Fungal nail laser the best treatment for fungal toenails and onychomycosis?

Nail fungus is an issue that has become more common in the 20^th century, and it can be dangerous for your health in the long run. Nail problems like onychomycosis and nail fungus in general can end up severely damaging your toenails and that’s why you want to address the problem as quickly as possible. However, before we identify any onychomycosis treatment, it’s important to figure out what causes onychomycosis and fungal toenails and why such problems appear in the first place.

What is onychomycosis?

Onychomycosis is a common fungal infection that particularly targets your toenails. Generally, it affects the toenails, but the fingernails can also be affected sometimes. In addition, onychomycosis can also end up with complications like cellulitis for the lower leg. There are a variety of fungi that can lead to onychomycosis, like fusarium or dermatophytes.

A thing to note about onychomycosis is that it has certain risk factors that can worsen the situation. These include a bad immune function, peripheral vascular disease, exposure to someone that already has onychomycosis, but also various nail diseases, and athlete’s foot.

Nail fungus symptoms that you should know about

Usually, there are a few symptoms that appear before you have a nail fungus problem like onychomycosis. It’s very important to study your nails and see if they are discolored, thickened, ragged, crumbly, or brittle. Sometimes, nail fungus can end up making your nails distorted, and they might even be separated from the nail bed. Fungal issues can also make your nails or toes smelly, so that’s a thing to keep in mind.

Aside from that, you should consider talking with your doctor if you have difficulties walking due to your nails, if the area around your nails is bleeding, if you have diabetes and experience any of the symptoms above, or if you have any pain/swelling around the toenails. If that’s the case, then addressing such issues as quickly as possible becomes a major thing to focus on.

If you encounter these issues, you need to talk with a doctor right away. The problem is that if you just leave things untreated, the skin around and under your nails will be inflamed. It will be very painful to walk or move your fingers, which clearly becomes a problem in the long run. Aside from that, you can also end up with dermatophytids. These are skin lesions that are free of any fungus, but they do appear as an allergic reaction to that fungal problem.

What causes onychomycosis and fungal issues?

Mold, yeasts and dermatophytes can all lead to a fungal infection and problems like onychomycosis. Dermatophytes, in particular, are a major cause behind onychomycosis, especially if you live in western, temperate countries. Those people that live in the tropical and subtropical regions deal with humid, hot climates and that’s when candida tends to be the major problem behind fungal problems and onychomycosis in particular.

Aside from that, we should also note risk factors. As you get older and especially surpass 60 years old, you are more prone to fungal issues like onychomycosis. The reason here is that your blood circulation will not be as fast, and you will also have your nails grow slowly, not to mention they get thicker. The fact your immune system is not as effective as you get older also creates a perfect medium for onychomycosis as well.

But that’s not all; there are other risk factors, too. Wearing socks that hinder ventilation, having psoriasis, sweating a lot, going barefoot in damp places, having damaged nails, diabetes, or circulation problems can also be extremely problematic.

There are five different types of onychomycosis

• First, we have the distal subungual onychomycosis caused by the trichophyton rubrum. That invades the nail bed and it also goes under the nail plate.
• Candida onychomycosis is caused by candida, and it’s common among people who deal with a lot of humidity.
• Endonyx onychomycosis is generated by leukonychia.
• Proximal subungual onychomycosis happens when the fungus penetrates the nail plate via the proximal nail fold.
• Lastly we have the white superficial onychomycosis that tends to be caused by a fungal invasion.

Regardless of what kind of onychomycosis you might have, it’s imperative to ensure that you find the right treatment, and fungal nail laser can be the right option to consider in a situation like this!

How do you diagnose onychomycosis?

Diagnosis relies on 4 different approaches. You have the potassium hydroxide smear that can help identify onychomycosis cases and fungal infections with ease. A histology examination can help, and the same thing is valid when it comes to a polymerase chain reaction. Nail plate biopsy combined with some acid Schiff stain can be reliable as well.

