Fungal nail infection (also called onychomycosis) is responsible for approximately 50% of all nail disease and in western countries it appears to be on the rise* due to our ageing populations and lifestyle changes.
If you suspect you have a fungal nail infection there are many treatments available—although success rates vary greatly.
Treating fungal nail
“Typically fungal nail infection won’t go away without treatment; this can include over-the-counter topical antifungal creams and ointments, prescribed oral antifungal pills, laser treatment, or, in severe cases, surgical nail removal,” says Dr Brenden, principle podiatrist and owner at A Step Ahead Foot + Ankle Care.
“The biggest problem with topical antifungal agents is that they’re often ineffective, while oral terbinafine—despite being considered a ‘first-line’ treatment—requires strict adherence for 12 weeks.”
In recent years laser technology has emerged as an effective method of treating fungal nail infections. Performed by your local podiatrist, laser allows light to pass through the nail into the nail bed, effectively treating the infection at its source.
The heat from the laser kills both fungi and spores. Providing every nail is treated (which is what we recommend), the likelihood of success is high.
Preventing fungal nail from striking
“Fungal nail infection is much like a tummy bug; it can be passed on to others you come into contact with, particularly family members. As such, it really does pay to know how to protect against fungal infection,” says Dr Brenden (A.k.a Dr Foot)
The following steps can help keep your feet and nails fungus free:
Avoid public showers. If you must use a community shower—wear thongs
Boil your socks. Fungi thrive in warm, moist environment (Hello sports socks!) but they can’t survive extremely high temperatures. Boil your socks regularly, for at least 10 minutes, to kill off any hidden fungi spores.
Keep feet clean and dry. In between sweaty toes is the ideal habitat for infuriating fungi. Stop fungal infection for striking by keeping feet clean and dry. If you’re prone to sweaty feet, try an antifungal foot powder, spray the soles of your feet with antiperspirant and don’t forget to change your socks daily.
Don’t share nail clippers. Sharing is caring but not when it comes to fungal nail infection. Be vigilant at the nail salon; ensure the nail tools they use have been sterilised.
Next steps…
We treat several people a day for fungal nail infections. If we can help you please let us know! You can contact us through our helpful front desk team. They speak to multiple patients a day with this condition. They can run you through our process and costings and reserve an appointment time that suits you best. Our number is +61 2 9673 2987 we would LOVE to help.
Medical clinics + other podiatry clinics
If you are one of the many Podiatry / Medical clinics that follow my posts please read the details in my clinic websites, I am currently developing a course for practitioners interested in learning more effective and efficient ways of treating nail fungus. If you follow our posts we will announce this as it occurs or simply send us a message and our office will save your details. We look forward to helping you as well! Our number is 02 9673 2987. Hope to chat soon.
Children spend at least 30 hours a week stomping around in their school shoes. This means that choosing the right shoe is really important for the health and comfort of your child’s feet.
“Ill-fitting school shoes can lead to a multitude of foot problems in adulthood, such as ingrown toenails, corns, callus, bunions and hammer toes. There’s also evidence to suggest that poorly fitting shoes can cause back pain,” says podiatrist and founder of A Step Ahead Foot + Ankle Care, Dr Brenden.
No parent wants to put their child through undue foot pain or cause feet issues in later life. By understanding how to select the right shoes for children and following the guidance of a podiatrist, parents can help ensure they’re a step ahead when it comes to picking out the best back-to-school shoes.
With Dr Brenden’s top tips, choosing the right back-to-school shoes for your child should be as easy as…well…A,B,C!
Get the best fit. It can be tempting to buy a size bigger, given how fast children’s feet grow, but the key is to allow a maximum of one thumb width between the top of the longest toe and the end of the shoe.
Heel support. Squeeze the back of the shoe to make sure the heel counter is strong and stable. This way you know you’re getting good heel support. The heel of the shoe should also be no higher than 1.5 cms.
