Toe Health Category

Proven Strategies for Healthy Feet from a Salt Lake City Podiatrist

Here’s a not-so-fun fact: approximately 10% of the global population suffers from a toenail fungal infection at any given point in time. Given this prevalence, even if you don’t need treatment yourself, you are likely to know someone who – at this very instant – does.

The appropriate treatment for a toenail infection isn’t always as clear-cut as a quick trip to the pharmacy. SLC Podiatrist Dr. Elizabeth Auger, DPM, advises speaking with an expert on the matter before deciding on a treatment plan for any toenail fungus infection.

That said, there is nothing wrong, and, in fact, only good to gain by sharing good faith information about toenail fungal infections. Let’s talk, then, about these common health problems and what we can do about them.

What Are Toenail Fungal Infections

First of all, let’s identify what a toenail fungus infection is. The technical term for the condition is onychomycosis, and it is what happens when parasitic fungi invade the keratin and/or nail bed in the toes. 

The word comes from “onycho-,” which means related to the nails,  “myco-,” which means fungus, and “-osis,” which means disease. 

Common Causes of Toenail Fungus Infections

The human body is actually quite adept at fending off invaders, including most fungi. Unfortunately, the nails are a more difficult part of the body to protect against microorganisms due to a lack of vascularity; no blood vessels means no blood flow in the nails.

While on the bright side, this lack of vascularity means infections are slow, it also means the causes of toenail fungal infections are usually out of reach of our body’s immune system. The most common culprits that make this area their home are dermatophytes, yeasts, and molds.

• Dermatophytes: These fungi are organisms specialized to live in keratin, making them the most common cause of onychomycosis. They thrive in moist and dark environments, such as indoor public showers and sweaty shoes.

• There are three main genera of dermatophytes (Trichophyton, Microsporum, and Epidermophyton) divided into about 40 species.

• Trichophyton rubrum is the most common dermatophyte responsible for toenail infections.

• Yeasts: Yeasts, particularly Candida species, are less common causes of onychomycosis than dermatophytes, especially because they are part of the body’s natural flora. However, in individuals with weakened immune systems, yeast populations can explode out of control, leading to infections.

• • • Yeasts will usually infect the skin before affecting keratin in the nails and hair.
• Molds: Infections by non-dermatophyte molds such as Scopulariopsis, Aspergillus, and Fusarium species are far less common than dermatophytes and yeasts, but again, they can invade the nail when the immune system is compromised. These are typically harder to treat than other fungi because of their ability to invade the non-vascular nail directly.

The specific cause of an infection will usually play a determining factor in choosing a treatment plan. For the most part, general treatments will work for a wider variety of causes if an infection is addressed early, while specialized treatment is usually needed for advanced infections.

Treating Toenail Fungus

Toenail fungal infections are generally known to be stubborn, but they aren’t impossible to get rid of. Depending on the level of infection, you may be able to handle them on your own at home or with a quick trip to a pharmacy.

That said, self-treatment is not always possible. Your doctor may prescribe more potent medications or suggest procedures to get rid of persistent fungal problems.

Home Remedies for Toenail Fungus

While most doctors won’t recommend these treatments without first getting a medical opinion, they can be effective (and cost-effective) on their own. The caveat to keep in mind is that you need to have a strong immune system, to begin with, so as not to need more potent treatments.

• Tea tree oil: While only possessing mild antifungal properties, tea tree oil is a powerful antioxidant whose real value in treating toenail infections lies in its ability to aid in healing damage that fungi cause. Most physicians will recommend supplementing treatment with other antifungals in addition to tea tree oil.

• Vinegar baths/soaks: Acidic environments are generally hostile to microorganisms, including many species of dermatophytes. As far as acids go, vinegar is one of the most accessible and safest chemicals one can use for an acid bath.

• Camphor: Camphor is toxic to many fungal species and is readily accessible as the active ingredient in Vicks VapoRub and other similar topical ointments. The chemical disrupts processes in vulnerable cells, causing them to break down.

• Garlic: Plants as a whole are infamous for adapting to threats via biological warfare; the garlic plant—and its cloves in particular—produce a sulfur-containing compound called allicin, which destroys fungal cells on a chemical level. Patients can try applying garlic directly to the affected area or increasing their garlic intake in their diets.

Over-the-Counter (OTC) Treatments

OTC treatments are, more often than not, more effective than home remedies. They are, of course, more expensive than treatments you can come up with at home, but they have the advantage of being purposefully formulated to target general infections.

• Generic antifungals: The most common OTC antifungals include clotrimazole and terbinafine. These are usually topical and applied directly onto the nail but may require additional medication for anything more severe than a superficial infection.

