Diabetes Forecast

How Do I Fight Toenail Fungus?

What can you tell me about the dreaded toe fungus? It seems to develop very slowly and can get vicious! I've heard it can get all through the system if not treated. Just what can happen? More important, is there a way to avoid it, besides the regular foot care, dry feet, no bare feet, etc.? Is there an over-the-counter cream that can cure the fungus before it gets so bad that oral meds are needed? Anne Perkins, Ashdown, Arkansas

Lee Sanders, DPM, responds: The medical term for the toenail fungus that you refer to is onychomycosis. This condition is a very common infection of the toenails caused by a mold or yeast. Onychomycosis is often associated with a chronic athlete's foot condition. A 2006 study published in the journal Acta Dermato-Venereologica showed that 22 percent of patients with diabetes have toenail onychomycosis. Many people live with this condition for their entire lives; however, onychomycosis can negatively impact your quality of life. In addition to the cosmetic effects, the toenail fungus can cause nail deformity, pain or discomfort while wearing shoes, odor, or recurrent ingrown toenails. In people with diabetes, onychomycosis can lead to serious foot complications such as foot ulcers and infections. Although topical antifungal medications are effective for treatment of fungus infection of the skin, they are relatively ineffective for infection of the toenails. The medication is unable to penetrate the nail plate to get to the fungus. For some people, oral antifungal medications can provide a cure for onychomycosis, when used appropriately.

However, clinical cure frequently takes close to a year, and recurrence of the infection is common. You should discuss treatment options with your physician or podiatrist. Prior to treatment, your physician should perform a careful medical history and a visual inspection of your nails, perform a fungal culture, and order a blood test to determine whether your liver function is normal.

Good foot care is essential for all people with diabetes. You should keep your feet clean and dry, wear shower shoes when bathing or when at the local swimming pool or health club, and wear socks made of a blend of absorbent fibers. Acrylic fiber socks transport moisture more efficiently from the surface of the foot than do cotton socks. And remember, inadequate laundering of clothing can be a source of reinfection following therapy for onychomycosis and athlete's foot.



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