Introduction to Chronic Venous Insufficiency

Your arteries are pipes inside your body that carry blood from your heart to the rest of your body and your veins carry blood back to your heart from the rest of your body. Veins have one-way valves that prevent the blood from flowing backward, to ensure they reach your heart properly.

When your vein walls and valves are damaged, the veins cannot manage blood flow as well as they should and it is harder for blood in your legs to return to your heart. This causes a pool of blood in your legs and increases the pressure on the walls of the veins; this is known as chronic venous insufficiency.

Chronic venous insufficiency is most commonly caused by blood clots (deep vein thrombosis) and varicose veins. In some cases, weakened leg muscles have trouble squeezing blood upwards and can contribute to venous insufficiency.

Other risk factors include obesity, pregnancy, sitting or standing for long periods of time without moving, and family history of venous insufficiency.

How to treat venous insufficiency

Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. This can result in skin changes such as reddish brown discolouration especially near the ankles which can lead to swelling and ulcers. The below are some ways to treat and improve venous insufficiency at home:

• Wear compression stockings to help with your blood flow return and relieve symptoms
• Lifestyle changed such as exercise and diet to improve your blood flow
• Stop smoking to improve your blood flow
• Calf muscle movement while sitting or standing for long periods of time
• Maintain good skin care by moisturising daily
• Elevating calves when laying down or sitting down
• Calf raises to activate the muscle pump that helps the blood flow up to the heart

The above measures may not be sufficient in treating your condition, and seeking medical advise from your Doctor is the best way to treat and look after your venous insufficiency. It is also advisable to speak to your Podiatrist about your concerns.

The Foot Force Podiatry

Ankle instability or ‘weak ankles’ is very common, especially when there has been a previous injury, such a sprain to the ankle. Weak ankles can affect balance and increase your risk of sprains which can lead to chronic ankle instability. Weak ankles can sometimes be caused by genetics, ligament laxity or even inappropriate footwear.

Chronic ankle instability is a condition characterized by ‘giving way’ of the outer side of the ankle. This condition often develops after repeated ankle sprains. Many athletes, as well as non-athletes, suffer from chronic ankle instability.

40% of people who suffer their FIRST ankle sprain will go on to suffer from chronic ankle instability within the first year since it has occurred. Inappropriate or inadequate ankle rehabilitation following an ankle sprain may result in chronic ankle instability.

There are many reasons why someone may have weak ankles. However, there are many things we can do to fix it!

Treatment:

• RICER: Rest, Ice, Compression, Elevation, Referral (to see a Podiatrist)
• Medications: Non-steroidal anti-inflammatory medication to help alleviate the pain and inflammation (temporarily)
• Bracing: provide appropriate support to your ankle and prevent your ankle from turning. It also allows the injured area to heal properly while allowing you to remain mobile
• Ankle rehabilitation: to strengthen the ankle, improve balance and range of motion, and retrain your muscles – See a Podiatrist for efficient rehabilitation
• Foot mobilisation: to restore normal function of your joints and bones of the foot and ankle – See a Podiatrist for efficient ankle mobilisation treatment

Best arch support thongs for foot pain?

If you suffer from heel pain, foot pain, knee or calf issues, you’ll know all too well how debilitating poor foot support can be. Unfortunately, many common brands of thongs do not accommodate to users with regular foot pain and associated conditions.

When the time comes to select new footwear, your best pathway is to opt for thongs for foot pain that are directly endorsed by podiatrists and physiotherapists. Arch support footwear is also a great alternative for those without existing foot pain and conditions.

No Compromise on Style

You no longer have to rely on flimsy rubber soles. Over recent years, the orthopaedic footwear industry has taken a number of significant strides. Purpose designed thongs for foot pain not only serve their primary function, but also bring first-class style and comfort.

Numerous men’s and women’s styles now exist that resemble traditional looks, yet feature the added benefits of certified arch support. In addition, the wealth of choices on offer means that you are no longer confined to one or two variations.

A Few of the Best

To make your choice a little easier, we have compiled a list of the best podiatrist certified thongs on the market. Read on below for dynamic compilation of men’s and women’s styles.

