Archive for the ‘Fungal Nails’ Category

Treatment of Fungal Nails

August 25th, 2014 by Dr.Chang

Toe nail fungus cures can include both oral and topical medication treatments. The gold standard for treating onychomycosis in an otherwise healthy individual is the oral therapy. The most widely prescribed medication today is Terbinafine ( Lamisil – Novartis). Newer oral medications are currently in development and clinical testing. Oral antifungals, like Terbinafine, are very safe medications if properly used. Terbinafine tablets has adverse response rate of less than 3 percent. Typically, the dosing for Terbinafine is one tablet per day for three months. Blue Ridge Foot and Ankle Clinic will take blood test to verify norFungus2mal liver function prior to starting this medication.

Dr. Murray and Dr Chang may also take a sampling of the nail and have it lab tested to confirm that it is true nail fungus. Visual inspection is adequate to make a diagnosis, but when uncertain or as required by insurance companies’ lab confirmation may be required. Sometimes a thickened nail is nothing more than hyper-keratinization of the underlying nailbed from repeated trauma. Nail thickening alone does not automatically make an Onychomycosis diagnosis. However, a thickening nail from thickened skin and repeated trauma makes is a good focal point for fungus to establish.

In addition to oral mediation, at the Blue Ridge Foot and Ankle Clinic we will also use topical antifungal medications to treat the infection from the outside. We also have very effective regimens of topical treatments which does help to reduce the fungal infection of the nails and help prevent this aggressive condition from getting worse. When attempting topical therapy, serial aggressive nail debridements by your podiatrist are recommended to enhance the outcome.

The best way to use topical medication is to see a foot specialist who will thin down and cut away as much of the diseased nail as possible (a painless procedure), so that the topical medication will penetrate to the live fungus more readily. The topical medications then are applied once to twice a day by the patient. The nail has to be maintained or kept thin on a regular basis. Depending on the degree of fungus this process can take upwards of a year for new healthier nail to grow out. We have seen some very gratifying results with the combination of oral and topical medication.

Laser treatment of toenail fungus is becoming more common. Laser treatment is indicated and recognized by FDA for temporary clearing of toenail fungus. It is not a covered by nearly all medical insurance companies and can be very expensive. The doctors at Blue Ridge Foot and Ankle Clinic do not advocate this form of treatment for toenail fungus.

As with any medial condition, there sometimes there can be unsuccessful results using either topical or oral medication but it is important to follow all of the directions for the best results possible. The outcome will often be dictated by the severity of the condition upon initiation of treatment. Returning toenails to a perfect pristine state is nearly impossible. Making toenails less ugly, less discolored, less thick and fungus free is an obtainable goal. 

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Blue Ridge Foot and Ankle Clinic
887 A Rio East Court Charlottesville, VA 22901
 417 South Magnolia AveWaynesboro, VA 22980

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.


Fungal Nails (Onychomycosis)

August 14th, 2014 by Dr.Chang

Fungal infection of the toenail, or onychomycosis, is characterized by a progressive change in a toenail’s quality and color, which is often ugly and embarrassing. It is often ignored because the infection can be present for years without causing any pain.Fungus2

This condition is an infection underneath the surface of the nail caused by fungi. The fungus that attaches to our toenails is ubiquitous in our environment and a natural inhabitant of our skin in very low concentration. When these tiny organisms take hold, the nail plate becomes darker in color and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails. If ignored, the fungi infection of the nail can spread and further distort nail shape and form. These often thicker nails are difficult and painful to trim and make walking painful when wearing certain shoes. Onychomycosis is often accompanied by a secondary bacterial or yeast infection in or around the nail plate.

Our toenails are especially vulnerable, since they are often around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers. Additionally, injury to the nail bed, such as repeated contact with a shoe, may make it more susceptible to all types of infection, including bacteria and fungus. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors are a history of athlete’s foot (skin fungi infection) and excessive sweating. Excessive sweating and contamination of interior surfaces of shoes can be treated with the application of safe topical medications provided in our office.

The podiatric physicians in Blue Ridge Foot and Ankle Clinic have been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.


  • Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.

  • Clean and dry feet resist disease.

  • Washing the feet and toes with soap and water, remembering to dry thoroughly, even between the toes, is the best way to prevent an infection.

  • Shower shoes should be worn when possible in public areas.

  • Shoes, socks, or hosiery should be changed at least once daily or more often as needed.

  • Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.

  • Wear shoes that fit well and are made of materials that breathe.

  • Avoid wearing excessively tight hosiery, which promote moisture retention.

  • Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks.

  • Disinfect instruments used to cut nails.

