DOCTOR'S BLOG

Goodbye Fungal ToeNails

THE BEST TREATMENT IS ALWAYS PREVENTION Therefore, a complete treatment program always has to start with prevention. Any preventive or treatment program works best when it has all the elements of how we care for our teeth. We use brush our teeth using toothpaste, we use floss to mechanically remove the debris that’s stuck, and mouthwash to cleanse the mouth. Continuing the analogy,  it’s best to be vigilant about keeping the toenails clipped and cleaned of any beginning fungus or discoloration. Using an antifungal cleansing product to mechanically clean fungus from the toenails and cuticles, (soaks, pads, soaps) and a cream to  condition and nourish the nail plate and the skin surrounding the nail. (A plug for the BeautiFoot Program: Balm Riche Duo). Keeping the toenails trimmed and cleaned of fungal debris is extremely important. The type of toenail clipper is an important part of this process. Use a toenail clipper that looks like this: 
 
 
Not like this: 

  
 
Treating these repugnant expanses of contaminated keratinous protein is not a simple project. One must realize that topically applied preparations alone are rarely  good enough to rid your toes of these offensive invaders. There is nothing you place on the toenail surface that can magically make these nails thinner and rid them of these discolored disease looking patches.  

As a matter of fact, any one single isolated method of treatment is rarely sufficient to accomplish the necessary eradication and resolution of fungal toenails.  
 
The best approach to treating thick nails with fungus is a stepwise approach: 
  1. It’s almost impossible to treat fungal toenails without professional assistance. Go to your foot care professional/podiatric physician & surgeon for the treatment. 
  2. The first thing they would do is to take a culture of the toenail to determine if fungus is the cause; and if it is, identify which fungus is involved.  
  3. Next of importance, the nails have to be mechanically debrided, that means that the thickness and “OOOchy”  discolored part of the nails should be cut away. This is usually done with an electric sander or a dremel drill that has a special medical grade sanding disk.  
    1. Sometimes the whole nail plate has to be removed, with the idea that the nail will grow out uninfected. But the best way to insure this will happen is to physically remove any contaminating particles of fungus monthly. It takes about a year for a nail to grow from the nail root to the end of the toe; therefore it is best that your podiatrist check your nails monthly to clean fungus or contamination off the nail bed and any other toenails being treated.  
  4. As prescribed by your podiatrist, an oral antifungal medication can be used. This treatment may last up to a year. While the medication is being taken, it is important that the nails are kept clean of observable fungus monthly by your podiatrist sanding down the toenails.  
  5.  During this “treatment year”, with the foot specialist’s approvals and recommendations, a home treatment regimen can be instituted. 

Commonly,  this would involve one or more of the following:  
  1. Daily soaking in a solution that would be unfriendly to fungus is always a good idea. (check with your doctor if it’s O.K. for you to soak and you are not allergic). ( Dr. Rehm uses the following solution to soak: Tub of warm water, ½ cup white vinegar, betadine solution to make the water light brown and ½ cup of sea salts)
  2. After soaking, one can apply topical antifungal agents to the nail bed, if the nail was removed, and the nail plate if the nails are being treated without total removal.  Topical agents may include an antifungal topical medication and/or the Balm Riche Duo. If you want to use a topical medication prescribed by your podiatrist, then use the Balm Riche Duo a different time of day.  
  3. Pay attention to footwear, shoes and socks, moisture and pressure.  
    1. Make sure shoes are kept dry especially if you are an athlete. Some athletes change off shoes every other day.  
    2. Make sure the socks wick moisture away and wearing clean dry socks daily are an important complement to both the treatment and the prevention of fungal contamination of toenails.  
    3. Dietary considerations should be made when one is concerned about fungus infection anywhere in the body. Inflammatory and high sugar diets are frequently discussed as a partial cause of these problems. 
    4. After the fungus is gone, it is important to go into Prevention Mode.  
    5. Remember  Fungus Can Occur Again and Again and has to be dealt with on a continual basis that would come with a pedicure set. If you choose to go to a podiatrist, they would use a dremel drill. You also need a pair of professional nail clippers that look like this: 
 In summary, realize that fungus of the feet is no treat, It’s hard to treat and therefore beat..... 
But with the right care, the cure is there.