Fungal foot and nail infections are by far one of the most common things we see through the clinic. Patients are often embarrassed by these conditions but they are much more common than they think. If you have a fungal nail or skin infection, you are not alone. Most of us harbor the fungi which cause these infections. Its only when the fungus gets a foot hold ( no pun intended ) that it becomes a problem.
Fungal infections can affect normal, healthy nail as well as nail which has already been damaged by trauma, or other conditions like psoriasis for example. The infection often starts at the free edge of the nail plate, typically the corners first. It tends to moves back ( proximally ) becoming established within the nail plate.
If untreated the fungal infection will progress relentlessly until it reaches the nail fold, where the cuticle is. As the fungus becomes established the nail normally becomes de-vitalised, discoloured, flaky and can sometimes smell unpleasant.
The skin around the nail is often also infected. This is called tinea pedis, better known as athletes foot. Single toenails can be affected, however the infection will often spread to neighboring nails and soon the foot in general.
Diagnosis of fungal infections of skin and nails are made clinically. Sending nail clippings for mycology is less common than it used to be. Often test results are not useful in the diagnosis therefore podiatrists diagnose these conditions based on the symptoms and presentation of each case.
When left untreated, the nail plate will begin to grow thicker. This complicates treatment, simply because the plate becomes so thick that topical treatments have difficulty reaching the seat of the infection.
When we see patients with fungal nail infections we will reduce the thickness of the nail plate in the first instance to enable treatments to penetrate deep enough to be effective. Often wider treatment of the nail and foot is required. We always advise our patients to be as aggressive as possible with their treatment. At least twice daily applications of treatment is often required to effectively treat fungal infections.
Things we hear a lot from patients include;
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| Athletes foot between toes |
“I’ve tried everything before”
“My GP said its not fungal”
“I’m not sure what that is”
“I get athletes foot from time to time”
We hear these statements from patients every day. All of them indicate the nature of fungal infection. It is often slow to respond to treatment and can take weeks or months to see improvement. It is often misdiagnosed and finally, the apparent recurrence of the infection is most likely to reduction in obvious symptoms but never having actually got rid of the infection in the first place.
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| Widespread Tinea pedis Infection |
Our advice is - don’t be embarrassed about nail and skin conditions of your feet. Ask for a professional opinion and start treatment for them as soon as you can. Remember that they are probably the most common thing we see in practice, and that we can help, even if it takes time.