Fasten up. Check that the fastening mechanism (laces, Velcro or buckle) holds the heel firmly in the back of the shoe. Slip-on shoes are not recommended for school wear.
Sole survivor. The soles of shoes should be fairly straight, rather than curved, as this accommodates the straightness of the foot. Also, if you attempt to ‘wring out’ the shoe by holding one hand at the heel and the other in the middle, it should not twist.
Flexibility. A flexible shoe allows for the natural movement of the foot but make sure that the shoe flexes at the ball of the foot; the shoe should NEVER bend in the middle.
A higher price tag doesn’t always mean a better shoe. Well-known brands, such as Clarks, do tend to outlast some of the cheaper brands but this is because they are well made using quality materials. Check to see that the shoe you’re considering buying is made from a high-quality, durable material.
Forget foot weights. You might be fooled into thinking that a heavy shoe is a sign of good quality. Yet a shoe that is particularly heavy is probably not going to be the most comfortable choice. A shoe should weigh no more than approximately 250 grams. That’s less than a can of soup!
Hand-me-down shoes are a no-no. Aside from the risk of fungal or bacterial infection, pre-worn shoes are likely to have molded to the shape of the previous owner’s feet. It’s also probable that the tread and heel counter have worn down, offering less support and poorer stability for your child’s feet.
Listen to your child. If your child complains of foot pain or discomfort or you notice they are walking differently, take a trip to your local podiatrist to have their feet checked.
“Parents commonly ask how long school shoes should last. Of course, this will depend on the quality of the shoe but on average they should last nine months to a year.
“However, if you notice your child has a growth spurt—check to see if their feet have outgrown their shoes. On average, children’s feet grow about half a shoe size every six months,” says Dr Brenden.
Plus, check out Dr Brenden’s YouTube reviews of some of the latest (2018) school shoes on the market (Includes Ascent Eve Black, ASICS Gel Trigger, New Balance 625 KX, Target Billy Senior—to name just a few!)
Despite the fact that fungal nail infections are notoriously tricky to get rid of, they’re thankfully quite easy to avoid—if you know how, of course!
Fungal infections are seriously easy to contract and super contagious, so it pays to have a few tips up your sleeve to beat a fungal skin or nail infection.
Top 5 tips for fungus-free feet
1.Boil your socks
We’re not kidding; regularly popping your socks in a pot of boiling water can help stop you from getting fungal nail and prevent friends and relatives from catching it (if you’ve already got it!).
Why? Fungus can’t survive extremely high temperatures. Boiling your socks for 10 minutes at 55-60 degrees will kill off any fungus that might be lurking in your socks. But remember, simply washing your socks on a regular (40-60 degree) wash cycle will do nada to nuke fungal spores.
2.Don’t share showers
Communal showers are a breeding ground for fungus. This is because fungal infections are extremely common and public showers are high-traffic areas; lots of feet means a much greater chance of catching a fungal infection! Think Gyms, swimming pools, beach side change rooms!
Super tip; If you must share a shower area, be sure to wear thongs to help minimise the risk of picking up fungal spores.
3.Be nail salon smart
A professional pedicure can be a relaxing way to prep your feet for summer—but not if you go home with more than you bargained for. Busy nail salons can be a breeding ground for fungus, so make sure you seek out a reputable nail bar. Ensure a new set of tools is opened just for you and the foot basins are lined with plastic protectors that are replaced at every use.
Super tip; If you want to be super vigilant, take your own nail file.
4.Shower outdoors
If you’re at the beach or swimming pool and there are outdoor and indoor showers—take the outdoor option.
Indoor showers are darker and might not have the drainage that the outdoor showers do, which means that water can collect. This creates a dark and wet environment—the perfect place for a fungal spore party!
Super tip; Outdoor showers on the other hand have the benefit of UV rays, which dries the shower area and reduces the likelihood of a fungal infection.
