Do you have toenail fungus?

Advice from a Toenail Fungus Podiatrist: Yellow and thick toenails are usually note even caused by the fungus, but by the skin under the nail bed!

Kill your toenail fungus infection

Causes of a severe toenail fungus infection?

Yellow and thick toenails are not always caused by a problem with the cells that are responsible for growing the nail. Yellow and thick nails are actually caused by what is happening in the nail bed!
Dr. Bradley Bakotic , THE leading foot dermatology-pathologist (backed by cutting edge publications),  states that the toenail itself is rarely even thickened. He states that it is the skin under the toenail becomes thick and spongy; it then causes the nail to lift and the callus makes the toenail appear yellow. The thick skin under the toenail is really what is making the nail look yellow and deformed!
Over time the nails lose their blood flow from the skin underneath them and become dry, brittle and detach from the skin underneath it. The nails lose their pink appearance because the blood vessels underneath the nail plate are no longer visible. This also means that the immune cells don’t have access to the area under the nail because they are blocked off by the spongy and thick tissue. This leaves the area ripe for fungal invasion.

A less pink nail bed makes the nail yellow, not the fungus!

Only now does fungus get under the toenail

Once this process begins to happen, it creates a space for fungus to enter underneath the nail. This is why nail fungus is so hard to cure! Toenail fungus is not really the cause of ugly nails, but an inevitable progression from the callus formation under the nail states Dr. Bakotic and recent literature. The fungus is not what is causing your nail to look bad. Your nail looking bad is what is allowing the fungus to get underneath it! My mind was absolutely blown the first time I heard this!

Ask yourself these questions before kill or remove the fungus:

It is a good idea to skim over these commonly encountered problems. Otherwise you could spend months and huge $$$ attempting to treat the wrong problem!

Solutions to save time and money!

1) How to fix severe toenail fungus?

**No need to read this if you read the stuff above, but make sure to understand that the fungus is not the only thing to fix!**
Read this before attempting any home cure! You must understand that the fungus is not what is causing your toenail fungus. If you attempt to treat only the fungus your nails will never look better! There is something predisposing you to being able to catch the nail fungus. Read point #2 to find out why you are susceptible and if it is even worth pursuing a cure.

2) Who is most susceptible to toenail fungus

First there must be some type of trauma causing
Systemic Factors

• old age.
• Immunosuppression.
• Poor peripheral circulation.
• Nail psoriasis.
• Onychomycosis susceptibility genetics (very rare).

Agent Factors

• Exotic non-responsive organisms (<10%)
• This is very unlikely

Environmental Factors

• Occupational factors- excessive sweat
• Occlusive footwear
• Prolonged contact with water or sugary food

3) Is toenail fungus contagious?

Toenail fungus is not contagious unless you are susceptible to it. There is fungus everywhere, but not everyone gets it. It is only usually systemically compromised people. The people listed in #2  are more contagious and susceptible for toenail fungus because of their systemic problems. You also need to be experiencing some microtrauma and irritation; this allows the fungus a route to get under the nail.

4) Does nail polish cause toenail fungus?

It is very common to remove your nail polish and see white chalky nails. But don’t panic, it is probably not nail fungus! This is a condition known as keratin granulations almost all of the time; unless you are already susceptible for fungus and the nail polish was just masking it. There is still a chance it may be a type of nail fungus called white superficial onychomycosis; if you are worried go see your toenail fungus podiatrist because running a lab test is the only way to know for sure.

5) Black toenail fungus?

If you have black toenail fungus, then this is likely not even toenail fungus. If you suspect black toenail fungus then look at these options first:

• Bleeding under the toenail - Heavy running, traumatic injury or new shoes can cause this.
• A mole underneath the toenail – If it is a black streak or a linear smudge.
• Pseudomonas infection- if it is black and green.

What should you use to clear and eliminate your toenail fungus:

Should you try a  Natural Home Cure? Or go straight to the podiatrist for heavy duty treatment? If you meet the criteria for option number 1 – you should try using home, natural or topical treatment first. There is no guarantee that it will work, but there is no harm in trying it out. Going to a good toenail fungus podiatrist will  boost your chances from about 0% in severe toenail fungus to above 90% according to published medical studies.

