TOENAIL & SKIN CONDITIONS

TOENAIL FUNGUS

• Do You Have Thick, Yellow, Discolored Toenails?

• Are You Embarrassed To Wear Your Open-Toed Shoes In Public?

Chances are you have fungal toenails, a condition also known as onychomycosis.

Fungal toenail infections can persist for years without ever causing pain. The disease, characterized by a change in a toenail’s color, is often considered nothing more than a mere blemish, but it can present serious problems if left untreated.

There are several fungal organisms which can cause some very unsightly changes to the toenails. Just like the well-known, and well-loved, mushroom, fungal organisms generally prefer a dark, moist environment. The inside of a shoe is the perfect scenario. No wonder fungal nail infections are running rampant through our society.

Nail fungus is a progressive infection, albeit slow and gradual, inexorably worsening. Once the infection is allowed to establish itself, it usually will be a life-long presence. Some predictable changes ensue, including a variety of unusual color changes, along with thickening of the nail. Also typically noted is a distortion in the shape. The latter two alterations are responsible for most of the symptoms. The most common change in the shape of the toenail is increased curvature, so that it is more likely to grow down into the toe, causing the gradual development of “ingrown nail“ pain.

As a nail becomes increasingly affected, the nail thickens, and puts pressure on the toe. This can cause pain, or even lead to the development of an ulceration, in which there is an actual hole in the skin. For anyone with an impaired immune system, like a diabetic, this can be a dangerous situation, since the nail unit is a great place for bacteria to hang out. Thus, a simple ingrown nail can lead to a limb-threatening infection!

The fungus likes to grow in warm, moist places like your shoes. Many patients pick up fungal toenail infections in the gym locker room, from a nail salon, wet shoes or from trauma. Fungus can stay in the nails for many years and can be passed from one person to another. Treatment for fungal toenails includes topical and oral medications, which used together are very effective.

If you're tired of looking at those unsightly toenails, book an appointment now with Superior Foot & Ankle Centers.

INGROWN TOENAILS

When most people think of the services provided by podiatric medicine, care of chronic wounds, or perhaps, ankle arthritis, is not the first thought that comes to mind. Yes, these are problems the average podiatrist will treat, but, in the mind of the common man, nail problems are the most common condition treated by podiatrists. Perhaps this is appropriate, since podiatry’s roots are in the barber-surgeon, who would treat various nail or callus problems.

One of the most frequent “diseases” we see is not nearly so “interesting”, but so incredibly common that I felt it a necessity to write about it. It is a condition that befalls so many, from various walks of life, and develops for a great variety of reasons. Admittedly, an ingrown nail may not seem like a glamorous condition, and yet, due to the high concentration of nerve endings in the toes, this can be a very painful one.  A surprising aspect of this problem is the large number of causes for an ingrown nail. Some likely could be considered rather predictable, such as inappropriate cutting of the nail. When someone attempts to trim their nail back towards the base, it’s easy to leave a rough edge, or perhaps a small spike of nail. As the nail grows, and is pushed out towards the end of the toe, this spike will become embedded in the toe, and ‘voila’, they have a painful ingrown nail.

Very different is the situation whereby a fungal infection of the nail leads to malformation, with an increase in the curvature of the nail plate being the most common. With sufficient pressure, as is the case with a slimmer shoe, pain is the result. Even without the presence of a fungal infection, shoes are a common cause of ingrown nail pain.  Age can effect the shape of the nail plate, as it does so many parts of our bodies. Alternatively, trauma, such as having someone step on a toe, or a sports injury, can instigate a painful ingrown nail condition.

Whatever the cause, the nail unit is a region of the body that cannot be thoroughly cleansed, so when the edge of the nail penetrates the skin that lies alongside it, a bacterial infection is often the result. For someone with diabetes, this “minor” problem can (and has) led to amputation. To them, no infection can be considered minor. To most individuals, an ingrown nail is rarely such a grave concern, at least if the sufferer has a strong immune system, and good blood flow. The side of the toe may become swollen or red, and a bloody drainage is sometimes seen. Antibiotics are often prescribed, yet this generally is not the solution. The swelling and pain is primarily a foreign body reaction (like stepping on a tack: removing the tack is obviously critical).