• Nail lacquers: Some cosmetic nail products are formulated with medication. These are typically long-term treatments designed to penetrate the matrix of the nail over the course of several months in order to kill the fungus.

• Urea: Urea has the distinct function of softening and thinning the nail matrix, allowing other medications to penetrate further into it. Creams that include urea often have other active ingredients that deal with the infection itself.

Prescription Treatments

The most severe cases of toenail infections almost always require specialized treatment. Prescriptions are needed for these treatments because of potential risks and side effects as a tradeoff for their higher success rate with difficult-to-treat cases.

• Oral Antifungals: Some antifungal drugs, such as terbinafine or itraconazole (Lamisil and Sporanox, respectively), are able to treat fungal infections from inside the body by being transported into the nail bed by the circulatory system. These drugs poison the fungal infestation but should only be taken as prescribed in order to avoid side effects such as liver toxicity.

• • • Also, note that these drugs still take several weeks to several months to take effect as the treated nail matrix needs time to grow out of the nail bed.

• Topical Prescriptions: Typically used in combination with OTC medications, topical prescription treatments are potent enough to kill mature fungi and their spores as well, potentially preventing the resurgence and transmission of the infection. Drugs such as efinaconazole are usually prescribed for daily use over the course of up to six months.

• Laser Therapy: The focused light and heat of a laser can kill most organic tissue, with effectiveness increasing the simpler an organism is. While the treatment is expensive, controlled lasers are harmless and painless to most humans while simultaneously being lethal to fungal cells.

• Surgical Procedures: If an infection does not respond to other treatments, physicians may recommend partial or total removal of infected toenails. Surgery is considered a drastic last resort, so most people don’t have to worry about reaching this point, however.

Toenail Fungus Complications

Fungi, living creatures that they are, do what all living things do: they feed and grow. In the case of toenail fungi, this feeding and growing will eventually take its toll on the nail, leading to increased damage over a long period of time.

This damage to the toenail manifests in different ways, but here are some common complications associated with toenail fungi.

Brittle Nails

In order to break down the tough proteins found in our nails, parasitic fungi produce chemicals called keratinase. These enzymes weaken the structure of keratin to make it easier for the colony to consume.

Because nails serve a protective and reinforcing function, having weakened nails compromises your ability to properly walk or stand, let alone perform heavy lifting or other manual tasks.

Worse still, partially broken nails can damage the soft tissue of your toes, opening up the possibility of more dangerous bacterial and viral infections should any microbes enter the wound (but we’ll get to that).

Thickened Nails

Fungi breaking down keratin for sustenance sends signals to the brain that that specific body part is in danger. The body’s response is to produce more keratin to rebuild the damaged nail, paradoxically creating thicker nails.

If the fungal colony does not spread too quickly, this overproduction of keratin can lead to nails that are tough and often distorted in appearance. The problem is exacerbated by the accumulation of degraded keratin and, sometimes, fungal and skin cells under the nail caused by the body fighting back against the infection.

Paradoxically, it is possible to have nails that are both thicker and weaker than normal.

Fungal Outbreaks

While nail fungi will happily gorge on the nail, you have to remember that they’re really after keratin. This is most commonly found in our nails, which is why fungi prefer to form colonies there, but it is also found in every strand of hair on our bodies… and we are covered in hair.

A severe enough fungal infection can lead to the colony spreading to other nails or even adjacent skin as the keratin supply diminishes at the original site of infection.

Bacterial Infection

Different species of bacteria can be found in the same environment as fungal colonies, and there are varying relationships between these life forms, depending on the species. The way they interact with each other can range from mutualistic (the presence of one helps the other) to antagonistic (they compete for the same resources).

Regardless of the relationship between bacteria and fungi, however, it is usually bad news for the human body.

If they benefit from each other, they help each other proliferate, making it more difficult to clear the infection. If they compete against each other, they can speed up the rate at which the nail degrades and leave more toxic byproducts in their wake as they fight for dominance.

What we call polymicrobial infections can be extremely difficult to address, as a treatment for one organism might not necessarily work for the other. In some cases, a colony of fungi might even serve as a barrier protecting bacteria from medication.

Multiple treatments are often required to clear out these infections, and only after a thorough assessment by a podiatrist or other health professional, purely out of the complexity of interactions between multiple drugs and multiple microorganisms.

How to Know When Toenail Fungus Is Dying

Several factors involving the nature of toenails and fungal infections can make it difficult to tell when a fungal infection is going away. Looking back at the aforementioned indicators of nail health, it is possible to make fairly accurate guesses on your own, but there are certain difficulties.