1) Natural, homeopathic home remedies or topical creams:

The home remedies and topical creams are not very effective on their own. They normally work under 40% when the conditions are right. If the conditions are not right, then there is virtually a 0% chance of them working. This does not mean that they are bad, you can combine for greater effect with strategies I will show you. There is also no harm in trying the easy solution first and seeing what happens. So see if you qualify for these home remedies:
Use Home Treatment or Over The Counter Medication if:

• Area of nail involvement is under 50% of the total nail surface.
• There is no ingrowing of the nails into the skin edges.
• The nail is not painful.
• The skin under and around the nail still looks normal and has not yet become thick.
• No White, yellow, orange, brown streaks in the nail exist.

2) Go see your toenail fungus podiatrist:

**Unfortunately if your nail is over 50% involved, it will be very difficult (but still possible) to cure your nail fungus at home**
A toenail fungus podiatrist can provide you with many services such as evaluating why you are predisposed to toenail fungus in the first place. They can correct these problems and make sure you are not susceptible for further toenail fungus. They can also place you on systemic medications, which when combined with dremeling and topical medications can produce an 90%+ cure rate.
You need a Podiatrist if:

• If you have trouble walking or have toe pain.
• If you have never been evaluated for why you have space under your toenail.
• If this is all very overwhelming to you.
• If all toenails are 100% involved, thick or crumbling.
• Immunosuppression (Diabetes, Rheumatoid arthritis or any systemic disease).
• Diminished peripheral circulation (Peripheral vascular disease, smoking, high blood pressure or more).
• Poor nail growth (nail has detached before, loose edges).
• If you are over 65 years of age.
• If you are a child under 18 years of age.

How to get cured: the home treatment review guide

Note #1: Be careful using any of these methods at home- this guide is for educational use only and should never be attempted without a toenail fungus podiatrist for supervision.
Note #2: Remember that any home treatment or topical medication will only give you a 40% cure rate. And that is if you qualify for home treatment. Home Treatment or Over the Counter Medications will not work if you have any of the following:

• >50% nail involvement.
• An entire hand or foot involved.
• Any systemic abnormalities that will depress your immune system: Smoking, PVD, Diabetes etc.
• Any of the criteria listed above.

Note #3: If you still want to try these- your toenail fungus won’t get any worse. It may even be advised that these be combined with the more advanced systemic medications. Check with your toenail fungus podiatrist.

Home treatment reviews (in progress - check back!)

Before you get started, get one of the following tools:

• Emery Board.
• Nail File.
• Pumice Stone

Thinning your nails makes treatment 25%+ more effective!

Studies show that using an emery board to file your nails down in thickness increase the effectiveness of all of the following treatments by 15-25%. This is especially impressive when they only had a 40% chance of working in the first place!

A thick layer of fungal biofilm needs to be removed to allow treatment penetration.

The toenail fungus can create a thick impenetrable layer of biofilm that prevents treatment agents from entering into the nail bed. This lack of penetration under the nail plate is the #1 cause of treatment failure!
Research states that as you thin down your nails with an emery board or a pumice stone as described in treatment, you gain a 15-25% increased chance of the following treatments in working for you. So trim and thin your nails before the following treatments are tried!

A) Vick’s vapor rub treatment

• A Spanish study states that Vick’s Vapor rub is very effective.
• The Mayo Clinic states that while many people vouch for this treatment method, it is difficult to prove that the Vick’s Vapor Rub is effective.

Vick’s Vapor Rub contains ingredients which have been independently proven to have anti-fungal properties in studies.

• Camphor (4.8%).
• Thymol (1.2%).
• Menthol (2.6%).

What to do:

1. For this to work, you must fix whatever is allowing you to be infected with toenail fungus in the 1st place.
2. Rub it onto your nail every night before you go to bed.
3. Put some socks over it so it does not get onto your sheets.
4. It is essential that you do this for at least 6 weeks to 3 months to eradicate the fungus from your nails.
5. The nails then need 6-9 months to grow out.

