Fungal Nails

Fungal Nails occur in around 8% of the population in the UK 

There are different types of infection, or onychomycosis, but by far the most common is that which is caused by fungi  tracking from the skin of the foot.

It starts at the end of the nail and moves back towards the 'half moon' leaving yellow or brown patches and streaks as it progresses.  The nail is very crumbly when it is cut and may have a bad odour.

Another type  invades the top of the nail plate directly and causes a white, pitting effect. Less common variations  can cause complete destruction of the nail matrix, but it is worth remembering that  any one person can display a combination of all types and once one nail becomes infected, it can easily spread to the others.

Any fungus likes a warm, dark and moist environment and, these are the conditions you offer your feet when they are constantly encased in footwear.  Of course, the fungus needs to be present in the first instance , but it can be easily picked up from other warm and moist areas such as swimming pool changing areas and shower rooms. Once present, a fungus can survive in footwear  for up to six months. It usually enters the skin through small cuts  or through small separations between the nail and the nail bed.

People with poor circulation, those with diabetes and those with a weakened immune system should take extra care as they are more vulnerable to fungal nail infections.

Two dermatophytes are responsible for around 90% of all fungal infections. Trichophyton rubrum  is usually responsible for the fungus which progresses from the end of the nail towards the half moon, whereas Trichophyton mentagrophytes  is more often associated with the superficial white areas attacking the nail plate. An infection which starts at the 'half moon' moving towards the free edge is usually caused by non-dermatophyte moulds.

At first, a fungal infection will probably not cause any problems other than cosmetic changes in the nail, but it is possible that in severe cases they can become very uncomfortable and even  painful as the nail thickens and causes inflammation of the nail bed.

Treatment can be topical or systemic or both. There are obvious problems associated with any systemic medication and so the first line of treatment is usually topical. As the nail has a very hard top layer, it is advisable to file the nail to enable the antifungal agent to penetrate the nail plate more easily.  Research has also found that applying a urea cream to the nail prior to the antifungal lacquer, allows for better penetration and better results.

                                                                                                                            

 Progress of any treatment is slow. As a toenail grows on average 1.5 - 2mm per month, it can be disheartening when there appears to be little improvement after diligent treatment.  It is important to recognise that the affected part of the  nail will not improve in appearance, but as the yellow and white areas grow and are cut away, new growth should look nice and clear. Complete resolution can take around a year to eighteen months.

Perseverance is paramount. Application of the treatment must be carried out every day, preferably twice a day; alongside allowing the feet to breathe without permanently wearing occlusive footwear.

New therapies are becoming more widely available, such as laser treatment and aromatherapy products.

Body Essentials have developed an aromatherapy product for the treatment of fungal nails, Nourish Your Nails. This has been well reviewed and is definitley worth trying. If your nails are yellowed or if you think you may have a fungal infection in your nails, Nourish your Nails will gently lighten and brighten the nail plate.

Bursitis

Bursae are fluid filled sacs which help protect particular structures of the body from friction. In the foot there is only one naturally occurring bursa which lies between the Achilles tendon at the back of the heel and the heel bone (calcaneus). It helps the tendon slide easily over the bone.

Feet are constantly undergoing repeated stresses during walking and other normal activities. These stresses are compounded by ill fitting shoes. With every step, the pressures and shearing stresses upon the feet cause damage and the body responds by forming bursae. As a consequence there are many bursae on the feet. Again, their purpose is to protect the structures from further damage.

Common sites for these include over the big toe joint, commonly mistaken for a 'bunion' and over the tops of the toes.

From time to time. these bursae become inflamed due to even more pressure or trauma and produce the painful condition known as bursitis.

Bursitis may occur as a result of exposure to cold weather or injury during contact sports. The bursae may also be irritated as a result of any direct trauma, inadequate 'warming up' prior to exercise or excessive repeated exercise as in long distance running. They may be due to friction from a shoe.

 The naturally occurring bursa behind the heel often becomes inflamed in this way, due to the heel counter of a shoe rubbing against it. This is called Haglunds Deformity and is most common amongst females.

Pain occurs as a protective mechanism to warn you to stop doing whatever it is that is causing the pain, to prevent further destruction.  This is not always very easy, or practical. Try the obvious things first and attempt to reduce the inflammation with ice therapy and find some footwear that is comfortable.  Often, immobilising the affected area with some strapping (tape) may reduce the friction. Padded socks or soft gel toe protectors often relieve the symptoms.

If the pain refuses to subside, there may be an infection, arthritis or gout and a visit to your GP or a podiatrist will help to identify the problem.

 A biomechanical assessment may provide evidence of walking difficulties as a causative factor of bursitis, and corrective insoles could prevent the painful condition. 