Women’s Zullaz Range

The women’s Zullaz collection of orthotic thongs features a number of stylish alternatives. Of course, each individual option comes with purpose built qualities well suited to foot pain sufferers. Zullaz flip flops are excellent for foot pain, offering five star treatment on each and every use. You can not only find a tailored option, but also various colours to match your personal preference and style.

Men’s Zullaz Range

The Zullaz range isn’t exclusive to women. For all the men out there with regular foot and leg pain, they too can access 5 star treatment. Fitted with excellent arch support, comfortable materials and contoured footbeds, Zullaz represents the latest in podiatrist recommended technology. Similar to the women’s range, men’s Zullaz footwear is also offered in a diverse set of styles, colours and fabrics. The choice will be all yours.

Birkenstock EVA Flip-Flops

In the world of footwear, Birkenstock is synonymous with style and comfort. Their EVA flip flops for foot pain are no different. With contoured technology and flexible insoles, these sandals can be adjusted to the unique shape of your foot. During use, they will also cradle each and every curve across your arches.

Another key feature of these thongs are the cork base/footbed. This base naturally absorbs shock to support everyday movement and ensure comfort at all times.

Olukai Ohana Flip-Flops

Foot pain can arise at anytime. When the summer hits, foot pain sufferers should still be able to enjoy the beach in style and comfort. This is where Olukai Ohana thongs fill the void perfectly. With water resistance and quick-dry technology included, this supportive footwear allows you to enjoy the outdoors and take your mind off foot pain.

Like the men’s and women’s Zullaz range, Olukai Ohana flip flops come in a wide array of fresh and vibrant summer colours. Don’t bring foot pain with you on your next vacation, opt for premium podiatrist footwear instead.

Contact a Professional for Assistance

For a comfortable and fashionable orthotic option, it’s hard to look past leather sandals and thongs. Some of the best leather podiatrist-recommended thongs providers include Archies, Aerothotic, Zullaz, Olukai, Rainbow, Reef and more.

In this context, professional assistance could come from a Podiatrist. Once a recommendation is made, you can then browse all the orthotic thongs on the market and make a purchase that suits your individual needs. Any of the aforementioned options are high-quality and the product of innovative medical design.

Nivi Watson
Experience Guest Blogger 

Ball of Foot Pain

Pain that is felt in the ball of the foot (the area just before the toes as shown on the image on the left) is quite common among the general public and can be caused by a number of reasons. In most occasions, people who are experiencing the pain in this area are labelled as having ‘metatarsalgia’ which is a very vague and common term used to explain pain in the ball of the foot. People with ball of foot pain tend to feel an aching pain and inflammation in this region. Some may even feel a sharp shooting pain, numbness, and even pain when flexing the toes.

As a Podiatrist that deals with many biomechanical cases with my patients, it is the second most common concern I hear and see in the clinic. There are many causes and reasons as to why people get pain in that area of the foot, and one of the most common culprits is ill fitting shoes! In most cases, the types of shoes that increase the risk of pain in the ball of the foot are shoes with a heel. The reason for this being is that, normally, this is the area where people place most of their weight when standing and walking. Wearing a shoe with a heel will increase the pressure and load on the ball of the foot, causing issues and pain.

What are the risk factors for ball of foot pain?

The risk factors that can be leading to pain in the ball of the foot are:

• Having a high arched foot causes an increase pressure at the ball of the foot.
• Having the second toe longer than the first: this can cause an increase pressure at the base of the joint, where it connects at the ball of the foot.
• Being overweight which can lead to an increase in pressure and weight on your feet.
• Intense physical activity which can lead to increased pressures on the ball of the foot.
• Wearing heeled shoes (even a small heel) or shoes that are too tight can increase pressures on that region of the foot.
• Having toe deformities can lead to increased pressures on the feet.
• Age: The fatty pad that provides cushioning to that region of the foot diminishes with age, increasing pressures on ball of foot. Arthritis usually increases with age, which can cause damage and increased pressures on the ball of the foot.

How can I Treat my Ball of Foot Pain at Home?

