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Fighting off nail fungus
By TOM VALEO Editor's note: In this continuing column, we'll look at how the body ages and what we can do to keep it healthy, part by part. * * * Texans use a vivid expression to describe a person who looks weather-beaten, gnarly and ill-groomed: "He's ugly as Grandpa's toenails." Which calls to mind the scourge of aging toenails: fungus. Onychomycosis (ah-nee-ko-my-KO-sis), or toenail fungus, starts with subtle discoloration; the toenail turns yellow or dark brown. In rare cases the nail turns white, gets powdery and sloughs off. The tip of the nail may thicken and become a challenge even for the sharpest nail clippers. Debris, or "toe jam," under the nail might develop an odor. As the fungus grows, it can turn the nail into a lumpy, misshapen black cap that hurts like the devil and looks just as evil. Why does this happen? Toenails need two things to remain healthy: oxygen and attention. As we age, less oxygen makes its way to the feet because the lungs become less efficient at supplying blood with oxygen and the heart pumps blood with less force. As a result, the toenails, at the end of our longest appendages, must make do with less oxygen. Also, toenails are easy to ignore. They are out of sight most of the time, and out of sight generally means out of mind. Some people even lose their ability to inspect their toes due to weight gain or arthritis. Without sufficient oxygen and attention, toenails become increasingly susceptible to fungus, an unusually stubborn affliction that almost never clears up on its own. Even oral antibiotics, the most effective treatment, take weeks to eradicate the infection. Topical treatments, such as medicated toenail polish, may take longer. Without treatment, fungus can deform the nails, causing pain and making them more likely to press into the skin and trigger infection. That's an especially serious threat to people whose circulation has been compromised by diabetes, heart disease or aging. The best way to help your toenails resist fungus is to keep them clean, dry and undamaged. Fungus thrives in warm, dark, moist environments and loves to feast on keratin, the protein that makes up the toenail. Blood, rich in oxygen and antibodies, fights this invasion effectively, which is why children, who have robust circulation in their feet, almost never get fungal toenail infections. More than half of adults over 65 have problems, says Joshua Bernard, a podiatrist and assistant professor of surgery at the University of South Florida. "When we get beyond 60 or so, the skin tends to thin out and atrophy," Bernard said. "The blood supply to the tissues, including the toenails, tends to decrease, and the body's immune system loses vigor." Consequently, the routine assaults on toenails that were tolerated in youth start to create problems. Nail polish, for example, inhibits the evaporation of moisture from the toenail, encouraging the growth of fungus and bacteria that older people have a hard time fighting off. Tight shoes can bruise the toenails, a problem compounded by jogging. Ingrown toenails, most commonly caused by clipping toenails so they have rounded corners, are also more likely to cause infection. Toenails become more vulnerable if you develop diabetes, which causes the level of glucose in the blood to rise. This excess sugar causes a host of problems that damages the arteries, leading to diminished circulation. "Diabetes makes a blood vessel 10 years older," said H. James Brownlee Jr., chairman of the University of South Florida's Department of Family Medicine. "The blood vessels down there in the feet get smaller and smaller, so they clog more easily, and the blood of diabetics has more of a tendency to clot. Many who have high blood sugar also have high cholesterol and high blood pressure, which also damages the blood vessels." As the toes quietly suffocate from a lack of oxygen-rich blood, an infection from an ingrown toenail or some other injury can flare out of control, leading to gangrene and amputation. If your immune system is compromised by radiation treatments, steroids or other powerful drugs, or by HIV, you can expect your toenails to give you trouble. The first line of defense against toenail problems is the simplest: Wash your feet vigorously every day with soap and water. The soapy runoff from a shower is not sufficient. "People probably wash their hands five to 10 times per day," Bernard said. "If they're lucky, they wash their feet once a day. A lot of people can't even reach their feet." Failure to wash the feet vigorously gives fungus an opportunity to grow, especially when toenails develop tiny cracks. Stubbing your toe or dropping something on it can crack the nail, but toenails can suffer "microtrauma," as Bernard calls it, simply from rubbing against the inside of tight shoes. Bernard recommends other simple precautions: Change your socks every day. Wear flip-flops or aqua socks when using a communal shower at a gym or pool. Dry your feet thoroughly and apply foot powder. Allow your shoes to dry completely before wearing them again. For extra protection, swab the inside of your shoes with cotton balls soaked in a mild bleach solution. Trim your toenails straight across but not too short. And do not round the corners because that may encourage the skin to swell, leading to an ingrown toenail. Disinfect your clipping tools before trimming and cleaning your toenails. If you can't reach your nails comfortably, have someone do the job for you or get a professional pedicure. Be gentle when working on your feet. "When you dig or pick at your nails and produce bleeding, you allow bacteria and fungus to invade and set up shop," Bernard said. "Infections and ingrown toenails are two of the biggest problems, and the vast majority of these problems are self-made." - Tom Valeo is a freelance writer who specializes in medical and health issues. Write to him c/o Seniority, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731 or send e-mail to floridian@sptimes.com On the Web:The American Podiatric Medical Association: www.apma.org. (Type onychomycosis in the search box at the top of the page.) The site for Lamisil, a treatment for nail fungus, sponsored by Novartis Pharmaceuticals USA, the company that makes the drug: www.lamisil.com.
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From the Times Seniority pages |
