Ugly Nails and Unpleasant Skin Conditions

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There are many problems that can develop within the internal structures (bones, muscles, tendons, nerves, vessels) and tissues found in feet, but it is important not to neglect skin (the largest organ in the body) and nail issues—especially if you are diabetic! As is often the case with any problem—medical or otherwise—it’s in your best interest to address a problem at an early stage. Doing so typically provides the easiest resolution and greatest opportunity for success.

That is especially true when we discuss ugly toenails and unpleasant skin conditions. The sooner you start treatment, the easier it is to resolve the problem—so help us help you!

Come in at the earliest possible opportunity when you start noticing problems like toenail fungus, ingrown nails, plantar warts, tiny blisters with redness, and calluses.

Toenail Fungus

As we noted in the introduction, early intervention can make a profound difference when it comes to treatment—and toenail fungus is a shining example. (Maybe not “shining,” though, since the condition causes nails to lose their shine…)

Recognizing a Fungal Nail Infection

The first thing that you will notice (and probably ignore) is discoloration at the end or side of the nail. When left untreated, a fungal toenail infection will eventually advance and cause your toenail(s) to become severely discolored, abnormally thickened, and separate from their nail beds. Further, the nails can change shape and start to become ingrown.

The ingrowing can be especially problematic because the barrier—the nail bed, that is—between the nail bed and the underlying bone is roughly the same thickness as 10 sheets of paper. A severe ingrown or thick nail can pierce through the nail bed, and create the potential for dangerous bone infections, which is simply bad news.

While a bone infection is one of those things you wouldn’t wish upon your worst enemy, you still do not want the embarrassment of having discolored toenails in the first place. This can be a quality of life issue, especially when it means you don’t want to wear sandals, go to the beach, or spend time at your friend’s pool in the summer. Instead, you’ll want to hide your unsightly nails under the perceived security of socks, shoes, and nail polish—but that can contribute to the problem!

The fungi responsible for nail infections—which are the same ones behind athlete’s foot—love dark, warm, and damp places. Encased in socks and shoes, your feet are in a dark, warm, and damp place, which is a dance party for fungus.

A Stubborn Infection

Now, there are footwear options that are better than others (specifically, you want to choose socks made from moisture-wicking materials and shoes that allow your feet to breathe), but this really doesn’t matter if fungal spores have already made themselves at home in your nail, skin, and shoe. Toenail fungus does not go away on its own!

Think of it this way: let’s say you were on a Caribbean island with unlimited food and drinks, it wasn’t costing you a dime, and all of your favorite people—including Dr. Leibovitz—were also there. Would you ever leave on your own? Of course not!

So how does this problem happen in the first place?

Well, fungus is everywhere (as is the case with certain microscopic organisms). This is usually fine and it doesn’t affect us—until it has an opportunity to enter the body.

In the case of fungal toenails, that opportunity comes in the form of some kind of separation between a toenail and its respective nail bed. This is typically the result of physical trauma, like dropping something heavy on your foot, accidentally stubbing a toe, repetitive micro trauma in a dress shoe, running … you get the idea. Other contributing factors can include constant application of nail polish (which traps the fungi in the nail) and immune or circulation issues.

Keeping the trauma part in mind, the nails most likely to be affected are the ones on the big and little toes (since they are more susceptible to physical trauma), but any nail can potentially become infected.

Toenail Fungus Progression

When a toenail becomes infected, there are three stages of progression:

  • First stage – Up to around 20% at the top of the nail has started to discolor. It will be somewhat yellow, brown, or gray (the colors smokers’ nails become). In this stage, topical treatment—more on this in a moment—has a high success rate. The key is recognizing the early nail changes. But this is often overlooked and ignored, and the “easy button” for treatment is lost.
  • Second stage – The discoloration has become more extensive, covering 50%-100% of the nail, and the nail is thicker and harder to clip. You may start to see the infection jumping to neighboring toenails. The fungus has declared “squatter’s rights” and is using the nail as a protective armor. The treatment plan at this time will typically include both oral and topical medications.
  • Third stage – During this stage, we often find nails that have dramatically changed shape (ragged edges, with buildup on the surface causing distinct bumps), thickened, and separated from their nail beds. Whereas a combination of oral and topical medication previously had an approximately 70% success rate, that rate has now dropped to 20%. They don’t tend to mention this in the advertisements for the medications. Those who have healthy immune and circulatory systems are more likely to find themselves in that 20%.