B) Apple cider vinegar soak treatment

• A Michigan State University (MSU) study shows that Vinegar has anti-fungal properties.
• The MSU study has specifically to reduce nail fungus symptoms and even cure the fungus, but it was in very superficial fungus in completely healthy people.
• Apple Cider Vinegar provides a inhospitable acidic environment for the fungus. It is common to hear stories about how pouring just a little bit on foot skin fungus has made people almost instantaneously better!

What to do:

1. Pour some apple vinegar or some white vinegar (either is fine) into a tub of warm water.
2. The mixture can be 50/50 or 33/66 if your skin becomes irritated.
3. If the skin becomes irritated, then slow the treatment down; do it every second day instead of every day.
4. It is essential that you do this for at least 6 weeks to 3 months to eradicate the fungus from your nails.
5. The nails then need 6-9 months to grow out.
6. Put lemon or orange peels into the vinegar while you are storing it within the fridge, this will help eliminate the vinegar smell.

C) Listerine treatment

There is much less research behind using Listerine for toenail fungus. But like vick’s vapor rub, there is a good amount of testimonials stating it works, and the ingredients are anti-fungal. Thus there has to be something behind it.
Listerine contains the ingredients which have been independently proven to have anti-fungal properties in studies.

• Camphor.
• Thymol.
• Menthol.

What to do:

• The goal is to rub it onto your nail every night before you go to bed for six weeks.
• Pour some Listerine into a tub of warm water.
• The mixture can be 50/50 or 33/66 if your skin becomes irritated.
• If skin is irritated do it every second day instead of every day.
• It is essential that you do this for at least 6 weeks to 3 months to eradicate the fungus from your nails.
• The nails then need 6-9 months to grow out.

Prevent toenail fungus from coming back!

It is amazing how difficult it is to treat your fungal nails, but then people jump right back into the situations that caused it in the first place. It is essential that you start to control your sweating, correct your footwear (and throw out the disgusting gym shoes!), use anti-sweat powders and use lysol to spray down your old shoes.

To learn more about toenail fungus treatments see this link.

Do you have fractured hallux?

A fractured hallux usually occur as a result of severe impact and usually have associated bruising, but there are times you don’t have much bruising at all. If you think your toe is broken from running or repetitive stress, then it is likely just a sore bruised toe or a stress fracture, not a broken toe.
The only way to know for sure is to go in for an X-ray, because if the toe is not obviously deformed then it is impossible to know for sure. There are some tricks that may sway you one way or the other, but this is risky because ***If the fracture is serious and not properly healed – you will have permanent arthritis****.

Broken 1st & 2nd toe

Rough guide for a fractured hallux vs bruised hallux:

1) Feel for a deformity – if it is uneven it is a broken toe.
2) Wiggling your toe- if no severe pain or rubbing/popping sound, may not be a break.
3)If your toe is extremely swollen (2x the size)- it may be broken.
4)Compare that toe to your other foot, if it looks shorter or bent – it may be broken.
5)Check your temperature- after a break you are more likely to have the surrounding area inflammed.

Concerns of a bruised or fractured hallux

• Pain: Instant if fracture or gradual if a stress fracture from running.
• Swelling and Stiffness occur very quickly, the toe will not look normal.
• Blood under the nail called a subungual hematoma which needs be drained if swollen, or the nail could fall off and be abnormal for the rest of your life.
• An open fracture with a tear in the skin is extremely prone to infection and will need to be treated with antibiotics at the emergency room.
• ***If the fracture is not properly reduced – you will have permanent arthritis, it is better to play it safe and get it X-rayed if it looks really bad***
• Often with fractures of the smaller toes, the patient is not aware that they have a fracture.

When to call a podiatrist for a fractured hallux?

• Play it safe and go get an X-ray right off the bat, it probably does not need surgery or the re-attachment of ligaments, but better to be safe than sorry. Most people will get arthritis and pain for the rest of their life is it is even slightly displaced.
• If the pain is getting worse, especially after anti-inflammatory treatment and icing as described below.

When to go to the ER for a fractured hallux?

• Toes turn white, blue or gray colored- *Arterial injury*
• Numbness or tingling *nerve injury*
• Play it safe and go get an X-ray right off the bat, it probably does not need surgery or the re-attachment of ligaments, but better to be safe than sorry.

