Nails that just don't look right? Do you have fungal nails?

Fungal foot and nail infections are by far one of the most common things we see through the clinic. Patients are often embarrassed by these conditions but they are much more common than they think. If you have a fungal nail or skin infection, you are not alone. Most of us harbor the fungi which cause these infections. Its only when the fungus gets a foot hold ( no pun intended ) that it becomes a problem. 

Fungal infections can affect normal, healthy nail as well as nail which has already been damaged by trauma, or other conditions like psoriasis for example. The infection often starts at the free edge of the nail plate, typically the corners first. It tends to moves back ( proximally ) becoming established within the nail plate. 

If untreated the fungal infection will progress relentlessly until it reaches the nail fold, where the cuticle is. As the fungus becomes established the nail normally becomes de-vitalised, discoloured, flaky and can sometimes smell unpleasant. 

The skin around the nail is often also infected. This is called tinea pedis, better known as athletes foot. Single toenails can be affected, however the infection will often spread to neighboring nails and soon the foot in general. 

Diagnosis of fungal infections of skin and nails are made clinically. Sending nail clippings for mycology is less common than it used to be. Often test results are not useful in the diagnosis therefore podiatrists diagnose these conditions based on the symptoms and presentation of each case. 

When left untreated, the nail plate will begin to grow thicker. This complicates treatment, simply because the plate becomes so thick that topical treatments have difficulty reaching the seat of the infection. 

When we see patients with fungal nail infections we will reduce the thickness of the nail plate in the first instance to enable treatments to penetrate deep enough to be effective. Often wider treatment of the nail and foot is required. We always advise our patients to be as aggressive as possible with their treatment. At least twice daily applications of treatment is often required to effectively treat fungal infections. 

Things we hear a lot from patients include; 

Athletes foot between toes

“I’ve tried everything before” 

“My GP said its not fungal” 

“I’m not sure what that is” 

“I get athletes foot from time to time” 

We hear these statements from patients every day. All of them indicate the nature of fungal infection. It is often slow to respond to treatment and can take weeks or months to see improvement. It is often misdiagnosed and finally, the apparent recurrence of the infection is most likely to reduction in obvious symptoms but never having actually got rid of the infection in the first place. 

Widespread Tinea pedis Infection

Our advice is - don’t be embarrassed about nail and skin conditions of your feet. Ask for a professional opinion and start treatment for them as soon as you can. Remember that they are probably the most common thing we see in practice, and that we can help, even if it takes time. 

Barefoot / minimalist running - where do we go from here?

My advice about barefoot running......beware of trends

‘Barefoot’ or minimalist running is the latest trend for runners. As a podiatrist I am asked frequently for my opinion about it being a good thing or bad. 

The fact of the matter is not enough is yet known about the effects of barefoot running on caucasian feet. Some people think that barefoot running is harmful. Part of this could be for physiological reasons but part of the solution involves the runner learning to run as a barefoot runner. Podiatrists are seeing one stress fracture after another directly related to poor barefoot running technique. 

Caucasian feet are different from the traditional barefoot running races normally associated with it such as the african runner, zola budd being an exception. White athletes have become used to running in a shoe, on tarmac. The African foot is much flatter, and unlike white posterior muscle compartments which tend to sit lower, the calf muscles in black athletes sits higher with longer tendon and ligamentous tissue. 

Traditional barefoot runners are also ‘forefoot strikers’ meaning the initial contact phase of gait is on the ball of the foot rather than the heel. White runners tend to be heel strikers, which is completely normal for them and inconsequential when wearing a decent running shoe. The style of running is completely different and unless you change the way you run you can soon look forward to joining the thousands of others sporting injuries from barefoot running. 

If you must run barefoot there are a couple of  things you can do to prevent injury.

First of all, start slow and keep it short. 

Run on grass only, and always try to run somewhere unlikely to have broken glass lying around. 

Speak to someone who knows about barefoot/minimalist running. Take advice on footwear. Most of all remember, it is not for everyone, and everyone is not the same. 

Remember that just because someone makes a picture like this...

Does not make it a scientific fact.