Ingrown Toenails

The very thought of a true ingrown toenail is enough to my toes curl! (More on curly toes later!)  It is a very painful condition and by the time a patient seeks help, it is often very inflamed and even infected.

Some people are prone to ingrown toenails, due to the natural shape and condition of the nail plate. Others are unlucky enough to suffer trauma to the nail, which causes it to ingrow.

If your nails are very 'tight', almost like a staple, they are possibly 'involuted'.  This type of nail is often inherited and extremely difficult to cut.

 Attempts to cut these nails may leave small spikes down the sides and, unfortunately, they only become apparent when they start causing pain.  The spike of nail literally grows into the flesh at the side, in the sulcus. At first it is only a slight irritation, but very quickly it rubs, pierces the skin and sets up an inflammatory response. As there is a lot of bacteria present, both in and around the nail, it soon becomes infected.

The skin is an incredible organ and as we all know, makes every attempt to heal itself.  Ingrown toenails are no exception.  The inflammatory response encourages the body to repair the skin break, delivering more blood to the area.  The next stage of the healing process is granulation of the wound. This is when a matrix is laid down in the wound for new capillaries to grow.

With a spike of nail present, the wound can't heal.  The body reacts to this by trying to 'reject' the foreign object and produces more granulation tissue, until there is 'hypergranulation' tissue. 

This is a lump which rises above the level of the surrounding skin.  It isn't painful itself, but it does bleed very easily due to the number of blood vessels present.  This is the stage when people usually seek help as looks quite alarming in addition to the pain.

Your GP will often prescribe antibiotics for this, which will help if there is a bacterial infection present, but will not resolve the problem. The only way to 'cure' the ingrown toenail is to have the spike removed.

This is not as painful as it sounds, even if the toe is very sore. An experienced podiatrist can resolve the problem in a matter of minutes, once the location of the spike has been found.

Once the spike has been removed, relief is immediate. The hypergranulation tissue will usually shrink back within hours and the toe will heal completely within days. 

A very easy resolution to a very painful condition!

Incidentally, the medical term for an ingrown toenail is 'onychocryptosis'. A very suitable name for a condition which is crippling.

So, if you think you have left a spike of nail when trimming your nails or have knocked your nail and think it may have split, hot foot it to your podiatrist who will sort you out in no time :)

Raynaud's Phenomenon

Many of us suffer with cold hands and feet during the winter months, but if a quick trip around the refrigerator aisles of your local supermarket leaves you with white finger  tips and feet that feel like wooden blocks to walk on, it could be that you are a sufferer of Raynaud's Phenomenon.

Raynaud's  is a relatively common condition, affecting more females than males and can occur at any age. although it is rare in the very young. It is named after a French doctor, Maurice Raynaud who discovered that over-active sympathetic nerves cause a constriction of the blood vessels to the extremities.  In 1862 he published a thesis "On Local Asphyxia and Symmetrical Gangrene of the Extremities ".

The condition can be alarming, especially when it happens for the first time and when the colour changes from white to blue to red as the blood slowly reaches the affected areas. There is often numbness and pain associated with it and if this is severe, then a doctor should be consulted.

Being aware that you may have Raynaud's is the first step to managing the condition.   Primary Raynaud's is the more prevalent and  is usually inherited. Secondary Raynaud's  is associated with underlying disorders such as rheumatoid arthritis and scleroderma. In these cases the symptoms are often more acute.

Treatments for the condition vary in their usefulness and obviously if you are worried , then your GP should be consulted.  Sufferers of the disorder  should be aware that it is a relative change in temperature that causes the problem so maintaining an even ambient environment is the best management. Now, we can't all stay indoors, out of draughts and away from air conditioning forever, so the use of hand warmers and layers of thin gloves and socks may help  to maintain the temperature.

Your feet require special care. Raynaud's patients are very prone to chilblains. Be certain that your shoes do not rub and don't use sharp instruments to deal with issues. Always see a podiatrist as there may be ulcerations present which require hard skin removal to promote healing. Your feet will be very sensitive and the skin very fragile.

Washing feet and moisturising daily helps to keep them in good condition and gives you the focus to inspect them for any breaks in the skin which are all too common with this phenomenon.  Here at the Foot care Clinic, we sell a very useful aromatherapy product, ' Warm your Sole'  containing Ginger, marjoram, lemon and geranium. This has all the properties to soothe  your skin  and keep it warm.

The Raynauds and Scleroderma Association website is full of useful information. 

So,  the next time you head for the refrigerator aisles at your local supermarket, wear double layers of thin gloves and socks, don't let your shoes rub and get out of there as fast as you can!!!