Fungal infection, or onychomycosis, is a common foot health problem. A majority of sufferers don't seek treatment, perhaps not even recognizing the existence of a problem. One reason that people may ignore the infection is that it can be present for years without causing pain. Its prevalence rises sharply among older adults. 

The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish -- ugly and embarrassing. It is apparently assumed that since white markings or a darkening of the nail are minor occurrences, the change represents something minor as well, even when the blemish spreads. 

In many cases, however, that change in color is the start of an aggravating disease that ultimately could take many months to control. It is an infection underneath the surface of the nail, which can also penetrate the nail. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in or around the nail plate.

What is Nail Fungus?

Onychomycosis is an infection of the bed and plate underlying the surface of the nail caused by various types of fungi commonly found in the environment. Fungi are simple parasitic plant organisms, such as molds and mildew, that lack chlorophyll and therefore do not require sunlight for growth. A group of fungi called dermatophytes easily attack the nail, thriving on keratin, the nail's protein substance.

When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even fingernails.

Other contributory factors may be a history of athlete's foot, improper cleansing, anxiety and excessive perspiration.

Prevention

Because fungi are everywhere (including the skin) they can be present months before they find opportunities to strike, and before signs of infection appear. By following certain precautions, including proper hygiene and regular inspection of the feet and toes, chances of the problem occurring can be significantly reduced.

Clean, dry feet resist disease. A strict regimen of washing the feet with soap and water is the best way to prevent an infection. Shoes, socks, or hosiery should be changed daily. Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.

It is very unlikely that a few exposures to an unclean environment will cause a fungal infection. Walking barefoot once or twice in a public shower will not generally spread the infection. Similarly, it is also unlikely that a single visit to a pedicurist will cause the infection. Lengthy exposure to a contaminated environment is often required in order to contract the fungal infection although individuals may be more susceptible to fungal infections than others.

Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles. This can be helpful in denying a hospitable environment for the fungi to grow in.

Artificial Nails and Polish

Moisture collecting underneath the surface of the toenail would ordinarily evaporate, passing through the porous structure of the nail. The presence of an artificial nail or polish impedes evaporation.

Treatment

Depending on the nature and severity of your infection, treatment may vary. Most over-the-counter treatments are minimally effective at best, but almost none of them have produced a permanent treatment. The main reason for these poor results is that the fungal infection resides deep within the nail or nail bed, and the topical medications have great difficulty in penetrating to this depth. A fungus may work its way through the entire nail, penetrating both the nail plate and the nail bed.

Podiatric Medical Care

Your doctor can diagnose a fungal infection, culture the nail, and form a suitable treatment plan. Treatment may include topical or oral medication and debridement (removal of diseased nail matter and debris.)

Newer oral anti-fungal medications are the most effective treatment. The two most common oral medications are Lamisil and Sporonox. These medications are very similar in most respects, and are about 75% effective. The medication is taken for only three months. A total of approximately nine months is required to see new healthy nail growth. Current studies show that for a very small percentage of the population there are some unwanted side effects with an oral antifungal, however these are usually reversible when medication is terminated.

During mid-2007 generic forms of the above two medications became available in the U.S.  In the past, the cost of the three-month therapy was approximately $900.00.  With the current availability of the generic forms of these medications, the three-month therapy is approximately $90.00.

A topical medication is Penlac Lacquer. This prescription medication is generally less effective than the oral medications, and is best used with a limited fungal infection. Penlac is applied approximately three times per week for several months.

In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed. If there is no response to other treatment methods, permanent removal of a chronically painful nail may become necessary.

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