Slow Growth Rate

Toenails grow just a little over one millimeter a month, which is less than half the rate at which fingernails grow. Unfortunately, this means it can take a long time before any visible improvement can be observed, even longer if the growth rate is further slowed by the infection.

This slow rate of nail growth also makes it hard to identify whether or not treatment is working. Improved hygiene, nutrition, and medications are all assumed to work based on common medical practice, but you typically won’t notice the effects if you count down the days yourself

For the most part, you will have to wait for new, healthy nails to grow out whilst trimming away damaged areas. Keep your doctor informed during your treatment so they will know how to adjust accordingly.

Delayed Healing

Another problem with treating toenail infections is the fact that the toenails are not vascularized. The nail matrix – the part that creates the keratinized nail plate – is, but the plate itself does not have any easy means for the body to deliver material to it.

This is why the immune system has a difficult time fighting off fungal infections. It is also why medications take time to work.

Even topical antifungals do not take immediate effect against serious infections because the nail is meant to be difficult to penetrate in order to serve its protective function. Medications have to enter the nail before they can start affecting the fungal colony.

Environmental Factors

Most people wear shoes on a near-daily, if not daily, basis, and this means subjecting the feet to dark and damp spaces where fungi thrive. The environment inside shoes can also make it difficult to tell whether or not an infection is improving, even if the fungi have been eliminated, just because the moisture can make the damage look worse than it is.

Persistence of Fungal Spores

While the other factors on this list have the potential to make it difficult to identify improvement, fungal spores are the opposite in that they can fool you into thinking your condition has improved.

Spores are a natural part of a fungus’s life cycle. They are typically hardier than the main body of a fungus and have evolved to survive harsh environments for prolonged periods until more favorable conditions arise for their growth.

For context, fungal spores can survive extreme heat and cold, dehydration, many kinds of chemical agents, and even UV radiation. Some species can remain dormant for years, waiting for the right time and place to start a colony.

This obviously is not good for anyone with a toenail infection, as it means even if you do see improvement early on, there is a good chance of reinfection if you get careless and decide to stop treatment.

To make matters worse, it is possible for spores that survive a treatment to form a colony with resistance to that treatment in the future. Fungi do not typically adapt as fast as bacteria do, as their complex mechanisms are more gradual (vs. bacteria that can transfer genes to quickly develop resistances), but any degree of resistance at all is a bad thing for us.

This is the same problem that doctors face with many antimicrobial medications today, especially antibiotics. Patients see early signs of improvement and decide they are completely healed without consulting their doctor, and after a while, the infection resurges in a form more resistant to treatment than before.

How to Prevent Toenail Fungus From Coming Back

Once you start seeing signs that an infection has cleared, the first thing you should do is see your foot doctor to confirm it. Again, you don’t want to stop treatment without first being sure that the entire colony has been eradicated, and your doctor can determine this for you.

If your doctor gives you the all-clear, the most important thing to keep in mind in order to prevent reinfection is to monitor your lifestyle. This means keeping tabs on your hygiene, diet, exercise, and even sleep schedule.

In addition to this, it’s generally good practice to have regular cleaning and disinfection of areas in your home where fungi might gather, such as bathroom tiles or old and musty cabinets. Having antifungal powder ready to disinfect the inside of your shoes is also useful.

Prevent Toenail Fungus With the Help of SLC Podiatrist Dr. Elizabeth Auger, DPM

For 25 years, Salt Lake City Podiatrist Dr. Elizabeth Auger, DPM, has served the entire SLC community with three established clinics in Mill Creek, Sandy, and West Jordan. She offers professional treatment and healthcare plans to address patients’ foot problems.

Whether it’s custom orthotics, arthritis, toenail fungus, or any other foot issue in between, Dr. Auger is here to help with personalized treatment plans to get your health back in line with your lifestyle. Same-day appointments mean you don’t have to wait to get your feet back in shape.

One of the basic bits of information we learn as early as Kindergarten is that our body keeps growing, and some parts, such as our hair and nails, do so for as long as we live. This makes onychomadesis –  the clinical sign when nails stop growing – a perplexing experience for many.

At first glance, nails that stop growing might not seem like a major concern. However, that’s before you consider that nails serve important functions as protective layers for the fingertips as well as general indicators of health and well-being.

Nails are so replaceable that they continuously spawn out of the nail beds, ensuring that your body constantly has strong, hard plates ready to serve these purposes. Onychomadesis means they are no longer replaceable, and any damage your nails sustain becomes harder to repair.

Common Causes of Onychomadesis

At its core, onychomadesis is a condition defined by the cessation of activity in the nail matrix. In simpler terms, that means the area of the fingertips responsible for nail growth stops working.

