Clinic Team
It is getting close to that time of year again – BACK TO SCHOOL SHOPPING! We all know how active children can be, and with all that activity chances are you've got new shoes on your shopping list. Let's work together to make sure those shoes are the right fit for your little ones foot type.
Shoes come in all different sizes and shapes. So how can you tell if the SHOE fits YOU?
Well tip number 1 that most people don't realize is you should always go shoe shopping in the evening. This is because our feet have become tired from the day's activities and tend to expand. The expansion comes from stretched ligaments and tendons as well as over worked muscles. Therefore by shopping while your feet have expanded, you decrease the chances of buying a shoe that is too tight.
It is not that uncommon to have one foot bigger than the other. Infact, it has been reported that differing foot size occurs in 60% of the population. If this is the case for you, always fit your shoes to the bigger foot.
Many people are also unaware that shoes come in different widths. We do not want a shoe that fits too tight. This can cause unnecessary irritation, blisters, callus, nail damage, wounds and more. So how do we know what width we are? Well, shoe length and width go hand in hand (or should I say foot in foot). Infact, proper shoe length is also dependent on arch length. All of this is made easy by using a Brannock Device. You may not have recognized the name, but it's the shoe fitting you've probably seen in your local shoe store. This device can help make sure you are being fitted correctly before you buy your shoes.
The following is how-to guide for using a Brannock device. Most shoe personelle should be able to fit you correctly. If not, the following directions will help. You are also more then welcome to come into the office and we will help get you the correct dimensions and size.
As you can see there are many different components to measuring your foot, and they are all needed to find the correct shoe for you and your children! Remember the shoe should also feel comfortable, dont sacrifice a comfortable shoe for style.
I hope this helps you find a back to school shoe that perfectly fits your feet! Check back soon for another post to help you learn more.
Matthew Doyle DCh
Matthew Doyle DCh, Chiropody Foot Specialist