So, your toenail doesn't look like it did when you were seventeen.
To be honest, your face probably doesn't look the same either, but this is a podiatry blog, not a plastic surgery one, so I will get back to the subject at hand: your toenails!
Maybe your toenail is yellowing, thickening, white and flaky, or maybe crumbling like a poorly built starter home. Either way, there are reasons why your toenail has decided to become a rather unsightly part of your skin, and there are things you can do about it. The most likely culprit is: toenail fungus (onychomycosis). That being said, it is a good bet that if you have toenail fungus, that you also have a fungal infection of the skin of your feet as well. Some studies say it is a 100% probability. Most podiatrists or dermatologists can give you a pretty definite "yes" or "no" just by simply looking at your toenails as to whether you do indeed have the honor of having a toenail infected with fungus. Sometimes a small sample of your nail will need to be sent to a lab to get the final and definitive approval of some lab geek that spends his or her day testing toenail parts for the presence or absence of fungus (and you thought your job stunk).
If the lab results come back positive for fungus, you are left with five basic options:
1. Do nothing. There are worse things than having a funky toenail.
2. Use topical antifungals.
3. Use oral antifungals.
4. Use laser therapy.
5. Use a mixture of topical and oral antifungals as well as laser therapy.
Topical antifungals (prescription topicals) are effective in the treatment of toenails fungus, just be prepared for a slow, long slog of daily applications, for up to one year or more. The effective rate is hard to get a good idea of, as so many patients simply give up using topicals after months of treatment without seeing any improvement. Oral antifungals, the historical gold standard of toenail fungus treatment, are usually taken over a three month course, and the treatment also suffers from slow progress, but taking a pill is much easier than bending over to put medicine on your toenails every day for months on end. The negative of the oral medicine, however, is drug interactions, possible liver damage, and weird side effects such as loss of taste and smell! Blood work is recommended prior to starting oral therapy and during the course of medication as well in order to monitor the effect on your body. Laser therapy, the newest from of treatment, has no side effects and shows an effectiveness rate very similar to the oral medication (generally in the 85% range in my experience). If you have neuropathy or nerve loss sensation you should probably not get laser therapy as you might suffer a burn from the laser. There are usually three to four treatments and they are usually spaced out over a few weeks. Unfortunately, laser therapy is not covered by insurance, and can be expensive.
No matter which form of treatment you choose upon, treatment of your skin is imperative as well, with topical antifungals and anti-fungal foot powder as well. Throw away any disgusting yard shoes or house slippers that you got back in college. They are nothing more than reservoirs of foot disease and should bring shame upon your otherwise good family name. Bleach your bath tub and bath mats and go on a cleaning binge.
It is best to see a podiatrist to check out your toenail problems not only so you can get the right treatment for your toenails, but also to give you a definitive diagnosis that you in fact do have toenail fungus. Eczema, psoriasis, and allergies to dye in your shoes among other things can cause your toenails to get funky. No point in spending your precious time and money treating a non-existent toenail fungus!
Got a funky foot or toenail?
Come see Dr. Z!
Erik Zimmermann, DPM
923 W. Dixie Ave. Suite B
Leesburg, FL 34748
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