BoomerGirl Diary

Dear Crabby:

I’m really bummed, because I’m ready to get out my strappy sandals for spring, and I noticed that my toenails are thick and yellow. They look totally disgusting! What can I do?

Shoeless Jill

Dear Shoeless:

Toenail fungus, or onychomycosis (on′i-kō-mī-kō′sis), or OM, is a growing problem. It’s probably always been around, but since we didn’t display our toes as much in the recent past, perhaps people didn’t get as excited about it. The first case in the U.S. was noted in 1928, and the first OM related crisis occurred in a Manolo Blahnik boutique in NYC in early 1977:

Clerk: “Madame, remove those strappy sandals at once. Manolo Blahniks cannot be seen accompanied by ... this.” Gestures toward gnarly nails.

Shopper, weeping hysterically: “But it’s not my fault! My podiatrist says he can clear it right up. I beg of you, don’t take away my Manolos …”

Clerk: "Madame, please. The shoes. Or I shall call security.”

Kinda gives you the chills, huh? Not to worry. Soon after, that very woman established a support group for those afflicted (“F.O.O.T.: Friends of Onychomycotic Toes”) and they meet bi-weekly at a Designer Shoe Warehouse. I understand they’ve saved a lot of innocent victims and singlehandedly brought back the highbutton boot as a viable fashion option.

It’s estimated that 2 to 13 percent of North Americans have toenail fungus. Most are adults, and the rates get higher as we age. Hence the lack of cute, strappy shoes for the elderly. The recent increase in cases in the U.S. is thought to be in part from dermatophyte (fungus) immigration from West Africa and Southeast Asia. Who knew it could get a passport?

Yeasts and molds can also cause OM, but they do so to a lesser extent. And it’s not just a cosmetic problem—nail fungus, which can also affect the fingernails, can cause pain, loss of function, and increased susceptibility to infection.

There are a number of contributing factors, particularly your daily habits concerning your feet, your overall health, and genetics. Uh-huh, you heard me. Once again, your genetic makeup has bitten you on the … big toe. Go thank your parents, who are probably hiding their hideous feet in orthopedic-appearing shoes. There is a definite predisposition for nail fungus based on family history. Other risk factors for OM include:

• increasing age

• generally poor health and chronic problems like diabetes

• prior nail trauma

• living in a warm climate

• participation in fitness activities

• immunosuppression (e.g., HIV, or taking immunosuppressive drugs)

• communal bathing

• wearing occlusive (airless) footwear

• using communal footbaths and equipment at the salon

Obviously, some of these are more workable than others. To prevent OM from getting a, um, toehold, there are some preventive measures you can take. For example, you can wear flip-flops in the showers at the gym and the pool, take care of your health, and wear shoes that breathe. (Sandals with socks, anyone?) In fact, getting your feet out in the light and the air is quite helpful, as fungus loves a dark moist environment. You can also purchase your own manicure/pedicure tools for the salon, and forego the footbath (I know, I know, that’s the best part—sorry).

Once you get OM, it’s a little trickier. There are a number of “folk remedies” and these have worked for some. Rubbing the affected toe with Vicks VapoRub or Tea Tree Oil has worked for some, although it takes a long time. Others have sworn by soaking the feet in a pan of water daily with a teaspoon of bleach or a tablespoon of vinegar. None of these is particularly well documented, and all are a little stinky. After trying these and other Internet remedies, most people end up at their health care provider’s office seeking help. There are two major treatment categories, topical medication and orals medication, and both are prescription-only.

The topical treatment is a bit like clear nail polish. You apply a coat daily, letting it dry, and then once a week, you use alcohol and an emory board to essentially file off the surface of the nail. This may help the thickness of the nail, but doesn’t adequately penetrate the nailbed, so is not effective as solo therapy in the long-run.

There are several oral agents currently approved for treatment of OM, and each is taken for three months, one continuously once a day, and the other in pulsed doses (on/off doses). Both have the potential to interact with other drugs and also impact your liver, so your health care provider will do bloodwork before and during the treatment. These drugs are pricey, running over $400 monthly, and not all insurance companies cover them. Some companies require a fungal culture to prove that your gnarly yellowed talons are really caused by a fungal infection and not just bad luck, and this culture can take up to 10 weeks to grow out. So plan accordingly.

These drugs do work, over time, and generally the nail will grow out in the next 6-12 months looking normal. But the rate of recurrence is high—one study found up to a 45 percent recurrence rate within two years. This is discouraging, but helpful information to know if you are paying out-of-pocket for treatment. If your problem is just cosmetic, you may want to spend your $1,200 on a really kick-ass vacation and keep your socks on.

More radical treatments involve surgical removal of the nail (eek!) along with medication. This is helpful if the nails have gotten really thick and deformed, but requires a minor surgical procedure and a little bit of down time.

Prevention is still the best plan, as you can see, so do what you can to keep your feet clean, dry, and healthy. Forego the fancy spa pedicure for a home treatment, and get those little piggies out into the sunshine and fresh air. Take your flip-flops with you wherever you go, and take care of your health. See your health care provider, and good luck.