Posts for: August, 2014

11 tips to avoid toenail fungus: Easy to catch, hard to kill


 It's sandal weather, the pool and beach beckon — and that means naked, exposed toes. That thought fills millions of Americans with dread, because they are host to an organism that's ruining the appearance of their nails.

"They are keratin-loving species," explained Temple University podiatrist Tracey Vlahovic. Her sub-specialty within that field is dermatology, so, pretty much anything that makes the rest of us go yuck. "I don't think it's 'yuck.' I think it's fantastic. I love treating fungus and warts," said Vlahovic with a chuckle.

A closer look at the troublesome fungus

Toenail fungus is one of the main reasons people come to her office, and Vlahovic has studied the condition for years. Viewed through a microscope, her enemy appears rather meek. It looks like thin straws with little compartments in it — but it's part of an aggressive fungus family. "The fungus that affects the foot in general, they are called dermatophytes. They love hair, nails and skin, so actually the same organisms that cause athlete's foot can cause nail fungus."

If it gets into the nail bed, the fungus eats and digests the keratin in the nail, and that causes discoloration and thickening of the nail. It's a cosmetic condition that can become painful, but even if it's not, Vlahovic argues that it is an infection that should be treated.

Sizing up risk factors

People who have chronic athlete's foot are at risk for developing toenail fungus, and there seems to be a genetic predisposition. Sometimes the fungus gets into the nail bed after the nail was cracked or cut too short. The fungus also lurks in shared showers, around pools — and a lot of Vlahovic's patients tell her their troubles started after getting a pedicure.

The very place where people go to beautify their feet and toenails is often responsible for spreading disease, says Tennessee podiatrist Dr. Robert Spalding. He has written a book called "Death by Pedicure" and has been on a decade-long crusade to make nail salons safer.

"They use contaminated instruments, in some cases, or they don't take the time to properly disinfect and follow their state protocols," Spalding said. Nail fungus and other microorganisms are really tough to kill, and Spalding says the only sure-fire way to sterilize the instruments is to use something called an autoclave.

"An autoclave is basically a pressure cooker," he said. "It's steam under pressure, for a certain amount of time. It's how instruments are cleaned for surgery."

The foot-soaking tubs are another cesspool of infection that Spalding says some salons are eliminating. "Now they are going to tubs that have liners. They don't use the jets as much. And they are coming up with something called a dry pedicure, where they just take hot towels and soak the feet," Spalding said.

Spalding estimates that 75 percent of salons do not disinfect their instruments and tubs properly and according to state regulations. He has developed training seminars for nail-care techs, and he offers both an app and a website where consumers can check out if their salon is safe.

The 'secret society' of sufferers

Even though it's so easy to catch, toenail fungus embarrasses people. It's a hush-hush topic — and only a fraction of the estimated 55 million Americans who have the condition seek treatment in a doctor's office.

"I'm part of this secret society of tonail fungus sufferers. We can, like, band together and have meetings or something," said Liz, a Philadelphia mom in her thirties. She doesn't want to use her full name for this interview. "It looks terrible if you don't maintain it, and I mean — toenail fungus? That is the grossest thing!"

It started about 10 years ago when Liz cracked her big toe nail. After that, the nail started to look funny and became discolored. Then it spread to three more toes on that foot. When Liz realized she had nail fungus, she was faced with another unpleasant fact: It's really hard to treat.

"The toenails have the smallest blood vessels," explained podiatrist Tracey Vlahovic. "They are the furthest away from the heart. It's going to take anywhere from six months to a year, to even two years for some people, for the nail to grow from cuticle to the tip of the nail."

Few vetted treatment options

For years, it's been slim pickings in terms of pharmaceuticals. There is a topical called Penlac that seems to work sometimes for very mild cases. Laser treatments sometimes make the nails look a bit better — but have not been proven to kill the fungus. Then there are pills that people have to take for several months. The oral medications such as Lamisil or Nizoral are effective, but many people are afraid of them because of potential side effects, including a negative impact on kidney and liver function. Vlahovic admits the search for a cure has been a bit sluggish.

"It's not something that people are jumping at doing research on, because you don't have the instant gratification as you would if you would do a clinical trial for athletes foot that only lasts for six weeks," Vlahovic said. Toenail treatment trials have to last for at least a year — and that makes them costly.

An abundance of pseudoscience

A tough problem that embarrasses people makes for a fertile breeding ground for pseudoscience and old wives tales — which Liz found when researching online.

"Hydrogen peroxide, bleach. I mostly use tea tree oil and lavender," she said.

The abundance of "miracle cures" touted online makes Tracey Vlahovic's life difficult at times.

"Oh, don't get me started. If I had a dollar for everything I had heard, I'd be a millionaire at this point," she said. From benign treatments such as essential oil, vinegars and mouthwash to the noxious bleach option, Vlahovic has seen it all. "It's not just about applying something to the nail, it has to be something that will get through the nail plate and into the nail bed where the infection is. So, it doesn't matter what you use, it has to be able to penetrate."

More bad options

In addition to the questionable treatment options in your kitchen and bathroom cabinets, a slew of over-the-counter products promises a cure.

Vlahovic recently checked out the offerings in the foot-care aisle of a drug store near her office and examined about 10 products featuring terrifying before-and-after pictures of diseased nails. Vlahovic picked up a product that claims to attack the fungus with grape-seed extract.

"Basically it's water, xanthan gum and fragrance, so I'm not sure how effective it could be. And it costs $23.99," Vlahovic said.

She turned her attention to a bottle of ProClear. "The active ingredient is tolnaftate. It's basically an antifungal for athlete's foot," she explained. "It says nothing on the back about toenail. It basically it says it works on the skin around and under nails, but not on the nail. It's too large of a molecule to penetrate the nail, so again this is garbage."