The following changes can be made at home to relieve some of the pain and pressure that you are getting on the ball of the foot:

• Footwear: Wear shoes that are wide enough to allow movement at the toes when walking and when you are on your feet. Ensure the shoe you are wearing does not have a heel to reduce the pressures on the front of the foot. Please follow our guide to choose a good shoe for your foot by clicking here.
• Rest your foot when you can, especially after activity. Placing your feet in an ice water bath for 2o minutes every 4 hours may help relieve any pain, inflammation and swelling.
• Stretching: Where activity may be causing you pain, targeted stretching can help ease the pain, increase flexibility and improve strength. Ensure you do stretches a few times a day until you feel the pain has reduced.
• Manage Body Weight: Excess body weight can increase the load and pressures put not the ball of the foot. Reducing weight will relieve the loads on the joints and feet. We recommend seeing your GP to help you with weight loss and management.
• Pain medication: taking ibuprofen or Panadol as directed by your Doctor help alleviate some of the pain. Please keep in mind that pain killers only mask the pain and do not treat the cause, meaning that the pain will come back.

If you have tried the above mentioned home care advice for ball of foot pain and have no relief after 1 month, it is safe to say that the pain will not go away on its own. It is time to see a Podiatrist for an initial biomechanical assessment to figure out why you are experiencing pain and how we can help to alleviate it. Your Podiatrist will give you a tailored treatment plan which may include footwear change based on your foot type, stretching and strengthening rehab exercises and possibly:

• Custom Orthotics: Depending on the severity of pain, and also the condition that is causing your pain, your Podiatrist might prescribe you custom orthoses which will help treat the pain at the cause, relieve the pain you are experiencing and also reduce the ris of the pain returning in the future.
• Shockwave Therapy: Depending on your condition and why you are experiencing pain, your Podiatrist might recommend shockwave therapy to help heal your condition and relieve pain.

Dr. Fatima Al-Kathmi (Podiatrist)

The Foot Force Podiatry

What is Chilblains?

Chilblains is the inflammation of the little blood vessels in your skin as a response to repetitive cold weather exposure. It is often painful and more commonly seen on the extremities such as the toes, fingers and nose.

It is a misconception that the weather needs to be freezing before you see symptoms of Chilblains. It can be seasonal and occur more often in the colder months of the year. You can get Chilblains from repetitive cold (not freezing) weather exposure.

What are the risk factors for Chilblains?

The factors that may increase the risk of having Chilblains or it’s symptoms may include:

• Gender: women are more likely to have Chilblains compared to men
• Underweight: If you weight 20% less than your normal BMI, you have an increased risk.
• Poor circulation: If you have less than normal blood flow, your body is more sensitive to changes in temperature, making you more likely to get Chilblains. e.g. smoking.
• Clothing: If you tend to wear tight clothes and shoes in cold and damp weather can increase your risk of Chilblains. Same goes for wearing clothing that exposes your skin to cold, damp weather conditions.
• Environment and Season: Chilblains are less likely to occur in areas where the weather is colder and drier as people in those areas are more likely to wear warmer clothing. There is more of a risk of Chilblains when living in a humid and colder (but not freezing) area. Chilblains are more commonly seen in colder months.
• Raynaud’s Disease: Increases the risk of Chilblains.
• Autoimmune Disorders: Lupus is the most common autoimmune condition to increase the risk of Chilblains.
• Occupation: Working in colder environments such as delivering freezable goods, having to enter freezer rooms and other similar professions tend to have an increased risk of Chilblains.

How do I treat Chilblains?

Unfortunately, there is no cure for Chilblains. However, it usually clears up between one to three week’ time. This is also the case as the weather gets warmer. The best approach is to limit the exposure to the cold. Some things you can do to help ease and prevent the symptoms includes:

• Using certain lotions to ease the symptoms (please consult with your GP or Podiatrist before hand)
• Protecting yourself from the cold by wearing: a beanie, gloves and thermal socks (especially in the colder months)
• Limit your expose to cold weather or environments
• Cover all exposed skin as completely as possible when going out in cold weather
• Keep your skin, hands, feet and face dry and warm
• Keep your home and workplace warm
• Quit smoking

Chilblains do not usually cause permanent damage or injury. However, it can lead to infection, and if left untreated can cause damage.