5.Keep feet dry
Fungal spores love dark, damp places—just like between the toes of sweaty feet. An easy step to stop fungal infections in their tracks is to make sure feet are washed and thoroughly dried on a daily basis. Sounds easy right? Yet if it were really that simple, fungal infections wouldn’t be so commonplace.
Super tip; Help protect your feet from fungus by using an antibacterial foot powder or spray in your shoes and on your feet, changing your socks daily and washing your feet after exercise.
Facing up to fungus
Fungal spores are invisible to the human eye, so it’s important to be able to quickly recognise the signs of a fungal skin or nail infection. Symptoms include:
Dry skin or white patches around the toes that remain even after moisturising
Callused skin – people often think its just dry skin, look for the other signs
Small blister like patches on your skin.
Discolouration of the toenail (usually white, yellow or brown streaks)
Thickening of the nail
Crumbling nail
Let’s face it, sometimes fungal spores will get the better of us. The trick is to treat a fungal skin or nail infection at first sight.
You can start by trying a broad-spectrum antifungal cream or ointment containing the active ingredient terbinafine, which can help kill the infection. Yet despite being widely available, antifungal ointments, paints and creams have a very low success rate.
Our Podiatrist Dr Ryan explains that this is why A Step Ahead Foot + Ankle Care are fighting more and more cases of fungal nail with laser.
“Laser works by penetrating the nail, heating up the nail base and killing the fungal spores.
“To ensure the best results we always treat all ten toes so that every single spore is busted. We also use a mirco drill, which makes tiny holes in the toenail and enables the laser to successfully reach the nail bed. It can help with post-laser treatment too, as any creams applied will also make their way into the nail bed for better results.”
Added benefits of fighting fungus with laser include:
Laser can beat even the most stubborn fungal spores
Fiona is a 43 year old lady with two teenage daughters and a busy household. In the past six months she has returned to exercise by joining a gym, which she is …. or was really enjoying.
Lately she has been waking up in the morning, placing her heels on the ground, only to get what she describes as "excruciating pain". She feels the same pain if she sits for long periods and tries to stand: the pain, while not as bad as those first few step in the morning, can make her hobble. This is now a BIG problem as she was really enjoying her return to fitness and wants to see what she can do to rid herself of the pain.
Is it really a heel spur that causes the pain?
A visit to the GP
She visited her GP who spoke to her about a heel spur, he took x-rays and indeed there was a heel spur in the picture. He explained to her that generally very few surgeons will operate on heel spurs and there is little she can do but wait out the pain which on average would go away after about 18 months! He did give her some general stretches and said he could try an injection if she really wanted, but it was painful!
Fiona also went to the chemist to try to buy some heel pads to take pressure of the heel. She tried these for about a month. While they worked for a short while, the pain quickly returned. She also tried some very cushioned shoes, again while this was comfortable at first within a short period of time this very expensive pair of sneakers gave little relief.
On attending an appointment at A step Ahead Foot and Ankle care Fiona was just about to give up. A friend referred her after they had suffered a similar pain and our podiatry team had made her pain free.
A diagnosis
Our Podiatrist, after a thorough assessment, diagnosed Fiona with plantar fasciitis. Plantar fasciitis is a soft tissue condition of the underside of the foot starting at the heel, where much of the pain is located, however the pain can radiate out towards the toes where the fascia again ends. The pain can begin quiet subtly at first and can last on and off for many patients for many years.
Shock wave is a new and highly effective treatment.
Treatment
We discussed a treatment plan with Fiona to rid her of her heel pain, this included looking at some new more appropriate runners, a series of stretches, and soft tissue treatment options. Our Podiatrist provided Fiona with options which included:
Deep connective tissue massage – This is a firm to hard massage which is in this condition under taken on the base of the foot around the heel and into your calf muscle as this is almost always also tight. These session can range from as short as one a week for 3 weeks but up to 12 – 18 weeks long, dependent on how long your pain has been present.