This itself can be caused by a wide variety of factors ranging from trauma, disease, or even lifestyle changes. Depending on the cause, onychomadesis may manifest itself as a simple lack of production in the nail bed or as serious as complete shedding of the nail.

This variety and range often mean it takes time to diagnose onychomadesis, and this is especially true because other similar but different conditions, such as onycholysis, exist.

Temporary Causes

Interruptions to nail production are often caused by exposure to temporary scenarios, situations, or environments. This is usually the easiest form of onychomadesis to address, as the solution is simple: remove yourself from the presence of the cause.

In practice, however, this is not always immediately possible, as we will soon discover through a couple of examples. The bright side, though, is that temporary means, given enough time, things should improve, and people often recover.

Temporary causes of onychomadesis include the following:

• Major Stress Events: It’s common knowledge that high levels of stress can negatively affect just about every system in the body, and the integumentary system, of which nails are a prominent part, is no exception. It is possible for the stress brought about by intense negative experiences, such as the death of a loved one, to slow or even halt activity in the nail matrix.
• Chemotherapy: Without mincing words, chemotherapy is basically an endurance test where doctors hope your body withstands the effects of medication for longer than your cancer cells do. Unfortunately, chemotherapy affects rapidly dividing cells the most, and while this includes cancer cells, so do hair follicles and nail matrices, leading to telltale hair loss and interrupted nail growth.

Underlying Medical Conditions

When we started this discussion, we described onychomadesis as a clinical sign. This is because it is not necessarily a disease in and of itself but rather an objective observation that something is wrong (as verifiable by the fact a nail is stalled).

This means that when not caused by temporary factors, onychomadesis may indicate underlying medical conditions. Not all these conditions are treatable, and because the non-vascular nature of keratinized cells slows down healing, they are sometimes chronic.

Here is a list of conditions that may lead to onychomadesis:

• Peripheral Artery Disease: This is a condition where narrowed arteries – often caused by fatty buildup – lead to poor blood flow in the arms or legs. This, in turn, means poor nutrition and oxygen supply to the fingertips, which slows down or even halts nail growth entirely and, in the worst of cases, leads to shedding of the plate.
• Psoriasis: This is a very common chronic disease wherein certain triggers cause the immune system to attack healthy tissues in the integumentary system. While the disease primarily attacks the skin, most people who have psoriasis will, at some point, find that the disease extends its effects to the fingernails and toenails.
• Onychomycosis: More commonly known as a nail fungus infection, this occurs when dermatophytes, yeasts, or molds invade the nail plate and/or nail bed. While often treatable and not considered severe health risks, fungal infections allowed to propagate can worsen to the point the nail plate falls off and stops growing until the infection is cleared.
• Retronychia: A rare type of ingrown nail, retronychia occurs when the nail plate grows downward and embeds itself into the nail bed. This disrupted growth pattern can either directly prevent new nail production or lead to inflammation that does the same.

Nutritional Deficiencies

When not caused by diseases or treatments, stunted nail growth might be the result of lifestyle factors. Certain diets, drinks, or supplements might lead to imbalances in the body that make it difficult for the body to grow nails.

Nails are primarily built from keratin, just like hair. Nails themselves are not technically living tissue, which might make it seem strange to talk about “healthy” nails, and yet there is still an enormous difference between a nail matrix that receives enough nutrition and one that does not.

These are some nutritional deficiencies that can stunt the growth of the nail:

• Zinc Deficiency: Zinc ions (positively charged atoms) are used by the body to stabilize proteins; that is to say, these ions allow proteins to hold the correct shapes for the body to use. Without a sufficient amount of zinc, the body may have difficulty using proteins for essential functions such as the formation of keratin.
• Biotin Deficiency: Biotin, more commonly recognized as vitamin B7, is used in the process of converting food into energy and is necessary for the production of fatty acids, sugar, and amino acids. Thus, lower biotin levels in the body mean slower cell growth and division.
• Folate Deficiency: Vitamin B9, or folate, is most notable for its role in cell division and synthesis of DNA. This is important for nail production because, as we have noted, the cells of the nail matrix are some of the fastest-dividing in the human body.

These are not the only nutrients involved in the production of healthy nails. Protein, iron, vitamins A, C, and D, as well as healthy fats, are all necessary for the development and maintenance of healthy nails.

Generally speaking, a balanced diet should provide all the nutrition your nails need. If not, there may be factors at play that lead to these deficiencies, warranting a visit to a health professional.