Treatment

Home treatment for a fractured hallux:

• Ice: This is not just about pain! It will decrease the inflammation and decrease the time needed to heal. Put ice in a bag and hold apply it for 15-20 minutes every 2hours or so for the 1st day. Leave some cloth inbetween the ice and the skin.
• Elevation: Like above, it is more than about pain. Recline in a chair and elevate our foot while watching tv, the more the better, elevation can take days or weeks off your healing time.
• Non-weight bearing: wearing a surgical shoe or using crutches increases the healing rate and potential. There are clinic trials that correlate a reduction in body weight to healing time and quality.
• Pain medication: Ibuprofen or other anti-inflammatories are great at reducing inflammation, again this is not just for the pain, but it decreases the swelling and increases the healing speed. Check the recommended dose for your drug of choice.
• Combine icing, elevation, non-weight bearing and pain medication gives you the best chance at healing as quickly as possible.
• If it is a small toe it is possible to tape the toes together with a piece of cotton in between to keep them from bending as much.
• Play it safe and go get an X-ray right off the bat, it probably does not need surgery or the re-attachment of ligaments, but better to be safe than sorry.
  

What a podiatrist can do for your fractured hallux

• Get an x-ray to check the severity of the broken or bruised big toe.
• Reduction of the bone under anesthesia.
• Surgical shoe, cast or pneumatic compression boot to help prevent non-union or malunion.
• Surgery if the bone is displaced to prevent arthritis or deformity.
• Play it safe and go get an X-ray right off the bat, it probably does not need surgery or the re-attachment of ligaments, but better to be safe than sorry.

To see more information about a fractured hallux see this link.

Do you have swollen painful toe?

A swollen painful toe can be caused by a number of reasons. We outline and link to more detail of some of the more common ones.

 

What causes a swollen painful toe?

There are many possible reasons for a swollen toe. It could be due to a traumatic injury, overuse injury or even an underlying medical condition.
The toes consist of three bones called the phalanges, with the exception of the big toe (or hallux) which contains only 2. These bones are held together by ligaments. Tendons also pass through the toes and connect to these bones to allow movement when the muscles within the foot and lower leg contract. You will also find nerves and blood vessels in the toes.

Traumatic injuries

If you have dropped something on your toe or been involved in a traumatic incident such as a tackle or a car accident, then a swollen toe could indicate:

• A broken toe

• Bruising of the bone or surrounding soft tissue

• A ligament injury if the toe was bent backwards or twisted e.g. turf toe

• Overuse injuries- an overuse injury is one that comes on gradually, rather than following a specific incident. Pain usually gradually increases.

• Metatarsalgia

• Tendonitis – inflammation of one of the tendons in the toe.

• Bursitis – often secondary to a hammer toe and located on the top of the second toe.

   

 Certain medical conditions may result in swelling in the feet and toes:

• Gout - other symptoms will include redness, heat and pain.

• Arthritis.

• Infection.

• Venous thrombosis (blood clot).

• Allergic reaction (to anything from medications, to food, to insect bites.

   

Treatment of a swollen painful toe

Treatment will depend on the cause of the swelling. Visit your Doctor or a sports injury specialist for an assessment. If you suspect it may be any of the medical conditions listed, visit your Doctor as soon as possible.
If the swelling is as a result of a traumatic injury, swelling can be reduced by resting, applying cold therapy and elevating the foot.

For more on a swollen painful toe visit this link.

Do you have itchy rash on the arch or heel of the foot?

An itchy rash on the arch or heel of the foot is an extremely common problem to have. Since the arch of your foot is very thin, it is a prime target for feeling the effects of the itching and irritation. The most common causes are eczema, dehydration of the skin, dermatitis due to irritation by a material (sock or shoe) and athlete’s foot (Tinea Pedis). These are usually very easily treated since the offending agent can be removed or corrected and the fungus easily treated compared to the more difficult nail fungus.

Itchy Rash on the Arch or Heel of the Foot

Symptoms of an itchy foot arch rash:

• Red or violet skin color.
• Inflamed skin.
• Blisters if very severe (Assume acute fungal infection or athlete’s foot).
• Flaky dry skin (assume chronic fungal infection).
• Peeling skin.
• Bleeding and scarring from scratching.