Shockwave Therapy (Extracorporeal Shockwave Therapy (ESWT)) – Shockwave is a relatively new treatment which we have found very successful. The basic principles behind shockwave therapy are the high pressured acoustic shockwaves that travel through the skin to stimulate pain relief and tissue repair. We have found this treatment very successful and sees patients recover quicker. Most patients like Fiona recover within 6 to 9 weeks. This treatment is often recommended by sport physicians and orthopaedic surgeons. (Be warned - How long has your Practitioner been using this?)
Orthotic therapy – Orthoses are designed to hold your feet in a “corrected position”. Feet that are in poorly positioned or have poor foot posture have to over work which in turn causes muscles to over work and is most often the reason why people develop foot pain. While there are varying devices that do this there is no replacing custom made orthoses. These devices are made to match your foot exactly. - HARD RIGID orthotics can cause you MORE PAIN!! Soft pliable devices are the way to go!
A choice
In this instance Fiona opted for the quicker Shockwave therapy and orthotic therapy. Her podiatrist helped her select the correct foot wear to purchase from a footwear retailer. We then also provided her with an Isometric Strength exercises - NO NOT STRETCHES! that's right NOT stretching! Our team worked with Fiona to build up her strength readying the surrounding muscles for its work ahead at the same time as repairing the damaged tissue. On each occasion of shockwave reviewed these and provided supportive sports tapping to further support her foot.
A recovery
Fiona attended for shockwave over a period of five weeks and made good progress over that time with her pain dropping slowly over the first two weeks and then quickly once combined with her orthoses and more appropriate footwear.
At week five it was decided to push her appointments out to fortnightly and then when this was found successful out again another month. In total Fiona attended a total of seven times before her pain was relieved completely.
We introduced Fiona slowly back to attending the gym, with strict instruction on stretching and appropriate footwear for her foot type. Fiona made a full recovery and with a month had returned to three gym sessions a week and a walk with friends for exercise on weekends.
Interested in more information? How about the common myths around heel pain?
How come my child’s heel pain isn’t getting better ….
Soccer, rugby league and Netball all culprits for creating heel pain in kids if mixed with poor foot posture and growth spurts
“He had heel pain last year and now it’s back. They have NO idea what it is. They did an x-ray and it’s not Severs. The physio massaged his calves and it helped for a few weeks but it’s not better. It’s almost been 6 months. We had to halve how much sport he does now and he hates it. As soon as he starts running or playing a game, it comes on. He describes a tight feeling when he walks too”
Very honestly, these were the exact words that came from a frustrated and concerned mum, paired with an equally frustrated 13 year old boy, just before lunchtime today. This family traveled across the city to see us, which is not uncommon but it must be frustrating.
The tragedy in these words is that they’re NOT uncommon. At least a few times a week I hear grumblings from frustrated parents – and they most definitely have a right to be frustrated! – because they’ve seen various practitioners without a real diagnosis and just when something has been suspected, imaging has gone and ruled it out and we’re back at square one. Or are we?
The matter of the fact is: People make mistakes. Practitioners make mistakes. Radiographers make mistakes. We’re human! It’s going to happen.
I feel like I could host a conference discussing the amount of times I’ve been handed an xray telling me that there is nothing wrong with my patient that currently sits in front of me in AGONIZING pain!
If it doesn’t sound right, you better believe that it’s not. Let me emphasis: pain does NOT happen for no reason, and no amount of negative radio-graphs is going to magically fix your very real pain.
Kids stay happy and healthy and active – Kids should play sport PAIN FREE!
So then, WHY does this happen?
There can be a variety of reasons, and I’m going to give you the very real uncensored version that other practitioners may get annoyed at me for.
