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Common foot, skin and nail problems
Written by Debra Abrams Lee

This time of year, most women like to wear open-toed shoes or sandals after having a pedicure. However, some are embarrassed because they may have thick, yellowed toenails that are sometimes quite painful when wearing shoes. Some women are so uncomfortable even allowing a nail technician to perform professional pedicure is out of the question.

Fungal Toenails

Fungal toenails are caused by a fungal microorganism that lives underneath the toenail which can cause the nail plate to become discolored yellow, brown, black or gray. The nail debris may also cause the toenail to loosen from the toe and possibly fall off or the nail may become so thick that pain may be experienced due to the pressure on top of the shoe.

One may ask, how do you get fungus in the toenails?
Toenails may change color due to a variety of reasons such as trauma, hereditary factors   and poor circulation. More importantly, systemic disease such as diabetes or psoriasis can cause the toenails to turn color as well.

The medical term for fungal toenails is onychomycosis or tinea unguium. It is usually diagnosed by clinical observation and specific nail staining. A sample of the toenail is collected and a special laboratory stain is applied to confirm if there is a presence of dermatophytes. These are organisms that cause a fungal infection of the nail plate and skin.

Treatments for fungal toenails

There are a few treatment options for onychomycosis. If a positive test comes back, the patient may be a candidate for oral or topical medication. Oral medications work best because they penetrate the nail matix to rid the nail of fungus. Topical work more slowly and must be applied daily. They also have a very slow rate of clearing the toenail of fungus. Periodic debulking of the nail helps to eliminate the pressure from a thick painful toenail. The patient may also be given an option of having the toenail(s) permanently removed. One of the newest technologies for eliminating fungal toenails is LASER treatment. Studies are still being conducted to determine the efficacy and long term effects of this treatment modality.

Athletes Foot

Another common skin problem is fungal infection on the skin or tinea pedis or more commonly called athletes foot. Clinical presentation may include dry, white patchy and scaly skin which
is sometimes accompanied by itching and burning. This may be on the bottom and sides of the feet or in between the toes. Tinea pedis can also present with small blister-like lesions or bumps on the skin. Predisposing factors that may cause tinea pedis are genetics, environmental and systemic diseases. Tinea thrives in a warm moist environment. Excess skin moisture may lead to invasion of the dermatophytes onto the skin surface.

Treatments for athletes foot

Treatment choices for athletes foot infection include creams, gels, powders in both prescription strength and over the counter. One of the better methods of treatment include thoroughly drying in between the toes and allow periodic airing of the feet.

Heel Fissures

Thick callused skin specifically on the heels can be quite painful and problematic. Fissures are deep linear interruptions on the skin which can become infected. Prolonged barefoot walking and wearing heel-out shoes or sandals can contribute to the dry, callused skin.

Treatment for heel fissures

Usually creams containing urea can help soften and heal.

Dr. Lee attended the Ohio College of Podiatric Medicine in Cleveland, OH. She completed her residency at Wyckoff Heights Medical Center, Brooklyn NY. Dr. Lee is a Diplomate with the American Board of Podiatric Orthopedics and Primary Podiatric Medicine. She is also Board Certified as a Wound Care Specialist with the American Academy of Wound Management. Dr. Lee is a member of APMA, VPMA and the American Academy of Podiatric Practice Management.

Debra A. Womick Lee, D.P.M., C.W.S
704 Thimble Shoals Blvd, Suite 300B
Newport News, VA 23606
757-595-7634
www.womickpodiatryclinic.com