Men's Health

Foot Problems

Written by Mark Abell

According to an old adage, "a journey of one hundred miles begins with a single step"; taking care of your feet will help with the first of those steps. And when we think feet, sometimes the care of toenails comes to mind. So, let's provide some lip service to fungal infections of the toenails, as it seems to be more common than some people think. The problem is called onychomycosis - a disease of the nails due to a parasitic fungal infection.

Although more common in the elderly, the toenail looks as if it has become real thick when actually, debris grows under the nail, separating it from the underlying bed, or the matrix which secures the nail to the toe. Generally, the disease is commonly caused by two fungi, Trichophyton rubrum and Trichophyton mentagrophytes; but forget the names - it's just another set of names for that awful infected toe. And it's a nuisance. The nail becomes yellowed or white and seems to lose its normal "luster" appearance. Pain is usually the complaint, caused by the growth under the nail, pushing upwards.

Onychomycosis can affect any nail, whether it be on the hands or toes, but it just so happens that it affects the toenails more often. While there is no "real cause" of the infection, the fact that shoes are almost always worn with socks (or hosiery), it helps create the right environment - dark and moist. Perfect for a fungus. Actually, the problem is pretty common, affecting up to eight percent of the population; and the fungi which seem to cause the problem more commonly can be found anywhere in our environment, but mostly in our towels or even our clothing. Obviously, a warmer climate would help, and it is likely that we might see more of it down here in the south than people living in the northern part of the country.

Nails, whether on the fingers or toes, are there for protection, situated at the end of our "digits" . The nail is a "plate" made of tough, dense protein, called keratin, which is produced by a set of specialized cells in our skin, called the matrix. The nail plate rests on the nail bed, which is very vascular (a lot of blood supply) - but the nail itself is not vascular. When a nail becomes "infected" as in the fungal disease, it generally takes a long time to treat because of the makeup of the nail itself and the time it took to grow. The infection didn't happen "overnight" - it has been there for quite a long time - and if the pain is the complaint, then your body is "trying to tell you something" - get it treated. Since toenails grow at a rate of about one-third of that of a fingernail, the "worse-case" scenario, then, is the great toe, which happens to also be the most common toe affected. So much for luck. And if your an older adult, you might want to know that your toenails grow much slower than childrens'.

But, that's not always the issue. We see the fungal infections of the toes often enough, at least enough to raise the issue in an article, such as this. Problems arise in the ways in which the infections can be treated. And money is usually the one issue keeping the "fungus amongus".

Traditionally, and for some time, along with trying to remove some of the debris and trimming the nail(s), the medication most often used is called griseofulvin. The medication is prescribed to take every day until complete recovery, which means until the toenail grows out again with no signs of other infection. This can take a long time, up to four to six months. Recently, however, a newer medication, called Sporonox (itraconazole), became available; it works better and quite differently. Rather than simply being available in the blood stream to kill a fungal infection, Sporonox binds to the protein that makes up the nail plate (keratin); the drug stays in the area to kill the infection, even after it is stopped. The problem with Sporonox is that it is so expensive and that it is not for everyone, since there are a lot of drug-drug interactions, side affects, as well as "contraindications" for the drug, such as pregnancy (or even thinking about pregnancy in the near future). There are a few topical creams available, such as imidazole, but they don't do to well for severe cases. Sometimes, it might be necessary to remove the affected toenail while applying topical agents because of a problem treating those with oral medications due to cost factors or drug interactions (seldene, propulcid, and halcion, for example)

When being seen by your physician for one of those "yearly" examinations, your toes should be part of the exam. In fact, a lot can be said about examining the fingernails and toenails of any patient, since it will sometimes give clues to other problems, such as heart and lung disease. There is some value in examining your body, and you ought to perform your own "full body" self-exams once every couple of months; but make sure your doctor checks your feet. They are commonly overlooked.

While the need for a thorough check up should never be undermined, the medications designed for treating fungal infections in the toes are very expensive. But a few programs exist, sponsored by the drug companies, that lend assistance for those who cannot afford the drugs. While they are not available for everyone (as in those who can afford therapy), it might be of some value to check into it with your doctor or pharmacist.

For the most part, a lot of the fungal infections do nothing more than cause a nuisance and a cosmetic problem. When the pain associated with the infection becomes the problem, it's time to talk with your doctor. More importantly, however, let your doctor see your feet - often. It could help prevent problems in the future. And it could help your pocketbook.

For more information about toenail fungal infections, check out the following URLS on the Internet:

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