Advice on Foot Care

Onychomycosis is a fungal infection of the nail and affects about 6-8% of the population, but is more prevalent in the older population. The nail can appear thick and yellow, cloudy and white or have a patchy appearance. As the condition worsens, the nail becomes thicker, rougher and may crumble. There is rarely pain associated with the nail, but as the condition worsens, the nail thickens and pressure from the shoes may cause discomfort. The fungal infection may also cause the nail bed to alter and can result in the nail changing shape, ingrowing at the sides and causing pain.

Onychomycosis is caused by a mix of pathogens, most commonly dermatophytes, which are fungi that live on skin, hair and nails. But saprophytes and yeasts can also cause onychomycosis. Toenails are more commonly affected than fingernails because the feet are more often subjected to enclosed spaces with shoes, experience microtrauma from shoe pressure and grow more slowly. Dark, damp, enclosed spaces are the perfect environment for fungus. Feet are also in close contact with bathroom and shower floors, another moist warm area and perfect environment for fungus. Simple contact with fungus does not necessarily lead to infection. The fungus generally penetrate through small breaks in the skin around the nail. A cut or scrape, ingrown toenail, dry cracked skin or a loose nail will increase the chances of infection. When the skin is damp and moist, it also allows for easier penetration of the fungus. Once the nail is infected, it becomes extremely difficult to treat. The fungus infects the nail bed, which sits underneath the nail plate. The nail plate acts as a protective barrier against infection and trauma. Unfortunately, the nail plate also does a wonderful job of keeping medications from reaching the fungus on the nail bed.

Common treatments include over the counter and natural topical therapies, prescription topical treatments and oral medications. Many topical therapies have not proven to be effective and oral anti-fungal medications can be expensive and are associated with side effects.

In a new study in the Journal of Foot and Ankle Surgery, 55 patients with 289 toenails affected by fungus were randomly divided into two groups and treated with ciclopirox (Penlac® ) with debridement or debridement alone. After an average of 10 months of follow-up, the group treated with both ciclopirox and debridement had a 76.74% rate of mycological cure, a statistically significant improvement over those with debridement alone. None of the patients in the debridement only group had a mycological cure. Individuals who had hyperhidrosis (sweaty feet), who smoked cigarettes, who had fungal involvement of the lunula or had yeast on culture had a decrease likelihood of mycological cure.

This study was funded by Dermik Laboratories, manufacturers of Penlac® Nail Lacquer.

Malay SD et al. Efficacy of Debridement Alone Versus Debridement Combined with Topical Antifungal Nail Lacquer for the Treatment of Pedal Onychomycosis: A Randomized, Controlled Trial. JFAS Volume 48, Issue 3, Pages 294-308 (May 2009).