Prevention of itchy rash on the arch or heel:

The majority of causes of itchy foot arch rashes consist of irritations that should be removed by trying to remove different materials that may be irritating your feet such as the socks, shoes or detergents. The second major cause is due to dehydration which can be prevented by wearing thinner socks, moisturizing your feet after taking a bath or shower;  The third common cause is hygiene- simply washing and moisturizing may take care of it; the fourth major cause if fungal infection which will need an athlete’s foot medication to take care of the problem.

• Allergies to a material.
• Dehydration (low humidity and wet feet that need to be moisturized).
• Overly sweaty feet due to bacteria (pomphylox which may need medication and moisturizing).
• Overly sweaty feet due to heat (need better socks).
• Insect, tick or flea bites.
• Sock material irritation.
• Shoe material irritation.
• Soap, laundry detergent or perfume irritation.
• Pregnant women hormones.
• Poor foot hygiene.
• Lack of moisturizing after bathing or showering.

Home treatment of an itchy foot arch and heel rash

First you should identify what the cause of your athlete’s foot is which may be an involved process, but try the above preventions first.

Stage 1: Remove the cause of the problem

• Wash feet your feet with soap regularly.
• Moisturize with any moisturizing cream after your feet get wet (this prevents dehydration) every time for 2 weeks!
• Change the material of your socks or any other material that may be irritating your feet (perfume etc)

Stage 2: Try an over the counter cortisone cream or antihistamine medication

• Consult with your doctor and pharmacist, but 2/3rds of itchy rashes will be taken care of with a week or so of over the counter cortisone cream.
• If this works you likely had eczema or dermatitis.
• If the rash does not get better move on to step 3.

Stage 3: Assume Fungus

• If the rash got worse with the cortisone cream or antihistamines, it is likely athlete’s foot or a fungus.
• At this point you should go see your podiatrist for some foot medication.
• 2 weeks of medication will take care of almost any athletes foot with 100% certainty.

For more on itchy rash on the arch or heel visit this link.

Do you have dry cracked feet?

Dry Cracked Feet – Stop getting annoyed by itchiness, flaking and irritated skin. Find out what’s causing it and start treating it!

Why do you get dry cracked feet?

Usually if the the skin is severely dry an cracked as seen in the picture, something is causing it. The skin on the bottom of our soles is special because it is thicker than the rest of the skin in our body. It also relies more on sweat glands rather than oil glands to keep moist, so it is more important to keep it moisturized.

• It is important to keep the bottom of the feet moisturized, it is the ultimate cure for any cause!

This thick skin is more susceptible to dehydration to to lack of moisturizing; it is also more prone to inflammatory reactions and fungal irritation.

Dry cracked feet symptoms:

If the dry, cracked feet are very severe, then something else can be causing it. The symptoms will range from the following:

• Itchy skin.
• Red skin.
• Cracks in the skin.
• Bleeding may be associated with the cracks.
• Peeling at the bottom of the foot and heel.
• Flakes and flaking.
• Rough, uneven skin.
• Development of a rash.
• Worse after showering or bathing.

Dry cracked feet causes:

• Showering or bathing.
• Inflammatory skin conditions: exczema, psoriasis and many more.
• Contact dermatitis (irritation by a harsh substance- such us a lower quality soap, or chlorine).
• Cold weather (causing dehydration).
• Low humidity in your home (causing dehydration).
• Older Age (less blood supply)
• Peripheral vascular disease.
• Smoking.
• Diabetes.

Dry cracked feet causes:

Essentially it breaks down like this:
1) Assume initially it is dryness, dehydration or an inflammatory condition.

• 2/3rds are caused by inflammatory causes: eczema, skin conditions, irritation, dehydration, sweating disorders.
• **Inflammatory Conditions are all treated the same way, but different than fungal conditions**.
• For best results always go see your podiatrist or dermatologist!

Follow the link to see part 1 of treatment guide!

2) If part 1 does not cause your foot to get better after a week, it may be a fungal infection.

• 1/3rd are caused by Fungal Irritation.
• **Fungal conditions are all essentially treated the same way, but different than inflammatory conditions**.
• For best results always go see your podiatrist or dermatologist!

