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Toenail fungus more common in elderly and diabetics

Toenail fungus is not just a cosmetic problem. It‘s an infection of the nail. Fungal infection, a condition called Onychomycosis (ON-i-ko-my-KO-sis) is caused by germs called dermatophytes. It’s extremely common, affecting more than 35 million people in the United States alone. However, some 90 percent of these persons have not seen a doctor for any treatment. It is estimated that only 2.5 million Americans see a podiatrist annually for treatment of toenail fungus, however many more are infected. These individuals never seek help because they think toenail fungus is just a cosmetic problem that doesn’t need to be treated and cured. Toenail fungus affects two to 18 percent of all people worldwide and three to five percent of the people in the United States. It is relatively rare in children, affecting only about one out of every 200 people younger than 18. The likelihood of getting toenail fungus increases with age, and almost 50 percent of people have at least one toe infected by the time they reach age 70.

Risk factors

Anyone who wears tight-fitting shoes or tight hosiery is more likely to develop toenail fungus, especially if they also practice poor foot hygiene. Another risk factor is wearing layers of toenail polish for a long time, which prevents the nail from breathing. Toenail fungus can spread from foot to foot on the floors of showers and locker rooms. More often the condition also tends to affect people with chronic illnesses, such as diabetes or HIV and circulatory problems that decrease blood flow to the toes. The elderly also get fungal infections more often. However, many people have no identifiable risk factors for getting toenail fungus.

Toenails on the big toe and little toe are the most likely to develop fungus. This is because these toenails constantly receive mild trauma or friction from the sides of shoes. This trauma allows the fungus to enter the nail. Once these tiny organisms find their way under a nail, they begin to grow and infect the nail. The toenails make it easy for the fungus to grow since they spend most of the day in a dark, warm, and often moist environment in shoes and socks. This is the ideal environment for the fungus to grow.

Symptoms

When fungal infection begins to take hold, it can cause the nail to change color from a light to dark yellow, green, brown or even black. Fungal dust may collect under the nail, causing a bad smell. The nail may thicken and become flaky or lift away from the nail bed. Thick toenails may cause discomfort in shoes and make standing and walking uncomfortable for some people. They can also cause ulcers to the nail bed, which may not heal especially in diabetics. Moreover, because a fungal nail infection is an infection, it can spread to other nails, and possibly to other people. Something as ordinary as an emery board can carry the fungus from an infected nail to a healthy one.

How you get it

Fungal nail infection has little to do with personal cleanliness. Something as simple as banging a toe, trimming your nails too closely, or wearing tight shoes is enough to weaken the nail and expose the underlying nail bed to infection. The fungus that causes the infection resides in many common places such as locker rooms, swimming pools, showers, even in your garden. It is possible to get the infection while getting a manicure or pedicure from instruments that may have been used on others with the infection and not properly cleaned. Fungal nail infections are more common in persons with a history of athlete’s foot (a fungal infection of the skin) and those who sweat a lot on the feet.

Treatment

Fungal nail infection won’t go away on its own. There are almost as many home remedies as there are infections, but most of them do not work, and if they do, they take a very long time. The most effective treatments are available from your podiatrist and may include one or a combination of treatments such as topical (cream or liquid on nail), oral (pills), laser or surgical methods. The fungal infection can be treated and cured but it takes some time. On average it takes about 10 to 12 months for a new nail to grow based on how bad the nail infection is.

Preventing toenail fungus

Proper foot hygiene and regular inspection of the feet and toes are the first lines of defense against toenail fungus. Steps you can take to better care for your toenails:

• Wash feet with soap and water daily and dry them thoroughly; clean, dry feet resists fungal infection.

• Shoes or sandals should be worn in public areas such as poolside or showers.
• Wear clean socks, or stockings and change them daily.

• Toenails should be clipped straight across to prevent them from growing too long and to avoid trauma to the nail.

• Do not wear shoes that are too tight or that cause the feet to sweat.

• Wear synthetic fiber socks that tend to wick away moisture better than cotton.

• Use a separate pair of clippers and file on the infected nail, to avoid spreading the infection to other nails and disinfect instruments used for nail care.

• Don’t apply polish to nails infected with a fungus.

• Consider replacing old footwear to prevent re-infecting foot and nail.

• Have athlete’s foot (skin) infection treated with antifungal medicine as soon as possible to prevent the fungal infection getting to your nails.

During your treatment, you will start to see a new healthy nail growing from the base of the nail bed. This is the sign that the treatment is working. The old infected nail should begin to grow out and can be clipped away over several months until only clear, healthy nail remains. Nail re-growth takes some time, so be patient.

• For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996, or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport, Grand Bahama, telephone 373-7400.

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