There is something about feet and the toenails that fungi just love.

Sunset boating in Chicago. (Dr. Noorali Bharwani)
Sunset boating in Chicago. (Dr. Noorali Bharwani)

“There are about 80 types of fungi residing on a typical person’s heel, along with 60 between the toes and 40 on the toenails,” says an article in the Globe and Mail (Social Studies May 24, 2013).

It goes on to say that the feet are home to more than 100 types of fungus, more than any other area of the human body, quoting a study published in the journal Nature.

Many of the fungi on our skin are good for us in that they prevent bad fungi adhering to our skin. They protect us from getting athlete’s foot, plantar warts and stubborn toenail problems.

Most problems are not life threatening. Here are some examples:

Plantar warts: These are also known as common warts. They grow on the soles of the feet. They grow into the skin because we walk on them. They can be painful on walking. The virus causing the wart is picked up from walking bear foot in locker rooms and swimming pools.

Treatment: They may spontaneously disappear if you wait long enough – months to years. They can be managed by freezing, scrapping or burning. They can recur.

Callus and corns: These are thickened areas on the hands or feet caused by pressure or friction. This is usually related to work or sporting activities. Uneven pressure of body weight during walking or ill-fitting shoes can cause calluses and corns on the feet.

Treatment: Wear proper fitting shoes and use corn pads to relieve pressure on the corns. Thick calluses can be sliced down to normal skin over a period of time. If the source of friction and pressure is removed then corns and calluses should not recur.

Toenail problems: Mainly involves the big toe. It may be ingrown or overgrown. Ingrown toenails are commonly due to ill-fitting shoes pressing on an incorrectly cut nail. Poor foot hygiene encourages infection.

The problem occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Treatment: In an acute stage antibiotic, painkillers and bathing the foot in warm salt water are necessary. Surgery is required in most cases. The problem can be prevented from recurring by keeping the feet clean and wear correctly fitting shoes. Cut the nail straight.

Fungus infection of the nails: Usually affects toenails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Treatment: Anti-fungal therapy is required – orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

Our feet are subjected to more wear and tear and hence they get more problems than our hands. Our natural tendency is to take care of our hands more than our feet. Many of these problems are preventable.

In my view, walking bear feet is the worst thing you can do for your feet. Wash your feet at least once a day (twice if your feet sweat a lot) with soap and water. Dry them well with a soft towel. Apply some skin lotion or powder. Wear good quality clean socks and proper fitting comfortable shoes.

Have a wonderful Christmas and Holiday Season.

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Have you checked your toenails lately?

Big Toe with Fungal Infection.

Now that summer is here, people from all walks of life have given up on shoes and socks. Sandals, flip flops or bare feet, yes people walking bare feet, is the norm. Now look at your feet then look at your toenails. Are they full of calluses, plantar warts, ingrown toenails and/or totally deformed nails due to fungal infection?

Wow, that sounds horrific. None the less not life threatening. So, you will live long enough to fiddle fuddle with your toenails, with nail clippers and all sorts of sharp instruments people use to fix the problem themselves until they end up getting infection. And if you are a diabetic then gangrene and amputation may be the end point.

Wow again! But don’t panic. If this is getting scary then get a glass of wine (will keep your heart and feet warm), relax and read. Just pay attention to your feet and toes and toenails and you won’t lose your foot.

Nails protect the tips of our fingers and toes. Two most common problems I see with toenails are ingrown toenails and fungal infection.

Ingrown toenail of the big toe usually occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Ingrown toenails can be prevented by keeping feet nice and clean. Wear roomy shoes and clean cotton socks. Allow the outer corners of the nail to grow over the skin margins placing small piece of cotton soaked in an antiseptic just under the outer corners of the nail. Cut the nails straight. Antibiotics will help relieve acute infection but will not cure the primary problem. Eventually, surgical procedure done in the office under local anaesthetic becomes necessary.

Fungal infection of the nails is common as well. It affects toenails more than finger nails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Fungus infection is best treated with anti-fungal therapy orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence. If they are thick, stubborn, deformed, ugly and painful then surgery is required.

If you love your feet and toenails then keep your feet clean and shiny…yes you can do it.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!