QUESTION:

What can I do about my toenails? They seem to have developed a fungus and are splitting and cracking. They are also painful. I am 58 years old. Is there nothing that can help?

ANSWER:

Fungal infections make up about 50 percent of all nail disorders and can be difficult to treat. Known medically as onychomycosis, nail fungus often causes the end of the nail to separate from the nail bed. Debris - white, green, yellow or black - may build up under the nail plate and discolor the nail bed. Fungal infection of the toenails occurs four times more frequently than that of the fingernails, due to the warm, moist environment in shoes that promotes fungal growth.

An estimated 11 million Americans suffer from onychomycosis, and up to 48 percent of individuals have at least one affected toe by the time they reach age 70.

As the fungi grow, they feed on keratin, the tough, horny protein that makes up the hard surface of toenails. In about 78 percent of cases, the infecting toenail fungus belongs to a group of fungi called dermatophytes. Other culprits include yeast, mold, and bacteria.

Because toenail fungi can spread from foot to foot on the floors of showers and locker rooms, toenail fungal infections are especially common among military personnel and athletes. The condition also tends to affect individuals with chronic illnesses, such as diabetes, and those with circulatory problems that decrease blood flow to the toes. However, many people have no clear predisposing factors.

Toenail fungus is a chronic condition that gradually progresses to involve more and more of the nail, rarely healing on its own. Even if the affected nail spontaneously falls off or is knocked off, the nail that regrows is usually infected with fungus. In severe cases, surgical removal of nail may be necessary.

Presently, the best treatments (although still not very effective) are expensive oral prescription medications with potentially adverse side effects - itraconazole (Sporanox®), terbinafine (Lamisil®), and fluconazole (Diflucan®) - or topical treatments - ciclopirox (Penlac™ Nail Lacquer), the first topical agent approved in the U.S. for this disorder.

You should make an appointment with your physician, who may wish to refer you to a dermatologist - a physician who specializes in the treatment of skin disorders. You can help to prevent toenail fungus by:

• Washing feet with soap and water daily and drying them thoroughly.
• Wearing rubber shoes or shower clogs in communal areas.
• Selecting well-ventilated shoes that allow feet to "breathe." Avoid shoes made of synthetic materials. Wear proper fitting shoes with sufficient toe space.
• Alternating pairs of shoes to allow them to air out between wearings. Get out of wet shoes immediately.
• Wearing socks made of cotton or materials that "wick" away moisture. If your feet sweat, change socks twice a day and wash them in hot water after each wearing.
• Using drying powders to help keep feet dry, but avoid corn starch, which feeds any bacteria or fungi that may be present.