• Referrers can order the wrong TYPE of imagine study. If you’ve damaged a muscle, ligament, tendon or any soft tissue, your x-ray will show you are perfectly fine! Yep, go over there and sit your torn Achilles tendon down because you’re fine to go run that marathon. (Please DONT we are kidding)
• Radiographers are very HUMAN and can miss things. Some are likely to have seen more of a certain condition, or be more familiar with an area of the body, and so some may pick up or recognise things that others miss. And you can’t blame them – the body is composed of an extraordinary amount of bone and soft tissue and any expectation for every single person to be a scholarly expert on every single part is drastically unrealistic.
• Things CHANGE over time. Your imaging from a few months ago is a picture of what is happening in your foot a few months ago. Since that time, some tissues may have gotten better, some tissues may have gotten worse, and some ones may now be damaged that weren’t before!
Be assured:
There is NOTHING wrong with wanting a second opinion and getting a referral for another ultrasound or X-ray
There is NOTHING wrong with re-imaging if you feel that your injury has changed. And if you’re having pain but you’re being told there’s nothing wrong, you have EVERY right to be frustrated!
You SHOULD get a second opinion! or a third even if you are not getting the answers you need.
There is increasing evidence that we need to look past radiology reports and look at clinical symptoms
So what do you do next?
Your child should not have to play sport in pain, we can happily tell you that we work with kids to get them back to happy healthy and active every day. Our team will work with your child to develop a detailed care plan, this of course after a thorough assessment of their run + walk patterns; including video analysis. we will examine foot wear and make recommendation and look at the damaged soft tissue and assess what is the best way to rehabilitate this back to health! They may require a soft pliable orthotic for inside their shoes to wear while playing (just like our patients that are international level athletes!)
One of the delightful things about treating kids is seeing them return smiling and back to playing the sport they love!
And for all those wondering.. Yes our little champion from this morning did have Severs 😉
A Step Ahead Foot + Ankle care Penrith, St Marys and soon to come to a suburb near you!
A Step Ahead Foot and Ankle care have founded “My Kids Foot Doctor” a clinic specifically geared towards treating Kids feet. We see dozens of kids a day, unlike other practitioners who see your Grandma’s toe nails and the occasional kid we see these balls of fun all day every day.
About our clinics
Our team see dozens of kids from across Sydney every day
Our clinics are set up with kids in mind we have big toy boxes, TV’s coloring in and lucky dip boxes. Our practitioners are the kind that sit on the ground and chat to your child, who laugh, may wear silly glasses and love handing out chocolate WE LOVE SEEING KIDS!
What does this mean? It means we have built up an enormous amount of experience with kids because we get to see them ALL the time! If we can help you with your little one, if you have a nagging doubt or worry please call our helpful team on 96732987 we’d love to help!
Contact us at 9673 2987 with questions we want to truly understand what’s happening at present with your foot and leg pain if you are ready we will set up your initial appointment.
Learn more about your condition - Check out over 40 Educational videos our team has prepared on our Facebook page. From heel pain, and what’s the best shoes, to ball of foot pain; it’s all there.
Speak to A Foot Doctor - Reserve your free 10 minute review with one of our qualified Sports Podiatrists to review where you are up to and discuss what are your next best treatment options. (Availability limited due to demand)
Try our Heel Pain Treatment advisor. Answer 7 simple questions to get a quick, reliable report on what treatment options you should be considering!
Dr Brenden’s White paper report on the “6 Reasons You Won’t Beat Heal Pain” outlines what’s stopping you from beating this and tips on how to stop it in its tracks!
Heel Pain Report
IS IT REALLY GROWING PAINS?
7 simple signs every parent should know!
Are you worried about pain in your child feet? Not sure whats normal and whats not? Try accessing Dr Brenden’s helpful report on the “Growing pains – 7 simple signs every parent should know!”
Kids Pain Report
We would love to help! We realise you are busy. We popped this in to offer a quick way to get answers to your questions or problem
Dr Brenden’s White paper report on the “6 Reasons You Won’t Beat Heal Pain” outlines what’s stopping you from beating this and tips on how to stop it in its tracks!