sweaty feet, toenails, toenail fungus, yellow toenails

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Toenails

1. Question:
My question is about nail fungus. I have a minor case on three toes. I have been prescribed a cream called Nizoral 2% cream. I am choosing not to take the oral medications since I do not have the time/access to taking the blood tests. I was told I could have developed the nail fungus when wearing my leather Topsider boat shoes without socks. Have you seen cases of nail fungus from wearing boat shoes without socks? Also, is their a better way, other oral, to rid the fungus?

Dr. Karpati's Answer:
Thank you for your e-mail. To get to the point, yes there is a better topical way to attempt to eradicate the nail fungus. Onychomycosis, which is the fungus that you see on your nail, has its roots in the nail bed. There is a prescription called Penlac whose mechanism is to penetrate the nail plate over time, eventually reaching the nail bed and killing the fungus where it grows. This is the only FDA approved topical medication that can actually eliminate the fungus on the nail bed. Improvement is seen as the new nail grows out, which typically takes six to nine months. Recommended use for this product is one year or more. I would probably give it a success rate of about 70% in its ability to completely eliminate the fungus on the nail bed (this is called a mycological cure). Most people however do relate a significant improvement in their nail appearance even though they might not have a mycological cure. Unfortunately, the saying “fungus amongus” is true! The fungus is everywhere and one can inoculate themselves at any point in time. Typically, a moist, warm environment is ideal and that is why many people inoculate themselves in locker rooms, showers, by the pools, or on the lake. I have seen many people who have fungus who do not usually wear socks with their shoes. Repetitive trauma to the nail is also a good way for fungus to inoculate itself. This is typically seen with people that exercise. I do recommend you visit with a podiatrist in your area to make sure that what you are describing is in fact onychomycosis so that the appropriate prescription can be written.



2. Question:
Why does my toddler have yellow toenails? What could be some reasons for this?

Dr. Karpati's Answer:
Hard to know without taking a look at them. Young children typically do not have nail fungus. Are his//her finger nails the same color? Did his/her nails use to be whiter? I would find a podiatrist in your area (at www.APMA.org) if you are concerned for a quick look. This may give you piece of mind!

3. Question:
I have a question regarding toenail fungus and permanent toenail removal and would be grateful if you could provide me an answer to my questions I have about it. My boyfriend who is 46 yrs old has had toenail fungus for quite some time now. His toenails quite frankly look very gross!!! I don't mean to be rude but they area HUGE turn off... they just look very appalling.

All of his toenails are affected by it. I take great care of my own feet with weekly pedicures and I expect my partner to as well but he refuses to get treatment for his toenail fungus because he has crohn's disease (takes medication for the crohn's) and cannot take the oral medications to attempt to eradicate the toenail fungus because those medications would put his already at high risk liver into too much jeopardy.

Therefore he cannot take the oral medications to eradicate the toenail fungus. Also I feel even if he did take the oral medications and managed to eradicate his toenail fungus it would be entirely pointless because the fungus would come back eventually for certain. I say this because he is a stubborn man and refuses to wear sandals and insists on walking around the entire day in these sweaty boat shoes with no socks! When he takes these shows off you can tell that they are a breeding oasis for bacteria just by the way it smells! Why anybody would do that who is prone to toenail fungus is beyond me. It just boggles my mind and I am reaching my wits end. And of course those ointments you can put on the actual nails are not effective.

Therefore I brought up the subject of PERMANENT toenail removal to him. Not temporary removal because that does not get rid of the fungus of course (but permanent toenail removal) for ALL of his toenails since he is unable to or refuses to take care of them whatsoever and the fungus has been there for a long time and is slowly getting worse. So my main question is... is this a GOOD solution do you think... to have permanent toenail removal done on all of his toenail? Basically I want him to be de-clawed like a cat!

But what I'm mostly concerned about is will the skin be perfectly normal after the toenails have been removed and it has healed? Or will the skin be very strange in that area where the nails used to be? And what about the cuticle... when you do permanent nail removal how do you ensure that the cuticle NEVER grows back? Because that would be very strange to not have any nails but have cuticles still growing on your toes when you don't have any nails on them. Or am I incorrect in thinking this and the cuticles would also be prevented from growing back along with the nail??? When you remove the nail bed I suppose the cuticle is also permanently stopped from returning, am I correct? And my other main question was... in general how much does it cost to have 10 toenails removed?
Thanks for your time,
Disgusted :)

Dr. Karpati's Answer:
Dear Disgusted,
Wow! You have definitely thought this one through!

I agree that oral medication is out of the question given his medical history. The only other option for treatment is prescribed topical Penlac which takes about a year of use for any true result to be determined. If he is non-compliant with this medication, he may never get rid of it. You are also right about the increased probability of getting it back wearing those shoes!

Removal of all of his toenails is a pretty radical solution for this problem, especially if they do not cause him pain, because of the potential risk for infection (as is the case for any procedure). If his case is as extensive as you say involving all of his nails, then there is potential for transmittal to his foot resulting in Athletes foot. If this is a chronic problem, then permanent removal is a very good option for him. Permanent removal (called a Matrixectomy) is usually accomplished under local anesthesia using chemical called "Phenol" at the nail root, which sits underneath the cuticle, to keep the nail root from producing nail. It is about 90% effective in preventing the nail from coming back. The cuticle does not "grow", and stays as is. The nail bed may be sensitive for some time after that, but that usually resolves and most people are happy with the appearance of the nail bed. I suggest you consult with your podiatrist for their experiences with matrixectomies as I am only speaking of my own. As far as cost is concerned, that would be better answered by your podiatrist should your boyfriend decide to proceed!

I also want to caution you about the potential for getting nail fungus from your weekly pedicures if you go to a salon. Be sure your salon/spa is reputable and that they have enough time between clients to clean their instruments/ whirlpools. Better yet, bring your own files, nail sticks etc. to minimize the risk!

Finally, the very least your boyfriend should do is get some Summer Soles into those shoes to help wick away that sweat (and hopefully some of that smell!)
Question:


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Dr. Adriana Karpati is a trusted Summer Soles Advisor and frequently tests Summer Soles products before they are brought to the public. Her practice is located in Grapevine, Texas. For more information, visit: www.faant.com