What is an ingrown toenail?

An ingrown toenail is a toenail which has grown inwards into the skin, and often causes pain on the sides of the toe. This is commonly seen on the two big toes of each foot and may lead to infections which can leave the toe red, swollen, painful, and sometimes have pus coming out of it.

Ingrown toenails are very common, approximately 20% of people who visit their Doctor complain about ingrown toenails. In most occasions, these people are given antibiotics and asked to soak their feet in warm water with Epsom salts. However, the infection will persist if the offend nail is not removed.

WHAT ARE THE RISK FACTORS FOR HAVING INGROWN TOENAILS?

• Genetics – As frustrating as it is, ingrown toenails can be genetic. Your mum, dad, uncle, aunty or even a second cousin may have ingrown toenails. You would of received the same genes that predisposes you to ingrown toenails.
• Adolescents – During this period of life, the feet tend to perspire more, meaning the nail and skin soften, which may lead to ingrown toenails.
• Reduced ability to care for nails – Not taking care of your nails, or trying to take care of them when you physically cannot reach them can cause trauma and increase the risk of having ingrown toenails.
• Poor nail habits – Cutting the nails too short or trying to round the corners can encourage the nails to grown into the skin.
• Sports – Participating in activities that involve running or kicking, such as soccer, can increase the risk of trauma and injury to your toes. This leads to ingrown toenails.
• Health Conditions – Conditions that poor blood flow, such as Diabetes can increase the risk of ingrown toenails.

WHAT TREATMENT IS AVAILABLE FOR INGROWN TOENAILS?

When seeing a Podiatrist for ingrown toenails, your treatment is dependant on the severity, wether you have risk factors and/or the reason(s) that you get them. If this is the first time you experience an ingrown toenail and you think it may be caused from wearing tight shoes, conservative treatment will suffice.

Conservative treatment consists of a general treatment where the offending nail edge will be removed. In cases where the ingrown toenail is very painful, local anaesthetic can be given to numb the toe for a painless experience. This will give an opportunity for the toe and skin around the nail to heal. It will also reduce a lot of the pressure and reduce the pain dramatically.

In cases where the ingrown toenail is always coming back, and is causing issues on a regular basis, it is more appropriate to have nail surgery to remove the ingrown toenail long-term. At our clinic, we have seen up to 99% success rate with ingrown toenail surgery.

Why does my child have Heel Pain?

Heel pain in childhood is very common, it is one of the most common concern I hear from parents who bring their children into the clinic. Heel pain in children could be one of many reasons. However, the common reasons as to why children get heel pain include:

• Sever’s Disease: Also known as Calcaneal Apophysitis, it is a period of growth in the heel bone (growth spurt). This leads to pain as the growth plate in the heel bone is swollen and irritated.
• Achilles Tendinopathy: Overuse injury that causes inflammation and irritation of the Achilles tendon which is the attachment of the calf muscles to the heel bone.
• Heel Fracture: Heel fractures can occur from high impact activity or accidents such as falling off a ladder.
• Juvenile Insidious Arthritis (JIA): Is the most common type of arthritis which is found in children and teenagers. It often causes inflammation and pain in the ankles and knees.
• Retro-calcaneal Bursitis:  inflammation of the cushioning pads around the heel which causes irritation and pain.

The most common out of the above is Sever’s Disease and is commonly seen in more active children between the ages of 7 – 15 years of age and account for 90% of children’s heel pain. However, it can be seen in children as young as 5 years old. Boys are more likely to experience Sever’s in comparison to girls.

How do I treat my child’s Heel Pain at home?

Some conservative ways to treat your child’s heel pain at home includes:

• Wearing well-fitted and appropriate shoes for their foot type.
• Resting as much as possible and reduce any high impact activity or sports.
• Icing by putting feet into cold water with ice cubes for 20 minutes on and 10 minutes off multiple times a day.
• Immobilising the ankles by wearing a cast or brace. This reduces the side to side movement in the ankle, therefore reducing the overload on the structures around the heel.
• Stretching the calf muscles to reduce the tension on the heels and surrounding structures.

