Toenail fungus is not just a cosmetic problem. It's an infection of the bed and plate underlying the surface of a nail. Fungal nail infection, a condition called onychomycosis (ON-i-ko-my-KO-sis) is caused primarily by organisms called dermatophytes. It's very common, affecting more than 35 million people in the United States alone. However, some 90 percent of them have yet to see a doctor for treatment. It is estimated that 2.5 million Americans see a podiatrist annually for treatment of toenail fungus; however many more are infected but never seek help because they consider toenail fungus just a cosmetic problem.
Nail fungus is the most common infection and often goes untreated. Toenail fungus affects two to 18 percent of all people worldwide and three to five percent of people in the United States. It is rarely seen in children, affecting only about one out of every 200 people younger than 18. However, the likelihood of getting toenail fungus increases with age; up to 48 percent of people have at least one infected toe by the time they reach age 70.

Risk factors
Almost anyone who wears tight-fitting shoes or tight hosiery is more likely to develop toenail fungus, especially if they also practice poor foot hygiene. Another risk factor is wearing layers of toenail polish for a long time, which doesn't allow the nail to breathe. Toenail fungi may spread from foot to foot on the floors of shower and locker rooms. The condition tends to affect people with chronic illnesses, such as diabetes or HIV, as well as people with circulatory problems that decrease blood flow to the toes. However, many people have no identifiable risk factors for getting toenail fungus.
Of all the toes, the big toe and little toe are the most likely to develop a toenail fungus. This is because the big toe and little toe are constantly exposed to the mild trauma or friction from the sides of the shoes. This trauma allows the fungus to enter the nail. Often, toenail infections can develop if the client has a fungal skin infection.
Once these tiny organisms find their way under a nail, they begin to grow. Ironically, the nail itself provides a protective environment for the fungus to grow and thrive. The toenails are susceptible to infection, since they spend much of their day in a dark, warm and often moist environment in shoes and socks. This is also the ideal environment where the fungus grows best.

Symptoms
When fungal nail infection begins to take hold, it can cause the nail to change color -- often to a yellow/green, brown or darker color. Fungal debris may collect under the nail, causing a foul smell. The nail may thicken and become flaky. Thick toenails may cause discomfort in shoes and make standing and walking uncomfortable for some people. They can also cause ulcers to the nail bed, which may not heal, especially when the sufferer is a diabetic. Moreover, because a fungal nail infection is an infection, it can spread to other nails, and possibly to other people. Something as ordinary as an emery board can carry the fungal organisms from an infected nail to an uninfected one. That's why it is so important to seek treatment as soon as you think you have an infection. Your podiatrist may take clippings off your nail to send to the lab to confirm the diagnosis before he/she starts treating you.

How you contract the infection
Fungal nail infection has little to do with personal cleanliness. Something as simple as banging a toe or finger, trimming your nails too closely or wearing tight shoes is enough to weaken the nail and expose the underlying nail bed to infection. The fungus that causes the infection resides in many common places -- locker rooms, swimming pools, showers or even gardens. You can also contract the infection while getting a manicure or pedicure, from unsterilized instruments that have been used on others with the infection. Fungal nail infections appear to be more prevalent in those with a history of athlete's foot (a fungal infection of the skin) and people whose feet sweat a lot.

Treatment
A fungal nail infection won't go away by itself. There are almost as many home remedies as there are infections, but most of them do not work. The most effective treatments are only available from your doctor and may include one or a combination of topical, oral, laser or surgical methods. The fungal infection can be treated and cured but it takes time, around 10 to 12 months based on the severity of the infection.

What you can do
During your treatment you should start to see a new healthy nail begin to grow from the base of the nail bed. This is a sign that the treatment is working. The old infected nail should begin to grow out and can be clipped away over several months.
Proper foot hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails. Here are a few steps you can take during and after your treatment to better care for your toenails.
o Washing the feet with soap and water, and remembering to dry thoroughly, is the best way to prevent an infection. Clean and dry feet resist disease.
o Shower shoes should be worn when possible in public areas.
o Shoes, socks or hosiery should be changed more than once daily.
o Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
o Wear shoes that fit well, and are made of materials that "breathe", such as leather or canvas.
o Avoid wearing excessively tight hosiery that promote moisture.
o Socks made of synthetic fiber tend to wick away moisture faster than cotton or wool socks.
o Use a separate pair of clippers and file on the infected nail, to avoid spreading the infection to other nails. Disinfect instruments used for nail care and pedicures.
o Don't apply polish to nails suspected of being infected with a fungus.
o Consider replacing old footwear as this could be contaminated with fungal spores.
o Have athlete's foot infection treated with antifungal medicine as soon as possible to prevent spreading the infection to your nails.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

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