by Dr. Christopher Milkie
Toenails that have become discolored or thick and discolored are often a result of toenail fungus, otherwise known as onychomycosis. According to many studies approximately 20% of people age 40-60 have this condition. The color most often associated with this condition is yellow. Toenail fungus is so common because our feet are exposed to moisture, heat and darkness, all of which are the friend of fungi. The fungi first invade our skin and then assault our nails. So if you ever wondered where you got this condition from just look to your skin. Most people with toenail fungus have dry skin with areas that flake. Your feet don’t have to itch to have athlete’s foot. In fact the more common form of athlete’s foot is the dry, non-itchy kind.
But not all thick discolored nails are toenail fungus. Many of these nails have thickness of the nail bed called hyperkeratinization. It’s a callusing of the nail bed. It usually occurs because of microtrauma to the nail. This microtrauma is usually caused by an underlying abnormality of the bone structure or foot movement. A simple example is a hammertoe deformity. The toe bends downward leading to constant rubbing of the nail against the bottom of the shoe. Most people don’t feel the rubbing. The body responds to friction by building up callus to protect itself. The nail will become thick and often has a yellow or brown color. To determine whether the nail has fungus or just hyperkeratin a biopsy can be performed.
If the underlying bone deformity or biomechanical abnormality isn’t corrected the nail will continue to build up callus. Some deformities are easy to fix with a minor procedure or custom foot orthotics. Once the cause of the nail condition is addressed then the nail itself can be treated. If fungus is present then the new Laser treatment, oral medication or a combination of the two are the treatment options. In the absence of fungus, a thick nail has to be filed down and treated with Urea based products. Urea can help prevent recurrence of hyperkeratin.
Before you run to your family doctor or dermatologist to treat your “fungus” condition you should consult with a Podiatrist. A Podiatrist will not just focus on the nail condition but rather look at your entire foot for the root of the problem. Making the correct diagnosis will lead to a higher chance of success and will save you time and money.