Archive for Nails
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.
Bluish-black Toenails – Podiatry in Nacogdoches Texas
Posted by: | CommentsBluish-black toenails are usually dry blood accumulations beneath the nail plates that result from long-term repetitive trauma. This condition is frequently seen in distance runners, exercise walkers, and in those individuals involved in racquet sports. The toes involved are most often the second digits (next to the big toe) because of their being the longest. In most cases, these toes are painless but generally cause concern because of their progressively darkening appearance.
The cause of this nail condition is repetitive trauma secondary to shoe pressure. What happens is that when a person stops in walking or running, the undersurface of the athletic shoe grips the ground and forward motion is abruptly halted. However, the foot inside the shoe often continues for a short time period to slide forward until the toes jam into the end and upper portion of the shoe. The result of this repetitive traumatic jamming pressure against the toes is predictably a thickening of the nail plate with frequent bluish-black discoloration due to the accumulation of blood.
There are no effective treatments for this problem as long as the involved activity is continued. I recommend to patients that they check carefully their athletic shoes for a proper fit, consider the use of Band-Aids during the activity for added protection, and make sure that their nails are trimmed properly. On rare occasion, when discomfort is present and continued athletic participation is in jeopardy, the involved nail plate(s) can be removed. However, after all is said and done, these discolored nails and athletic participation seem to go hand in hand and in most cases, with no serious consequences to the participant.