How common is Heel Pain?

Heel pain is the most common foot complaint I hear from my patients that come to see me at the clinic. Being a Podiatrist, it is one of the most common things I see and treat day to day. Before treating heel pain, it is crucial to figure out what the underlying cause is. There is not only one reason as to why you are experiencing heel pain. This is why it is important to have an initial biomechanical assessment with your Podiatrist to figure out the underlying cause. With just this one appointment, we can set you up with a customised treatment plan which will treat your heel pain at the underlying cause to provide you with the fastest pain relief and reduce the risk of the pain returning in the future.

What are the risk factors for heel pain?

There are many factors that could increase the risk of you experiencing heel pain. Some of these factors are listed below:

• Having flat feet: Puts a lot of stretch strain and pressure on the foot and heel structures which can causes pain.
• Having high arch feet: Puts a lot of strain on the foot and heel structures which can causes pain.
• Out of phase pronation: Pronation is when your feet roll inwards when walking. Normally, when our foot hits the floor while walking, it rolls slightly inwards. However, when the foot rolls in more than normal or at the wrong time, this puts extra pressure on the innersole of the feet and this can lead to overuse and pain in the heel and foot structures.
• Long periods of standing or walking: Long periods of standing, walking and any other activity can cause a lot of strain and pressure on foot structures, which can cause pain.
• Running: Runners can put four times their weight force on their feet. When doing any activity, it can cause micro-tears in the soft tissue structures with each step and in turn cause pain in the foot and heel.
• Weak intrinsic foot muscles (muscles that run from below the ankle to the toes): Puts a lot of strain on other heel and foot structures which can in turn cause heel pain.
• Inactivity or not engaging in enough activity: This can cause shortening and atrophy to foot muscles and other structures. These structures tend to become less flexible and cause pain.
• Tight Achilles or calf muscles: When the calf muscles are tight, they tend to put a lot of pressure on the Achilles tendon which attached to the back of the heel. This in turn causes a lot of strain on the heel, which leads to foot and heel pain.
• Different leg lengths: a Podiatrist can accurately measure if you have legs that have different lengths, they can also determine whether this difference if from the bones or the muscles and treat accordingly.
• Obesity: Being overweight or experiencing a sudden increase in weight can cause extra pressure on our joints and foot structures. This can lead to overuse and pain.
• Training errors: Over-training or sudden increase in activity can put added strain on our foot structures which can lead to overuse and pain in the heel and pain.

What is the long-term treatment for Heel Pain?

If you have experienced heel pain for more than one month, it is safe to say that pain will not go away on its own and you may need to see a Podiatrist. The best way to treat heel pain is to figure out the underlying cause of the pain. This is best done when the affected structures or muscles are identified. Your Podiatrist will get you in for an initial biomechanical assessment to figure out why you are getting the pain and give you a tailored treatment plan which will treat the pain at the cause, giving you long-term relief and reduce the risk of the pain coming back. Some treatments your Podiatrist may discuss with you may include:

• Footwear recommendation: Your Podiatrist will assess your feet and the shoes you currently wear. They will recommend the most appropriate footwear for your foot type.
• Custom orthotics: If the reason you are getting heel pain is from flat feet, high arch feet, the way that you walk or pronating out of phase, your Podiatrist can prescribe you custom orthotics which are medical grade inserts to place in your shoe to correct your foot posture and redistribute the pressure evening in your feet.
• Soft Tissue Rehabilitation: Your Podiatrist can prescribe you specific exercises and/or stretches that will help with the development of your affected muscles or structures.
• Shockwave Therapy: Shockwave therapy is the most advanced treatment available for heel pain. It emits high frequency acoustic waves into the affected area of pain to speed up the body’s healing mechanism and de-sensitise the nerves to cause a numbing affect.This is done over approximately 5-7 sessions and these sessions are done weekly.

Dr. Fatima Al-Kathmi (Podiatrist)

The Foot Force Podiatry.