Simply removing the edge of nail generally leads to healing of the immediate problem. Yet, if the cause of the problem is the shape of the nail, the ingrown nail problem will often recur. This can become a repetitive cycle, with temporary removal of the nail edge providing relief, only to see (and feel) the pain return after what may be months of respite from the pain. And this is where the treatment options get interesting.

For years, medicine has recognized that permanently narrowing the width of the nail can provide lasting relief. A number of techniques exist to achieve this goal. In one, the nail root is literally cut away, typically entailing a painful recovery, producing a disfigured toe, and often ending with regrowth of the nail edge. Nowadays, when someone presents to a physician with this problem, most of the time, an acidic chemical is used to destroy the unwanted nail root. Unfortunately, the chemical burn created is extremely slow to heal, sometimes taking months to stop draining. All that may be for naught, since the edge frequently grows back, about half the time.

A new technology has the promise to make this sort of frustration and delay unnecessary.  Popular with plastic surgeons and otorhynolaryngologists, a device utilized at Superior Foot and Ankle Centers, which produces high intensity radio-waves, is used to vaporize the cells of the nail root. This provides numerous benefits. Healing time is usually less than a week, and there is typically minimal pain. Even better, the success rate appears to be above 90%. Whatever the cause, ingrown nails are not fun to live with, and can affect your quality of life. Certainly not least, they can reduce your ability to exercise. Some, diabetics especially, should look at ingrown nails very differently, as a potentially critical situation.

All things considered, one of my more common closing statements: don’t live with pain! Come to Superior Foot and Ankle for solutions to your ingrown nail pain.

CALLUSES & CORNS

WHAT ARE FOOT CORNS & CALLUSES

A callus is an area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe. While many consider them a skin problem, they actually are systematic of a problem with the bone.

Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness.

Calluses form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus. A great deal of friction or pressure over shorter periods of time can cause blisters or open sores. Calluses typically develop under a metatarsal head (the long bone that forms the ball of the foot) that is carrying more than its fair share of the body weight, usually due to it being dropped down or due to its longer length.

Calluses can be treated with over-the-counter callus removers that have strong acids that peel this excess skin away after repeated application. You should be careful with these products as they can cause chemical burns when not used correctly. Begin by soaking your feet in warm soapy water and gently rubbing away any dead skin that loosens. A pumice stone or emery board is then used to “file” this thickened skin. Apply a good moisturizer to the hardened areas to keep them softer and relieve pain. Non-medicated corn pads or moleskin (a thin fuzzy sheet of fabric with an adhesive back) can relieve calluses, but should be removed carefully to avoid tearing the skin. Diabetics or people who have impaired nerve function, should see a podiatrist for treatment because often they cannot feel when the acid has eaten into living skin.

If you need assistance relieving calluses, contact our office and schedule an appointment with Dr. Conway McLean. Calluses can be trimmed and comfortable padding can applied to these painful areas. In addition to medication to relieve inflammation, cortisone may be injected into the underlying bursal sac to rapidly reduce pain and swelling.

A plantar callus forms when one metatarsal bone is longer or lower than the others, and it hits the ground first, and with more force than it is equipped to handle, at every step. As a result, the skin under this bone thickens like a rock in your shoe. Plantar calluses that are recurring are sometimes removed surgically in a procedure called an osteotomy, which relieves pressure on the bone.

A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a “dropped metatarsal,” which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form. A “dropped metatarsal” can either be a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time.

How to prevent calluses:

• Switch to better shoes, or even an orthotic device.

• Buy socks with double-thick toes and heels and nylon hose with a woven cotton sole on the bottom of the foot.