  • Disinfect home pedicure tools.

  • Don’t apply polish to nails with suspected of infection, occlusion of sunlight allows fungus to flourish.

Click here for a free book offer.


Blue Ridge Foot and Ankle Clinic
887 A Rio East Court Charlottesville, VA 22901
417 South Magnolia AveWaynesboro, VA 22980
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

Blisters, Ingrown Toenails and Athletes Foot

July 28th, 2014 by Dr.Chang

INGROWN1Blisters are a result of the abrasion between your skin and sock or shoe. Because they can arise suddenly, it is important to take preventative measures to ensure your foot’s comfort. Preventing blisters begins with well fitting shoes, not too snug yet not too lose. Your socks should be snug fitting and made out of synthetic wicking material and with seams that cause minimal abrasion. Even after taking such precautions, many runners and athletes get blisters. If you find that you are prone to blisters, try regularly applying moisturizer to your feet, as dry skin is prone to friction, leading to blisters. Additionally, you may want to try rubbing your feet with Vaseline before a run if dryness is a problem for you, using foot powders to decrease moisture if your feet sweat too much, or wearing two pairs of socks so that they rub together instead of rubbing against your skin. You podiatrist may also prescribe prescription antiperspirants for more effective drying.

The rule of thumb is to leave small blisters intact so that the outer layer will protect the skin underneath. If you do get a blister on or off the trail, and it is large enough to see fluid inside, the best thing to do is to drain it and avoid it popping during activity. First, wash the affected area with soap and water. Sterilize a needle by rinsing it and soaking it in rubbing alcohol. Do not put the needle in a flame for sterilization as this method can lead to getting infectious carbon bits in your skin. Next, make a hole in the blister and squeeze out the fluid. Avoid removing the skin over a blister, because it provides padding and protection for the new skin growing underneath.  Finally, use hydrogen peroxide to prevent infection and wrap the area with antibiotic ointment and a bandage. You may want to use products like Second Skin or Band-Aid Blister Blocks, or soak your foot in Epsom salts to draw out fluid when you take off the bandages. If you find your blister is emitting yellow or green discharge, swell or reddens, you will want to see your doctor, as it is most likely infected. Additionally, if your blister is under or at the base of the toenail, see your podiatrist for treatment. Home removal of the toenail can cause infections and other complications, but your podiatrist will know how to drill a hole in the nail with an electric file.

ingrownIngrown toenails are one of the most commonly treated ailments. These are nails that are incorrectly shaped, so that they curve and grow into the skin, usually at the sides of the nail. This irritates the skin, causing pain, redness, swelling and warmth in the toe. Your toe may incur an infection if the nail breaks the skin, allowing bacteria to enter and cause an infection (indicated by a foul odor and a discharge of discolored fluids).  Ingrown toenails can be caused by a number of factors. While they are often hereditary, they can be the result of traumatic injuries, improper trimming, poorly fitting footwear, and nail conditions (such as fungal problems).

INGROWN3Home treatment of ingrown toenails should be limited to consistently cutting and filing the nail straight across and soaking the nail in Epsom’s salt. Never cut notches in the nail, do not repeatedly trim the nail borders, and do not place materials (such as cotton) beneath the nail, as all of these methods increase the likelihood of bacterial infection. Over-the-counter topical medications only relieve pain but do not cure the symptoms. “Home surgery” on your ingrown nails is not recommended, since repeated cutting of the nail can cause the condition to worsen over time. If your nail does not improve, visit your podiatrist for a simple procedure. Dr. Chang and Dr. Murray can easily perform a minor surgical procedure. They will take off the small offending border that is causing pain and permanently remove it so that it does not grow back into your skin. Note that they do not remove the entire nail, so this simple procedure can alleviate your pain with minimal recovery time.

Athlete’s foot, officially known as tinea pedis, is a fungal infection between the toes and on the soles of the feet. With this infection the skin on your foot may feel itchy or painful, will have scales redness and blisters. Podiatrists will recommend the applications of a fungicide such as Desenex, Tinactin, Lotrimin or Lamisil. Using these products a few times a day for two weeks to a month will help remedy the irritation and other symptoms. If symptoms reoccur, be sure to rotate the fungicide you use so that the fungus does not build up a tolerance to one brand. You may want to try additional remedies for the itching, such as soaking your feet in a baking soda and water solution, removing the dead skin with a pumice stone, or rubbing fine sandpaper along the bottoms of the feet (and disposing of the sandpaper after use!).


