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Embarrassing foot problems: Fungal nails


If you suffer with fungal nails, you're not alone. One in 4 people are affected at any given time.


Fungal nails appear to be more prominent in older people, those with compromised immune systems, diabetes and poor circulation to the feet. However they can affect anyone.


Onychomycosis is the medical term for fungal nail infection which causes the toenail to become discoloured, thickened and crumbly.


What causes it?

The fungus responsible is usually the same as the athlete’s foot fungus which infects the keratin in the outer layer of the skin. If untreated, this skin infection spreads to keratin in the nail, resulting in a fungal nail infection. Other types of fungus such as yeasts or moulds are less common and tend to infect nails that are already damaged. Warm, moist environments encourage fungal growth.


Signs & Symptoms

· Discolouration of the nail (yellow/brown/white)

· Infection usually spreads from the top of the nail, down towards the base, eventually covering the nail

· Thickening of the nail

· Fragile/cracked/crumbly nail

· Not usually painful unless nail thickness causes footwear pressure

· Often occurs along with a fungal skin infection


Prevention

· Keep feet clean and dry

· Avoid walking barefoot in communal areas

· Avoid putting cream between the toes

· Never cut the cuticles as they form a seal to protect the nail

· Wear breathable footwear and natural fibre socks such as bamboo

· Rotate footwear to allow shoes to air dry

· Treat any athletes foot infection of the skin


Treatment


Whilst treating the nails, it is important to make sure any skin infection is treated. Spray all footwear with antifungal spray and wash socks on a hot wash (at least 60 degrees) or better still, replace them. Fungal spores can survive a normal wash and repeated wear can reinfect your skin.



Treatments applied to the nail (topical treatment)

Topical treatments are most effective at early stages of infection. The most common Topical treatment is Amorolfine laquer which is usually applied once or twice a week.

Cure rate is lower than oral medication but regular podiatry treatment to remove abnormal nail material with nail nippers or a nail drill helps the treatment reach the nail bed, where most of the infection resides. Treatment must be used long term and can take up to 12 months.


Lacuna/nail fenestration

This treatment involves drilling tiny micro-holes through the nail plate at the area of infection. The medication is inserted through the holes using a small syringe to help the treatment reach the source of infection, which is in the nail bed under the nail. The patient then applies Lamisil spray (a fungal skin treatment) daily, with intermittent podiatry appointments to re-drill the holes.


Oral medication

Before prescribing tablets for fungal infection, the GP will usually require a nail sample to confirm the diagnosis. It is advisable to ask a podiatrist take the sample, to help prevent false negatives. Side effects are more common in oral treatments. Some medications interact with these drugs and some can affect the liver, so you may require blood tests before starting treatment.


Toenail reconstruction

If you feel embarrassed about the appearance of your nails, toenail correction/reconstruction can offer a solution to this. The cosmetic appearance is improved which in turn can improve wellbeing and confidence.

Toenail reconstruction involves rebuilding or repairing a damaged nail using a gel prosthetic nail, designed to be suitable for toenails due to its flexible structure. The gel contains an antifungal agent to help prevent spread of infection. The nail is prepped, removing any lose, crumbly nail and the gel is then applied in layers and cured under an L.E.D nail lamp. This treatment is purely cosmetic to improve aesthetic appearance and restore confidence. The nail last’s on average 6 to 8 weeks, so is great for summer months.


Other treatments

Some podiatrists offer laser treatments, but these are less effective than topical or oral treatment. Herbal treatments are not evidence based so we do not know about their safety or effectiveness.


For a fungal nail assessment and treatment with Ayres Health, go to the booking tab and choose 'Podiatry-footcare' to book online, or call our reception team on 01260 408514.

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