Treating Fungal Toenails

Looking a little closer at treatment for toenail fungus, topical medication can be thought of as a tool to prevent the condition from worsening, whereas the oral medication actually fights back against the infection (along with contributing as a protective barrier as well).

With regard to topical treatment, people put all kinds of weird stuff on their nails as “home remedies” to try toimprove fungal toenails. We wish we could say that vinegar, Vicks Vapo Rub, cat urine (I know… How do you collect that?) or tree tea oil will help, but it doesn’t. If they did, Big Pharma would be capitalizing on those (and this isn’t the case) … and the neighborhood cat lady would be rich.

Something else that isn’t effective is laser therapy. There are many very intelligent medical professionals who have bought in to this particular practice for some reason or other, but the scientific evidence simply doesn’t support it. In fact, the only thing we can say for sure that it actually does is make your pocketbook lighter.

(Yes, the U.S. FDA has approved laser treatment for fungal toenails, but this only means they’ve determined it will only create minimal damage and is not a significant health risk. The FDA has not proved it actually works!)

Going back to proven treatments for just a second, it is important to note that topical treatment only works when it is actually used as prescribed. When it fails, a major contributing reason is the fact people simply do not keep up with it as they are supposed to. If we prescribe a topical treatment and you want it to work, follow the prescribed regimen. Using it for 2 months, then missing a weekend and returning to use, only to miss a week will get you the same results as not using it at all. This is not a treatment if you are not a patient person because it may take 1-1.5 years to clear the nail if it is completely taken over by fungus.

Remember, early treatment is the key to optimal results.

Subungual Hematoma – Code Name: Black Toenails

People do a variety of things to their bodies to express themselves. Some use tattoos to turn their body into a living canvas. Others adorn their bodies with jewelry in pierced parts, like ears, and noses. A fairly common way of decorating the body is to paint fingernails and toenails in vibrant colors. Painting your nails black may be a fashion statement, but developing black toenails is an altogether different manner.

A Non-Fashion Statement from Your Body

Your body has various tricks to let you know that something is wrong. You experience shooting pain that comes with plantar fasciitis and swelling that accompanies an ankle sprain. Another indication that you have a health issue is tissue discoloration. When you develop black toenails, your body is drawing your attention to a problem.

The most obvious symptom of this particular condition is the fact that your toenails are discolored. In spite of the name, the color can range from brown to purple to red to black. The discoloration is due to subungual hematoma (blood pooling under the nail). The pooled blood can create pressure, which may lead to pain. Other signs that you may note include foul odor and discharge from underneath your affected nail.

Causes of Black Toenails

The most common cause of this condition is simply trauma or injury to your affected toe or nail. Runners will typically experience black toenails from long-distance races or routes that consist of a lot of downhill running. Some even consider a black toenail to be a “badge of honor” for the miles logged, but this issue should not necessarily be celebrated. The trauma sustained by a runner’s toenail often comes from constant rubbing of the toe against the front of a shoe.

In addition to running, other causes include dropping a heavy item on your foot, fungal infection, tight or ill-fitting shoes, and, in extremely rare circumstances, malignant melanoma. If you have developed a black toenail without an obvious traumatic incident, it is important to schedule an appointment with our office so that we can provide a diagnosis and hopefully rule out melanoma as the cause of your condition.

Black Toenail Treatment and Prevention Tips

No matter why you developed a black toenail, it is a smart move to come in and see our foot specialists. In some cases, your toenail will simply fall off and then grow back, but there is a chance you may require medical care. We will be able to let you know if so and then administer any necessary treatment, which may include removing the nail, cleaning the area underneath, and draining the fluid.

Black toenails aren’t always serious medical issues, but it is better to avoid the risk that one leads to infection or another complication. Also, you may be self-conscious about having a discolored nail and it could stop you from participating in warm weather activities that you enjoy. Fortunately, there are steps you can take to decrease the likelihood of developing one. These include:

  • Trim your toenails properly, which means straight across and not too short. Besides preventing discoloration, this is a good tip for avoiding potentially painful ingrown nails.
  • Wear shoes that fit you correctly. When your toes are pressed together it is a clear indication that you need to switch to shoes with a wider, deeper toe box. This tip will also help you prevent a variety of potential foot and ankle problems.
  • Take care when moving or carrying heavy objects. If your job depends on this, be sure to protect your feet with steel-toed shoes or other protective footwear.
  • Avoid developing a fungal infection by keeping your feet clean and dry, wearing clean socks, and alternating between two pairs of shoes to let them dry out completely between uses.

