It's probably NOT Toe Nail Fungus. Let's discuss!!

THAT MAY NOT BE TOE NAIL FUNGUS AFTER ALL!!

Hear me out!

Toe nail fungus affects many people, men and women and lets face it, it can be embarrassing!

We all want to wear nice sandals and flip flops in the summertime but that can be challenging when your nails aren’t looking it’s best.

Treatment for fungus include topical ointments, anti-fungal pills and/or very pricey laser treatments. But this blog post is not to discuss how to treat your fungal nails. Today we are talking about how to treat it when it’s NOT fungus.

Yes, NOT fungus! There are other nail issues/ disorders that have a similar appearance to fungus and sometimes as physicians we end up treating the clinical appearance and a year later the patient has the same result. 

In my practice, I make it a priority to have a confirmed diagnosis of fungus before I start my patients on treatment regimens that could be expensive, hard on liver etc….

To do this is pretty simple…. Take a nail biopsy. When the patient returns in two weeks, we would have a confirmed diagnosis and can then decide on which anti-fungal treatment option is best for the patient or we would then know that the cause of the nail issue is not fungus after all.

IF IT’S NOT FUNGUS, THEN WHAT IS IT??

I’m introducing a new term to you. Micro-trauma! Micro-trauma to the nail. “But I didn’t hit my toe doc?” No, that’s not the kind of trauma I mean (although that can damage the nail bed and cause thickening of the nail as well). I am talking about repetitive friction/forces to the nail secondary to shoe gear, bony deformity under said nail or a biomechanical abnormality that causes damage to the nail bed therefore affecting how the nail grows.

Micro-trauma tends to be overlooked and understated when it comes to nail issues. Any time the body feels extra pressure or friction in a certain area, outside of normal, it’s way of protecting itself is by building up extra tissue in the form of callous (hyperkeratinization) that then damages the nail bed and secondarily the nail plate. So that thickening and discolorizaion could be a result of micro trauma and not fungus.

Some causes of micro-trauma include

• Shoe gear - tight shoes, shoes inappropriate for your foot type

• Bone deformity - bony spurs/ exostosis

• Biomechanical abnormality - hammertoes/ bunions

In my experience about 35-40% of the time, what presents as fungus, after biopsy and proper examination and history ends up being negative for any fungal elements.  Therefore, It is important to consult a specialist that can determine the root of the problem and any underlying deformity causing the micro-trauma induced nail disorder and address it accordingly.

Dr. Knowles’ Footnotes

12/03/19