Blue Ridge Foot and Ankle Clinic
887 A Rio East Court Charlottesville, VA 22901
417 South Magnolia Ave Waynesboro, VA 22980


February 11th, 2014 by Dr.Chang

Ingrown nails

One of the more common and less glamorous conditions we see is ingrown toenails.   Sometimes there is an associated infection but many times it is pain along the nail border that brings patients to our office.  Many people suffer with ingrown nails for years not knowing anything can be done.  There is a simple, pain relieving procedure for this problem!   The procedure has been around for many years and most of the time offers a permanent solution.  The offending nail edge is removed.  A chemical is then applied to destroy the root.  This simple procedure is done in the office and requires no down time.  Daily cleansing of the area along with a band aid for 3 – 4 weeks is all that is needed.

Ingrown toenail

Athletes and Foot Fungus

June 8th, 2010 by Dr.Chang

In treating an athlete population, we find there is a high occurrence of fungus issues. Here are the two most common fungus issues our athlete patients deal with and some solutions to fix the problems.

Athlete’s Foot

The Athlete’s foot typically affects the skin on the feet between the toes, but can move anywhere and even affect the toenails. When the infection spreads to the toenails, they become thick and distorted.

Fungi are organisms such as mold and mildew and grow best in conditions that are moist. Bacteria may thrive also as a secondary infection, which worsens the symptoms of the disorder and makes it more difficult to cure

It is common to catch athlete’s foot from other people who have it by walking on floors that are moist or wet (e.g. at swimming pools and in shared bathroom/locker room facilities). Athlete’s foot is also much more common in people who tend to have moist feet, a condition called hyperhidrosis. Athlete’s foot can also be spread by sharing other people’s shoes or personal care items such as towels and wash cloths.

Athlete’s foot and fungus may also spread to other parts of the body, notably the groin and underarms, by those who scratch their feet and then touch themselves elsewhere.

Symptoms Include:
– Reddened, cracked, and peeling skin
– Some bleeding
– Itching
– Burning
– Stinging sensation
– Development of small blisters (Blisters often lead to cracking of the skin. When blisters break, small raw
areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads. In severe cases the skin may thicken, like a callus and begin to scale.

There are a variety of over-the-counter products that can be used to treat tinea pedis fungus, such as:
– Lotrimin, Lamasil AT, Clotrimazole (creams & lotions)
– Bromi-Lotion or Bromi-Talc Powder (drying agents)

After a period of time, if products used for athlete’s foot and fungus fail, physician strength or prescription topical and/or oral antifungal drugs, can be prescribed by your Podiatrist.

-Wear sandals or shoes when walking on moist wet floors
-Don’t share shoes or personal care items such as towels
-Wear socks made of absorbent materials such as cotton or wool
-Change socks frequently if you perspire heavily
-Choose footwear that allows for the circulation of air
-Keep the floors in shared facilities clean and dry
-Keep your feet clean and dry by dusting Bromi-Talc Foot Powder in shoes and hose and feet
-Clean athletic shoes frequently with a good athletic shoe cleaning product

Fungal Nails
Fungal infection of toenails, called Onychomycosis, is a common foot health problem that many people do not recognize. Fungi easily attack the nail, thriving off keratin, the nail’s protein substance, and exfoliated nail bed tissue. This is especially common among athletes where the repetitive stress of activity distorts the toenail construct and allows organisms, which already exist on the skin, to invade under the nail plate.

Onychomycosis is an infection underneath the nail that can also penetrate the nail. If it is ignored, it could impair one’s ability to work or even walk because it is frequently accompanied by thickening of the nails, which then cannot be easily trimmed, and may cause pain while wearing shoes. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in/or about the nail plate.

– Change in color (yellow or brown)
– Nail gets thicker
– Bad odor
– Debris collects beneath the nail
– White marks on the nail
– This infection is capable of spreading to other nails, the skin or even the fingernails.

There are a variety of products that can be used on the toe nails that fungus. We have had good results with topical:
– Formula 3
– Fungasil
– Gordochrom Fungicide-Germicide

Clean, dry feet resist disease. Wash the feet with soap and water, and dry thoroughly. Shower shoes should be worn in public areas. Shoes, socks and hosiery should be changed daily. Use a quality foot powder, talcum not cornstarch. Buy shoes that fit well and are made of materials that breathe.

Seeing your Podiatrist :
– A Podiatrist (DPM) can detect a fungal infection early. A suitable treatment plan may include prescribing topical or oral medication (such as Lamisil), and debridement (removal of diseased nail matter and debris) of an infected nail. Debridement is one of the among most common foot care procedures performed by DPMs. Debridement allows for reduction of fungal load and more effective penetration of topical medications when used. In some cases surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured and prevents the return of a deformed nail.



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