Trauma to the Nail Bed

Physical damage to the nail matrix may also lead to a slowing of growth. Damage is categorized into two types:

• Macrotrauma: This is a sudden injury, such as when a heavy object falls on a toe, and the person suffers abrupt harm. Tissues torn or compressed by macrotrauma may suddenly cease functioning as a result of sudden damage to large numbers of cells.
• Microtrauma: Repetitive irritation, such as from rubbing against the inside of a shoe, can lead to stunted nail growth through gradual disruption to the matrix. Chronic inflammation and growth of calluses in an attempt to cope with damage may limit the supply of nutrition for proper nail growth.

Treatment Options for Onychomadesis

Addressing the Underlying Cause

Again, onychomadesis is not the disease itself. Furthermore, unlike many other symptoms of diseases, there is no realistic way to encourage nails to grow again while underlying problems persist (topical medications and treatments are likely to be ineffective in most cases).

Because of this nature, doctors aim to prevent detaching and encourage normal growth by first identifying and addressing the underlying cause.

To paint a picture, imagine onychomadesis as a wilting flower. There is no way to revive the flower without first addressing the underlying issue of a lack of water or poor soil.

Providing Nutritional Support

Providing adequate nutrition ensures that the body has the building blocks it needs to continue producing healthy nails. More than that, sometimes, adequate nutrition also addresses conditions that lead to onychomadesis.

Also, consider that in severe cases where the nail has already detached, a healthy body will heal faster than an unhealthy one. Healthy individuals also often respond better to medications than unhealthy individuals.

Medications

Many causes of onychomadesis can be treated with medications, and those that cannot be treated can often be managed.

Fungal infections are often treated with antifungals (big surprise there). These are usually applied topically, though oral options exist that are just as effective.

Meanwhile, chronic conditions such as psoriasis have their own treatment options as well. Steroid creams, immunomodulators, and even light therapy can help reduce flareups to the point the nails are no longer affected.

Home remedies are also available for both of these examples. Of course, it’s still best to work with a professional to determine what medication is best for you.

Protecting the Nail Bed

While protecting the nail bed does not apply as a full treatment for all cases of onychomadesis, practicing safety measures to keep it safe can help promote healing. Tips for doing so involve a fair degree of discipline with regard to hygiene but are effective means of keeping nails healthy.

• Keep your fingernails and toenails short. This will help to prevent them from catching on objects and being further damaged.
• Avoid biting your nails or picking at them. This can introduce bacteria and fungi into the nail bed, which can worsen the condition.
• Wear gloves and/or other protective gear when doing housework or gardening. This will help to protect your nails from harsh chemicals and irritants.
• Moisturize your nails and cuticles regularly in order to help keep them healthy and flexible. Look for lotions or oils that contain ingredients like jojoba oil, vitamin E, or shea butter.
• See a doctor if you suspect you have onychomadesis. Early diagnosis and treatment can help to prevent further damage to your nails.

When to See a Foot Doctor

Because it can take time before you notice that your nail isn’t growing, you might end up getting a delayed diagnosis with a greater risk of complications compared to if you had gotten one early. As a result, it is often a good idea to seek medical advice as soon as you suspect the possibility.

Say, for instance, you suffered significant trauma to your nail, such as from a deep cut or a heavy blunt impact. In such a situation, it is advisable to visit your healthcare provider, as even in the event that onychomadesis is unlikely, other unexpected issues may result from the injury.

It is also important to have a doctor assess the risk of onychomadesis if you have any associated diseases, such as psoriasis or eczema. They may be able to put you on a treatment plan to keep onychomadesis at bay or possibly reverse the damage it has already dealt.

Finally, even in the absence of trauma or associated diseases, see a doctor if any persistent symptoms associated with onychomadesis persist. Watch your nail for any ingrowth, separation from the nailbed, discoloration, etc.

Contact Dr. Elizabeth Auger for Help With Nails That Stop Growing

Embarking on a journey toward optimal foot and nail health is a crucial step in maintaining your overall well-being. Your feet and nails play a vital role in supporting your daily activities, and addressing any concerns or discomfort is essential for a balanced and healthy lifestyle.

For personalized guidance and expert care, Reach out to Dr. Elizabeth Auger, DPM, a distinguished podiatrist operating in Salt Lake City, West Jordan, and Sandy. Dr. Auger’s expertise extends beyond the ordinary, and her commitment to foot and nail health is unparalleled.

To take the next step towards rejuvenating your nail health, consider contacting Dr. Auger at 801-845-3960. Your journey to healthier, growing nails begins with a simple call.

Remember, your nails are more than just a cosmetic facet; they reflect your overall health. So, take the initiative and connect with Dr. Elizabeth Auger to embark on a path of comprehensive nail care.