The way I would treat this if it was myself:

1) Assume inflammatory causes and start treating it that way.
2) If it doesn’t start getting better after a week or so, it is most likely fungal irritation.
3) Go see your podiatrist since something more complicated may be going on.


To check more information about dry cracked feet visit this link!

Toe Osteochondroma

Do you have osteochondroma deformity in the toe or foot?

An osteochondroma is a noncancerous tumor that develops on the surface of a bone near a growth plate. The reason it develops near a growth plate is because cartilage is developing there and an osteochondroma is made of both bone and cartilage. The osteochondroma usually appears in childhood and adolescence and starts growing as the growth plate grows but then stops growing when the growth plate stops growing. The toe and foot osteochondroma deformity is usually something that should be monitored by not really worried about in most cases.

Cause of the toe osteochondroma deformity

-Osteochondromas in the foot and toe are thought to be the most common benign (non-cancerous) bone tumors by a mile, making up about 1/3rd of all benign bone tumors in the foot. Like most tumors it is not exactly known why these things happen, anything could have caused it and it could even be genetic or through a random environmental agent.
-If you start to get multiple osteochondromas in multiple regions in the body you may need to start worrying about Maffuci’s Syndrome or other multiple osteochromatosis disorders, but otherwise you should be safe.
-It is difficult to prevent these because it is very difficult to predict who will get it and why they will get it.

Symptoms of toe and foot osteochondromas

In most people they will cause no problems and will not be noticed unless you are getting an X-ray for a different reason and the podiatrist happens to notice them.
-Painless bump that may be confused with a cyst
-Lifting of the toenail is the osteochondroma exostosis is underneath the nail
-Pain on pressure because the skin and nerves are being compressed
-Numbness or tingling because of nerve compression
-Impinged blood vessel if it is very severe

Home treatment

-The best option is to go see a podiatrist where he will give you surgical options or decide to just monitory it, but most of the time you will be ok just monitoring it
-The podiatrist will use X-ray, MRI or ultrasound to come to this decision as well as the normal physical and historical exam.

Foot and toe osteochondroma surgery recovery time

-Surgical is usually advocated if the podiatrist believes that the osteochondroma is:

• Causing Pain
• Putting a Nerve or Blood vessel at risk
• It has unusual characteristics on imaging

-If removed the osteochondroma will be checked with biopsy to see if there is anything to worry about, but usually there is not.
-The toe and foot osteochondroma surgery recovery time depends on how big it is and where the location is, but usually you should be on your feet in a couple of days or even immediately in a surgical with the main worry being to just get the wound closed.

 For more information about toe and foot osteochondromas see this link.

Do you have a soft lump on foot or ankle?

A soft lump on foot or ankle is almost always a “Plantar Lipoma”, this is simply the formation of a slow growing fatty tissue. Its actually quite common on the bottom of the foot and its nothing that you should be overly worried about. A lipoma is the most common formation of extra tissue or  tumor growth(but its not dangerous); it is non-cancerous and its nothing to worry about.

What should I do?

• Usually nothing needs to be done.
• This is the most common soft tissue mass in the population
• These are technically tumors but very common.
• They are non-cancerous.
• An evaluation by your podiatrist or foot doctor should be done if you are concerned.
• If they are uncomfortable they can be removed.
• Unfortunately surgery is sometimes considered cosmetic unless there is pain.

Is it dangerous if painful?

It is almost never dangerous, and if it is not causing pain then it doesn’t even require treatment. The only time is is even something to worry about is when it is in an unusually spot and compressing against a nerve or artery, then it may have to be removed. It can also be removed if it is in a pressure bearing area that makes it uncomfortable to walk, but otherwise there is nothing to worry about.

Can it be removed if there is pain?

Unless your podiatrist or foot doctor determines that it is causing you pain or it is dangerous, these are usually considered cosmetic surgeries and some insurance companies will not pay the money to have this tumor removed.

Treatment of soft lumps in the foot or ankle

The only real treatment is to have surgery to have the lipoma removed, there is no medication you can take or change in lifestyle that will make this extra fat tissue go away.

For more information about soft lumps in the foot or ankle see this link.