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Monday, February 6, 2012

Effectively Treating Toenail Fungus Requires Treatment of Shoes...

Proper Treatment of 
Fungal Infections of the Feet, 
Whether Skin or Toenails, 
Requires Proper Treatment of Your Shoes. 

This is a bit off my usual topic of reviewing shoes but
I thought - as long as I am encouraging you to invest in proper shoes - it would be appropriate to spend some time on discussing the proper care and treatment for your shoes if you are trying to rid yourself of a fungal toenail or skin infection.

If you do have a fungal toenail infection or suffer from a chronic athelete's foot infection 
(also fungal) - it is impossible to clear up the toenails if you do not clear up the skin infection and vice versa. 
More importantly,  
even if you do clear up those infections, if the shoes are not properly treated also, 
there are fungal spores that have been shed in your shoes and threaten to "break open" and re-infect your skin and toenails months after the infection has cleared. 

Scary Mary. 
What to do?? 

Well, here are my comprehensive recommendations for clearing toenail and skin fungal infections permenantly:

Stop walking barefoot! 
This will greatly decrease the chance of picking up fungal as well as viral infections such as warts. Not to mention foreign bodies, ect. 
Wear Croc Rx clogs around the house with the strap to the back for more biomechanical control.

When you do wear shoes - follow the
four rules of proper shoegear: 
thick-rigid sole, 
arch support, 
wide, soft square toebox 
and firm rearfoot control. 

A wide toebox is important because a tight toebox applies pressure to the toenails, which causes injury to the toenail (onychauxis) which is what sets out the "welcome mat" for setting up fungal infections of the toenails. 
even if it is constant repetitive micro-trauma to the toenails from a tight toebox or a flimsy sole on the shoe that allows too much motion through the forefoot area - will cause the onychauxis that sets up a perfect environment for a fungal infection to start. 
The typical presentation for a patient with fungal toenails is, 
"I dropped something on my toe and now it's thick and discolored." 
Injury = Fungal Infection. 
Protect the toenails!

Spray your shoes every morning before putting them on with an 
over-the-counter topical anti-fungal spray 
such as Lamisil or Tinactin. 
You don't have to break the bank - 
a good spray may cost anywhere from 
four to ten dollars.
Bowling Alleys use Lysol spray, which is also effective. 
You can also use over-the-counter anti-fungal powders but I have been informed by several of my patients who are Shoe Repair Professionals that powders will decrease the lifespan of your shoes as they tend to "build up" within the shoe and break down the sole quicker. 

Avoid wearing the same shoes every day. 
Try to switch off shoes every other day to allow the shoes a full twenty-four hours to dry out. Fungus loves a moist, dark, warm environment, which is basically inside a shoe after a long day's wear.

Cedar Shoe trees that you place within a shoe helps to absorb the moisture and keep the shoes dry. There are other over-the-counter ultra-violet products that help to treat shoes while you are not wearing them and for a severe infection, they may prove useful.

If you have a chronic infection of your feet and/or toenails and nothing clears it up - 
if you've tried everything and nothing works - 
it's probably not a fungal infection! 

 Follow up with your Podiatrist. 
In the worst case scenario, we can take a biopsy and send it out to a Pathologist to look at under a microscope and tell us what it is so that it can be properly treated. I rarely have to do this but it is always an option. 
It could be Psoriasis, Eczema, Dermatitis and any number of other skin conditions that are commonly mistaken for 
an athelete's foot infection. 
The same thing goes for the toenails - it is very easy to trim off a piece of the toenail and send it to a pathologist for what is called a KOH and PAS test to confirm the diagnosis of a fungal infection. There are many conditions that mimic a toenail fungal infection and, unless it is properly identified, it is hard to properly treat it. 

Talk to your Podiatrist about treating your toenail and skin fungal infections. 
Whether you choose to use oral antifungal prescription medication (i.e. Lamisil), topical antifungal prescription medications (i.e. Penlac), over-the-counter antifungal medications (Formula-Three) or homeopathic remedies such as white vinnegar, tea tree oil or Vick's Vapor rub - 
use something!
Your Podiatrist will be able to discuss the pros and cons of each type of treatment and together you can decide what is best for you.

The "Golden Rule" with fungal foot infections: 
If you don't treat it, it won't get better. 
If you do treat it, it probably will get better." 


Go to your Podiatrist or Dermatologist and get an accurate diagnosis of your foot infection - 
this will greatly skyrocket your chances of successful treatment!

Once you do start treatment, you must be "consistent and persistent" with any treatment plan and it should resolve. 

Hope this has been helpful!

Dr. Cathleen A. McCarthy



loreal said...

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Doctor of Podiatry Discusses and Recommends Shoes. said...

Thank you!

Anonymous said...

Dr. McCarthy, I just discovered your site and I love it. It seems like in a lot of your shoe reviews, you recommend either a custom molded orthotic or a good OTC arch support insert. Are there any particular OTC inserts that you would recommend for someone with high arches and metatarsalgia to go in walking shoes? I was wondering whether those oven molded insoles (e.g. Archmolds, Sole Custom Insoles) are better than say a New Balance or Spenco off the shelf insole. Thanks again!

Doctor of Podiatry Discusses and Recommends Shoes. said...

Thank you for reading the blog!

Any Podiatrist office will carry an excellent OTC insert and you don't always need an appointment - just call up and ask if they have one and if you can come in and try it on. Our office carries "Footsteps" which I personally think is the best OTC insert on the market and it costs $50. It's only available in Doctor's offices.

Some OTC inserts online or in the stores are "Powerstep" and "Superfeet".

The trick with OTC inserts is getting one that you cannot squish down in the arch area. It needs to be rigid enough to control your arch but also needs cushioning on top of it for more comfort.

I also recommend getting a full length insert and using that to replace the insert that comes with the shoe. Many people put the OTC insert on top of the insert in the shoe and it causes "crowding" of the toes, ect.

Also, keep in mind that about 10% of people can't tolerate arch support and if you are one of those people - just stick with the insert that comes with the shoe or whatever feels most comfortable. Arch support may feel "wierd" at first but it should not hurt. If the insert is causing any pain or discomfort than that is not the insert for you!

I hope this was helpful and thank you again for your kind comments!


Doctor of Podiatry Discusses and Recommends Shoes. said...

Oops! Didn't answer all your questions...
The oven molded insoles are very good - especially if you have someone with experience molding them. Oven molded insoles should be superior to the OTC New Balance or Spenco inserts.
For Metatarsalgis - make sure you purchase a shoe with a thick rigid sole that allows NO bend across the forefoot of midfoot area. The insert is important but the shoe is crucial!

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Emily Merrell said...

I couldn't agree with your "Golden Rule" more. I thought that my foot fungus would go away if I just let it heal for a few months. I didn't realize that it would actually heal so much faster if I took the time to treat it. The longer you leave it untreated, the longer it will take to heal in the end. http://www.essendonfootclinic.com.au/services/laser/

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