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The first step is to take a history of the problem,” said Mark Hinkes, DPM, CEO of HappyFeet LLC, and a podiatrist with 40 years experience. “In other words, I want to know how long have you had this and what previous treatment you’ve had.” A podiatrist needs to understand the extent of the problem, and also any other medical factors which may influence their choice of treatment.
Topical antifungal agents can be used but are often ineffective. Oral terbinafine is considered to be the first-line treatment for confirmed onychomycosis; the treatment course is generally 6 weeks for fingernails and 12 weeks for toenails.9 Azoles can also be used. Surgical debridement or removal of the affected nail is also a consideration for cases that are resistant to antifungals, and laser treatments for onychomycosis appear to be a promising area for future study.10
Oral medications include terbinafine (76% effective), itraconazole (60% effective) and fluconazole (48% effective). They share characteristics that enhance their effectiveness: prompt penetration of the nail and nail bed, and persistence in the nail for months after discontinuation of therapy. Ketoconazole by mouth is not recommended due to side effects. Oral terbinafine is better tolerated than itraconazole. For superficial white onychomycosis, systemic rather than topical antifungal therapy is advised.
Toenail fungus (onychomycosis) is caused by a group of fungi known as dermophytes. This group thrives on skin and on keratin, the main component of hair and nails. The fungus gets under the nail and begins to grow, damaging the nail so it discolors, becoming white, brown or yellow. Eventually, the nail might thicken, harden, become brittle and even fall off.
Flip-flops offer very little protection. The risk of getting splinters or other foot injuries is higher when the feet are so exposed. People with diabetes should not wear flip-flops, because simple cuts and scrapes can lead to serious complications. In addition, many flip-flops provide no arch support. Like ballet flats, they can aggravate plantar fasciitis and cause problems with the knees, hips, or back.
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Many podiatrists now consider this an effective treatment, but because it’s new, there’s not enough concrete data to compare with other treatments. Dr. Hinkes raises another concern: “A clinical cure and a mycological cure are two different things. With the clinical cure, you look at the nail and it looks fine. It’s pink and shiny and smooth and it looks great. But if you sample the nail, you might find that there’s mold or fungus there, so it does not have what we call a mycological cure—mycology is the study of fungi.
Take oral medication. The most effective way to get rid of nail fungus is systemic treatment with oral prescription antifungals. Treatment with oral medications can take 2-3 months or longer. Oral antifungal prescription medications include Lamisil, which is usually prescribed with a dose of 250 mg a day for 12 weeks. Side effects can include rash, diarrhea, or liver enzyme abnormalities. This medication should not be used if you have liver or kidney issues.
Food intolerances — Some yeast infections are due to food allergies. Try to avoid foods that cause negative reactions of any kind and pay attention to symptoms you experience when eating things like dairy, eggs, certain nuts, wheat-containing foods and grains. If you think you have a food allergy or sensitivity, try an elimination diet to figure out what foods are causing intolerance and work on removing those foods.
Following effective treatment, recurrence is common (10–50%). Nail fungus can be painful and cause permanent damage to nails. It may lead to other serious infections if the immune system is suppressed due to medication, diabetes or other conditions. The risk is most serious for people with diabetes and with immune systems weakened by leukemia or AIDS, or medication after organ transplant. Diabetics have vascular and nerve impairment, and are at risk of cellulitis, a potentially serious bacterial infection; any relatively minor injury to feet, including a nail fungal infection, can lead to more serious complications. Infection of the bone is another rare complication.
Sporty, fitted sandals and other "toning shoes" are designed for a more intense workout while walking. The American Council on Exercise says there's no evidence to support that claim, but they may have other benefits. The thick sole keeps your foot off the ground and away from debris. And Brenner points out, "they do have really good arch support." Several have a seal of approval from the American Podiatric Medical Association.
White superficial onychomycosis (WSO) is caused by fungal invasion of the superficial layers of the nail plate to form "white islands" on the plate. It accounts for around 10 percent of onychomycosis cases. In some cases, WSO is a misdiagnosis of "keratin granulations" which are not a fungus, but a reaction to nail polish that can cause the nails to have a chalky white appearance. A laboratory test should be performed to confirm.
Athlete's foot is caused by a number of different fungi. These include species of Trichophyton, Epidermophyton, and Microsporum. The condition is typically acquired by coming into contact with infected skin, or fungus in the environment. Common places where the fungi can survive are around swimming pools and in locker rooms. They may also be spread from other animals. Usually diagnosis is made based on signs and symptoms; however, it can be confirmed either by culture or seeing hyphae using a microscope.
Anyone reporting immediate results or healing is either paid to post the review or doesn't have a true nail fungus. I have been using the solution for about 3 weeks now and can see progress/improvement, which is more than what I can say about other anti-fungal products I have tried. It appears to have contained the infection and the nail is growing it out.
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