Nail Fungus, A Silent Foe

Nail fungus, also known as onychomycosis, is a common condition encountered by podiatrists in their daily practice.

This often overlooked or neglected condition can, however, reveal much about our health and hygiene habits. Onychomycosis is a fungal infection of the nail that can affect both hands and feet, although it is more common in the feet due to the moisture and warmth conditions often conducive to fungal growth. A brief historical overview shows that nail fungal infections are far from being a modern issue, with descriptions dating back centuries. However, understanding and treating these infections have significantly evolved, particularly with the advancement of medical research and diagnostic techniques.

To understand what nail fungus is, some anatomy is necessary. The nail is mainly composed of keratin, a protein that gives it its strength. Fungal infection occurs when pathogenic fungi invade this structure, leading to various symptoms. Certain foot types, especially those with excessive sweating or regularly wearing closed shoes, are more prone to developing onychomycosis.

Understanding Onychomycosis, Symptoms, and Signs: Identifying Onychomycosis Alerts

When a nail fungus starts to set in, several warning signs manifest, offering undeniable visual and tactile clues about the nail’s health. These symptoms vary in intensity and appearance but together constitute a call to action to prevent the worsening of the infection

Color Change: One of the first indicators of a fungus is a change in the nail’s natural color. Shades can range from pale yellow to dark brown, sometimes with white or yellow streaks, signaling the presence and proliferation of fungi under and on the nail.

Increased Thickness: Nails affected by a fungal infection tend to become thicker, losing their usual fineness. This increase in thickness often makes the nail difficult to trim and can cause discomfort in shoes, or even pain when pressure is applied.

 Altered Texture: In addition to thickening, the texture of the infected nail undergoes noticeable changes. It can become rough, irregular, and brittle, breaking easily at the slightest impact. This deterioration of the nail’s structure often indicates a progression of the infection.

Nail Separation: Onychomycosis can lead to progressive separation of the nail from its bed (onycholysis), starting from the free edge towards the root. This space creates an isolated, humid, and dark environment, ideal for the proliferation of fungi and other pathogens.

Brittleness: As the infection advances, the nail can become so brittle that it partially disintegrates upon touch. This brittleness compromises the nail’s protective barrier, further exposing the nail bed to infections.

These symptoms, though sometimes subtle at the onset, generally evolve into more severe manifestations if the infection is left untreated. Pain, although less common, may occur, especially in cases where nail thickness significantly increases, exerting pressure on the surrounding tissues.


Nail fungus Causes and Infection Risks

Nail fungus is primarily caused by three types of fungi: dermatophytes, yeasts, and non-dermatophyte molds. The risk of infection increases with prolonged wearing of closed shoes, inadequate foot hygiene, repeated nail damage, or a weakened immune system.

Without treatment, onychomycosis can lead to serious complications, especially for diabetic patients, where the risks of secondary infections such as cellulitis are increased. Walking and wearing shoes can become painful, significantly affecting quality of life.


Diagnosis and Assessment by the Podiatrist: The Importance of Laboratory Analysis

In diagnosing (nail fungus) onychomycosis, the podiatrist relies on a combination of meticulous clinical examination and laboratory analyses to confirm the nature and causative agent of the fungal infection. This approach allows for the development of a targeted treatment strategy, essential for effectively eradicating the infection.

Detailed Clinical Evaluation: The process begins with a thorough examination of the nail, where the podiatrist observes visible signs of infection such as changes in color, thickness, and texture. Collecting a comprehensive medical history is crucial, including any nail trauma, conditions predisposing to fungal infections, such as diabetes, or exposure to environments favoring such infections.

Sending Samples to the Laboratory: To confirm the presence and type of fungal infection, the podiatrist collects a nail sample to send for analysis, this may include:

KOH Test (Potassium Hydroxide): A small fragment of the nail is taken and treated with a KOH solution. This sample is then examined under a microscope in a laboratory to detect fungal filaments, indicating an active infection.

Fungal Culture: A nail sample is also sent for culture, allowing for the precise identification of the responsible fungus. This test helps determine the fungus’s sensitivity to different antifungal treatments, guiding therapeutic choices.

Nail History Analysis: The podiatrist also questions the patient about the timeline of symptoms, previous treatments, and their effectiveness. This information is essential for understanding the infection’s progression and adjusting the care plan.

Through these laboratory analyses, performed by specialized professionals, the podiatrist can obtain an accurate diagnosis of onychomycosis, a fundamental element for prescribing appropriate treatment.


Combined Approaches for Maximum Effectiveness

In the fight against onychomycosis, the podiatrist has several therapeutic tools, each playing a crucial role in the healing process. The treatment strategy is often personalized, taking into account the severity of the infection, any underlying patient conditions, and their response to previous treatments.

Aseptic Debridement and Milling of the Nail: This procedure is a fundamental step in treating onychomycosis. Mechanical debridement involves carefully removing the infected and damaged part of the nail, thereby reducing fungal mass and allowing better penetration of topical treatments. Milling, performed with sterilized instruments, helps refine the nail’s thickness, further facilitating the action of medications. These interventions are performed under aseptic conditions to prevent any secondary infection.

Topical Treatment with Antifungal Medications: Topical treatments, applied directly to the affected nail, play an essential role, especially in cases of mild to moderate infections. These medications, in the form of varnishes, creams, or solutions, act locally to eradicate fungi, without the systemic risks associated with oral treatments. Their effectiveness largely depends on the regularity of application and the product’s ability to penetrate the nail’s deeper layers.

Possibility of Oral Medication for Severe Cases: In situations where the infection is advanced or resistant to topical treatments, the use of oral antifungal medications may be necessary. These systemic treatments have the advantage of treating the infection from the inside, reaching fungi through the bloodstream. However, they require close medical monitoring due to potential side effects and interactions with other medications.

The combined approach, combining mechanical debridement with topical treatments and, if necessary, oral medication, offers the best chance of overcoming onychomycosis. Regular follow-up by the podiatrist is essential to adjust treatment according to the infection’s evolution and to ensure healthy nail regrowth.


Nail Fungus Prevention and Home Treatment

Prevention plays a crucial role in the fight against nail fungus. Simple measures like maintaining good foot hygiene, avoiding walking barefoot in public places, and choosing shoes and socks that allow for good foot ventilation are essential. At-home topical treatments can also complement professional care, especially in the early stages of the infection.

Specific Target: Athletes, the Elderly, and Field Professionals

Athletes, due to their frequent exposure to moist conditions and repeated nail trauma, the elderly, who may have reduced blood circulation and a weakened immune system, as well as professionals who spend long hours standing or moving, are particularly vulnerable to onychomycosis. For these groups, prevention and early diagnosis are even more important.


Nail Fungus Prevention is the Key

In summary, onychomycosis is a common but significant condition that requires particular attention both in prevention and treatment.

Podiatrist advice, combined with good lifestyle hygiene, is essential to avoid complications and ensure the health of our feet. The treatments available today, though varied, underscore the importance of a personalized approach tailored to each case. Ultimately, understanding the risks and adopting preventive measures remains the best strategy for effectively combating nail fungus.


Dr Martin Tranchemontagne podiatrist, is the first of this new generation of children of a former or existing podiatrist. We can say that he fell both feet in the trade! He loves to discuss trips with his patients. Passionate about his work, he is always looking for new techniques or technologies that can improve their well-being. Working as a podiatrist for almost a decade, he makes sure you are in good hands when consulting with him!

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