Archive for Fungus
Toenail Fungus – Onychomycosis
Posted by: | CommentsOne of the most common foot conditions Dr. Sowell sees everyday is painful onychomycosis. That is to say that fungal nails have become very common in our society today and it is estimated that over 35 million people have fungal toenails in the United States alone. Fungal toenails are characterized as being thick, yellow, crumbly and abnormal in growth. They often times become very painful and can be embarrassing for patients. At Sowell Podiatry we take this condition very seriously and address it with a protocol that should provide a higher success rate.
1) We clean and sterilize all instruments properly using autoclave and chemical baths for each instrument that touches a patient.
2) We biopsy toenails before treating the toenail to verify that the condition is in fact caused by a fungus. There are some conditions such as micro-trauma and psoriasis to name a few that mimic onychomycosis.
3) We provide in depth debridement services for fungally infected toenails to reduce their risk of spread.
4) We measure and record fungal infection to determine if the condition is getting better.
5) We offer multiple treatment options to help the patient find a treatment course that fits their goals.
At Sowell Podiatry it is our goal to reduce the spread of fungal toenails in our community and we do that one toe at a time. If your toenails look abnormal, yellow or painful please give us a call.
Fungal Toenails aka Onychomycosis at Sowell Podiatry
Posted by: | CommentsOnychomycosis is an infection of the nail by fungi that include dermatophytes, non-dermatophyte molds and yeasts. The nails become thick, yellow, opaque, brittle and dystrophic. This can become painful over time and often spreads from nail to nail or skin. Onychomycosis can be very difficult to manage and when it worsens it can become painful and limit one’s ability to walk or wear shoes. The incidence of onychomycosis has been increasing since the Vietnam War likely due to increased awareness.
There are other dermatological diseases that can have a similar appearance so I recommend a biopsy of the nail plate for diagnosis before choosing a treatment. This condition can be very difficult to treat and is typically addressed with either topical medications or oral prescriptions. Topical treatments typically consist of an antifungal medication in medias that attempt to penetrate the tough nail. I have found these approaches to be fairly unsuccessful and I only use them at patient request, in mild cases or if health issues limit the ability to choose oral antifungal medications. In my experience the best topical treatments include Pen-lac, Formula-3, and Tea tree oil. Patients should be reminded that application must happen daily and for at least one year. Patient compliance tends to be difficult and cure rate is low. Oral medication, such as Lamisil, has a much higher cure rate as well as a much higher risk level particularly concerning the liver. Taking an oral antifungal requires compliance from the patient and follow-up that may require additional blood tests to make sure the medication is being tolerated well.
A proper diagnosis and consideration of treatment options is imperative if the patient is to have success concerning fungal nails. Please see a podiatrist, dermatologist or primary care physician when trying to decide. Thorough debridement (reduction of thickness and length) should be part of any treatment regimen. Feel free to call Sowell Podiatry if you have any questions!
Medicare Changes on Toenail Debridements
Posted by: | CommentsIn August 2011 our regional version of Medicare made significant changes in how podiatry is practiced. Unfortunately, in my opinion, it is not for the better and I feel obligated to try to explain it to my patients because there is much confusion surrounding the changes. Before I get started I want to say that these changes affect any professional that provides these services and, in fact, there are many more Medicare changes that are directed at other physicians that I am not discussing today.
In a nutshell, Medicare, in our region, no longer allows the debridement (reduction in thickness and length) of painful mycotic (fungal) toenails for otherwise healthy patients. They now require a patient to have a qualifying medical disease (list available in my office) for a patient to receive this treatment. Medicare has provided a list that reasonably contains diabetes, peripheral vascular disease, neuropathies, etc. I agree that these patients desperately need this care but I disagree that they are the only ones that need it. From the beginning of my podiatric career a patient could have their toenails debrided and their fungus treated if they were painful or limited a patient’s ability to ambulate.
I believe this is a significant change in policy for Medicare. Before this change… pain was enough to qualify for care and now pain is not enough. In my opinion, pain is not normal and requires attention that is often medical.
Additionally, Medicare has decided to reduce how often a qualifying patient may have their toenails cared for. If I remember correctly, when I began practice thirteen years ago a patient with painful fungal toenails could have them debrided every nine weeks. Then Medicare changed the frequency to every twelve weeks. Now the frequency has been changed, per my best understanding, to six times every two years, or basically every four months! Basically, the highest risk patients must wait four months to get care that may help them avoid infections, ulcerations and amputations. During a phone call, I asked the Medicare representative if she would please wait four months to trim her own toenails so she could see if this was reasonable and she said there was no way she could do that? It bothers me that she realizes that her, likely, low risk feet need more care than what Medicare is willing to provide for high risk feet.
If you are a patient of mine and have Medicare, please know that foot pain is not normal and please come and see me. Yes we are still accepting Medicare and we want to help you. Please know that most of the time your care is covered and if it is not we will discuss this with you so there are no surprises. We want to be your foot care specialist.
Please know that to my best understanding this change is currently regional so not all podiatrists are affected, yet. Typically these changes are “test driven” in a region and then many times if “successful” in lowering costs they are made nationwide. I see these changes as a bit insidious because our patients are often told their services are not being cut by Medicare but in fact they are being cut for some on Medicare. Sure the treatment is still available….but only for a more restricted list of patients and on a much more restricted schedule.
Sure, debridement of my patient’s toenails sounds like a small fish in the big ocean of healthcare. I recognize that. However, small fish like these are schooling in every medical specialty and that should concern us.
Athlete's Foot
Posted by: | CommentsProbably one of the most missed diagnosis of the foot I see is Chronic Dermatophytosis, aka Athlete’s Foot. We all seem to recognize the acute form many get in high school where the feet itch excessively and the skin between the toes is wet and has turned white, aka maceration but we often mistake the chronic type of dermatophytosis as dry skin. Patient say, “Doc I keep putting moisturizing cream on my skin but they still look dry”. Well that’s because their problem is a fungus, not dry skin.
You do not have to be a member of a sports team to get athlete’s foot. In fact, believe it or not, you don’t even have to play a sport. The condition itself usually results from an overgrowth of a particular fungus organism. In most cases, the areas between the toes and the arch of the foot are most often involved. Athlete’s foot may appear in different stages, each with its own presentation. For instance, the acute stage may have blisters or have intense itching. In addition, there may be maceration between the toes and occasional drainage. The chronic condition is characterized more by a dry and scaly appearance and rarely itches. My favorite description of chronic dermatophytosis (yes I have a favorite!) is “a moccasin distribution of dry ruptured vesicles”. There is some confusion as to how this skin condition can be transmitted but at the present time, the consensus of opinion is that there is a contagious capacity. In short, you might be able to catch it from the next guy or gal, so watch your barefoot walking! Also, it can come from fungal toenails if you have those.
Occasionally, an athlete’s foot condition will become infected and require more extensive therapy. In actuality, the threat of subsequent infection is probably a prime reason for treating more aggressively the earlier stage of the condition. After all, one might ask, what is really so bad about a little itching between the toes. Well, by itself, probably not a whole lot. But in those cases where that little itching develops into a more involved complication, then we might be facing a more serious problem.
At the first sign of an athlete’s foot condition, I would recommend a short trial period of a medicinal preparation available at the pharmacy in spray or cream varieties. Following several days use, if the condition persists, I would recommend a visit to the foot specialist. One thing is for sure, do not give up your athletic status in the hopes of relinquishing your athlete’s foot!