Corns are calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other.

Improperly fitting shoes are a leading cause of corns. Toe deformities, such as hammertoe or claw toe, also can lead to corns. In a visit to our office, your corns can be shaved with a scalpel. Self care includes soaking your feet regularly and using a pumice stone or callus file to soften and reduce the size of the corn. Special over-the-counter non-medicated donut-shaped foam pads also can help relieve the pressure. 

FOOT WARTS - PLANTAR WARTS

Are you tired of dealing with painful, stubborn warts? Our Podiatry team at Superior Foot & Ankle Centers are very excited to announce that we have a brand new and effective treatment for surface based skin lesions, ESPECIALLY PLANTAR warts.

WARTS: VIRAL INFECTION OF THE SKIN TO TREAT

Upon reviewing the characters in many fairy tales, let us consider the plight of the poor witch, who always seems afflicted with that most hideous of conditions: the facial wart. How did such an appendage come to be? And why was it on her nose, of all places? Upon further review, we may not want to answer this last question, but perhaps we might delve into some other pertinent concerns about this very common entity.

Naturally, one of the first questions I am asked is “what is a wart”? A reasonable question, certainly, but this is not much of a mystery. A wart is caused by a particular type of virus, although not the type that causes the flu (an influenza virus). Instead, in the case of skin, it is called, a verrucoid infection. Viral organisms are quite fascinating, since they stretch the limits of the term “living”. There are aspects of viruses that don’t really fit our definition of life. Still, to this day, biologists consider them to lie in a grey zone between living organisms and a collection of chemicals.

The behavior of the common wart can be something of a mystery, as well, and highlights how much we do not know about viral infections, particularly of the skin. Virology is not a well-developed science, as evidence by the fact that we have no antibiotic for a viral infection. Certainly, we can treat the symptoms, but because viral particles replicate inside our own cells, we have no medication that can find the “organism”. The common cold is a viral infection of the respiratory system, and the modern pharmacy is overrun with products for treating this nefarious sickness, but none of them actually stop the infection. It’s simply your body’s natural defenses that eventually do that. And depending on the vitality of your immune system, this can take quite some time.

Because of changes that occur to our immune system as we age, viral infections of the skin, aka warts, are much more of a problem in the young. When an adult gets a wart on the bottom of the foot, it can be stable and unchanging for years, whereas a wart in a young person is wildly unpredictable. They can have a single lesion one day, and a few days later, there can be twenty or more. Or, alternately, a child can be cursed with many warts, present for months, causing pain on a daily basis, and see them disappear practically overnight.

Warts that infect skin have a particular appearance, tending to develop into a well-defined, localized prominence. The exception would be when the infection is spread by walking on a surface where some appropriate viral particles are present, thus causing the infection to develop on the bottom of the foot. The pressures of weight bearing prevent the growth from protruding from the skin, instead forcing it to grow into the foot. But these never invade deeper tissues, only residing in the skin.  Regardless, developing this mass is understandably painful.

Where this topic gets interesting is in the number of different treatment approaches and methods that have been utilized over the years. The commonplace options include destruction with a topical acid or application of intense cold, to simple surgery. Options get a little more unusual from there. There is application of a skin cancer medicine, injection of another, and even a “home remedy” where the wart is covered repeatedly by tape.

A rather bizarre technique is where one of the warts is cut out, and then buried beneath the skin elsewhere, in an attempt to help the body recognize the wart as a foreign invader. Perhaps the newest is the use of photo-dynamic therapy, in which the lesion is treated with a special liquid medicine that is activated by a unique light source. The positive with this method is how easy it is for the patient, that it’s painless, and the lack of any possible complication.

Many physicians find these a particularly frustrating condition. They are very resistant, prone to recurrence, and many of the therapies have significant complications. But warts are an infection, and can come to cover large areas of skin. Obviously, getting it looked at is recommended. After all, what if it’s not a wart?!