Tinea Pedis (Athlete’s Foot)

Athlete’s foot is caused by a fungus—the same type responsible for fungal nail infections. In fact, this can be a sort of “which came first: the chicken or the egg?” kind of situation because sometimes nail fungus starts to spread out to skin, and other times a case of athlete’s foot leads to the development of fungal toenails.

Whereas some cases of fungus in the nails can be rather difficult—though not necessarily impossible—to treat, there is generally a high success of treating it in the skin.

It can be reasonably estimated that around 15% of the general population is affected by this particular condition, but that number jumps to about 40% for those who visit clinics. Further, the percentage tends to be much lower for cultures that do not wear shoes.

So why does wearing shoes make a difference? Well, you need to consider the environment of a shoe and how it relates to the preferred conditions for fungus.

The inside of a shoe is a warm, dark place (when it contains a foot). If fungal spores are looking for a place to reside, that’s already a great starting point. Besides warmth and darkness, fungus needs moisture to thrive, and feet produce tremendous quantities of sweat. This is an invitation for fungal (and bacterial) growth.

The itching and burning sensations of tinea pedis are bad enough, but sweat can contribute to room-clearing odor. (Just ask the mother of any teenaged boy!)

Since moisture plays a significant role in the proliferation of athlete’s foot, two related conditions that can increase the risk of an infection are hyperhidrosis and bromhidrosis. This is important to know because a key part of treating tinea pedis is to address underlying issues—like these ones—that contribute to the problem.

Given how footwear and athlete’s foot relate, it’s important to not only treat the person who has developed the problem, but also to address the socks and shoes. (Something that isn’t always considered, and especially when performing care at home.)

With that in mind, keeping your shoes dry as possible is necessary for preventing the condition in the first place, making sure an existing infection doesn’t worsen, and even as a treatment component.

There tends to be more cases of athlete’s foot in the winter—something that can be attributed to the fact the skin produces less oil. This affects the situation in two different ways. One, the oil produced by our bodies is antifungal, so you have less natural protection during this season. Two, the drier winter air can lead to cracks and fissures in feet—and especially the heel areas—and these can be thought of as “welcome mats” for fungus.

Fungal spores can stay dormant for years, plus fungus is everywhere, so you can’t necessarily blame your most recent trip to the Indy Island Family Aquatic Center or Momon Community Center’s pool for the tinea pedis!

OK, but if “fungus is everywhere,” why are feet so susceptible to this infection?

The skin in your feet can be as much as 40 times thicker than in other areas of the body. You can think of this is as being more “playground” for the fungus, which helps explain why it happens in the feet (in addition to the perfect environment created by non-breathable, closed-toe shoes)!

Typically, the condition is seen between the toes and on the soles, although it can certainly spread to the tops of the feet as well.

In the early stages, you can recognize a case of athlete’s foot by itching, burning, and reddish patches that can contain scales. More severe infections can have drainage of either clear or yellow fluid from tiny red blisters. When the itching and burning sensations are no longer present, the condition has become chronic. (Prior to that, we consider it to be an acute infection.)

Redness, itching, and burning are symptoms of other conditions—including psoriasis, eczema, and contact dermatitis—so it is important to properly diagnose the problem. With that said, you can likely rule out a case of contact dermatitis (which is an allergic reaction, usually to dye in socks, shoes, or laundry detergent) if there isn’t a problem between your toes. The simple reason for that is because those areas do not come into contact with socks or shoes.

You might also be able to rule out psoriasis or eczema if you have similar symptoms elsewhere on your body. (That said, the fungus responsible for athlete’s foot can also cause jock itch.)

Individuals who have a higher risk for tinea pedis include those who have immune issues (since their immune systems are less capable of fighting off infections) and men. Men are more likely to develop the problem than women because they wear closed-toe shoes more often.

Over-the-counter antifungal sprays, powders, and lotions tend to be quite effective when it comes to treating mild cases of this infection, especially when administered early. The containers for these products will often specify an appropriate amount of time to see results, but if your condition is not improving you should schedule an appointment with us.

We will provide stronger treatment, which may entail oral anti-fungal pills or stronger topical medication to clear up the infection. Whether you would like additional information about black toenails, athlete’s foot, or need treatment for any other unpleasant skin condition of the foot, we are here for you. Simply give our Indianapolis office a call at (317) 545-0505.


9505 E. 59th St., Suite A
Indianapolis, IN 46216

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