"Garbage" is the verdict for the rest of the products that claim to cure nail fungus, and all cost well over $10 for a small bottle.

Some official-looking "research" websites claim to test and rate alternative toenail fungus treatments for their effectiveness, but they turn out to be run by the producer of the highest-rated product.

Is there any hope?

So — is this story just a total bummer for toenail-fungus sufferers like poor Liz?

"I'm just so over it," she said with a deep sigh, admitting that she has "toenail envy" when she sees people who have pretty, freshly pedicured feet.

No, says Tracey Vlahovic. In fact, the FDA has just approved a new topical treatment for fungus, the brand name is Jublia. Canadian drugmaker Valeant Pharmaceuticals expects sales of $800 million in the U.S. And another product will come out shortly.

"It's a class of antifungals we're all familiar with," Vlahovic said. "The data there is very nice, it's beautiful, and I think that patients will really like the further topical options that are coming out."

The new topicals have higher cure rates than topical options currently on the market — and they can be used under nail polish, something that's very important to many women who have nail fungus.

Vlahovic says there is currently a lot of movement in this field, which has been stagnant for a while — but even with better treatments, patients have to accept one bitter truth: There is no quick fix for this.

"Nothing is going to work within a week. Nothing is going to work within a month, you must give things time," Vlahovic said.

So, if any person or product promises you to cure this thing quickly — just don't buy it.

Tips from Dr. Vlahovic: How to avoid nail fungus

  1. Treat athlete's foot quickly.
  2. Wear shower shoes when using shared bathrooms.
  3. If you have been affected by foot fungus or nail fungus, consider buying a shoe sterilizer.
  4. If you are concerned about nail fungus, seek treatment right away. The more the fungus spreads, the harder it becomes to treat. 

Tips from Dr. Spalding: How to pick a safe nail salon

  1. Watch nail techs treat a customer before you get a pedicure and take a close look at their practices.
  2. Nail techs should be wearing gloves and surgical masks.
  3. Nail techs should not be cutting calluses.
  4. Call the salon before scheduling a pedicure and ask them about sterilization.
  5. Ask the salon if they use an autoclave to sterilize instruments.
  6. If the salon does not use an autoclave, ask if you can purchase your own instruments for them to use.
  7. Safe pedicures might cost more because the techs are better trained, and sterilization equipment is expensive — but it's worth it!

Foot Care Tips to Keep You Moving While on Vacation


February 28th, 2013 | The Tolucan Times

T11-Filler 2

(BPT) – Decongestant, check. Sunscreen, check. Antacids, check. So you’re going on vacation and your bag is well-stocked with remedies for every illness that could possibly derail your good time – from sunburn to an upset stomach. While you’re taking steps to preserve your good health on vacation, don’t overlook the body part that will carry you through all that fun: your feet.

“Foot health is especially important for travelers,” says Dr. Joseph Caporusso, a podiatrist and president of the American Podiatric Medical Association. “If your feet hurt or you sustain an ankle injury, your whole vacation can be ruined. Plus, poor foot health can have a long-term detrimental effect on your overall well-being.”

The approach of warm weather means more Americans will be planning their spring and summer getaways. Before you step out on vacation, APMA offers a few foot health tips for travelers:

On the way

Whether you’re flying or driving to your destination, proper footwear is important. Knowing you’ll have to remove your shoes to pass through airport security screening may tempt you to travel in flip-flops or other footwear that’s easy to slip off. But travelers should not forego safety and support for convenience.

“Flip-flops are never a great walking shoe, and if you have to walk long distances from gate to gate or from your gate to ground transportation, or if you have to hurry, flip-flops could lead to problems,” Caporusso says.

What’s more, flip-flops mean you’ll be barefoot when you step through security – and that can leave your feet exposed to injury from sharp edges, uneven surfaces and germs. If shoes with laces will be too inconvenient for security lines, choose comfortable slip-ons that provide a thick, stable sole. And always wear socks through security.

Drivers also need to be aware of proper footwear on the road. Choose comfortable footwear that minimizes the risk of your foot slipping off a pedal. Never kick off your shoes while driving either; a shoe lodged under the brake pedal could interfere with your ability to stop quickly in an emergency.

On the beach

For many Americans, spring and summer vacations mean time spent on the beach. Whether you’re relaxing in a lounge chair, walking on hot sand or frolicking in the surf, it’s important to protect your feet from the singular risks of beach time.

Since most people wear flip-flops or sandals on the beach, don’t forget to apply sunscreen to your feet. Be sure to cover the tops of your feet, the front of your ankles, and even the soles. Limit the amount of walking you do in bare feet; walking in no shoes at all increases your exposure to sunburn, plantar warts, athlete’s foot, ringworm, other infections and even injury. Never walk barefoot in pool areas or locker rooms.

Always pack an extra pair of sneakers or water shoes so that if your shoes get wet you can have a dry pair. Wearing wet shoes for prolonged periods may lead to bacteria or fungal growth.

On the move

Sometimes, no matter how careful you are, injuries happen. Wherever your vacation takes you, it pays to pack a foot care bag so that you’ll be prepared to treat minor problems that can quickly evolve into major vacation setbacks. Your bag should include:

  • Sterile bandages for covering minor cuts and scrapes.
  • Antibiotic cream to treat minor skin injuries.
  • Emollient-enriched moisturizer to keep feet hydrated.
  • Blister pads or moleskins to prevent blisters and protect sore feet if blisters do form.
  • An anti-inflammatory pain reliever like Motrin or Advil to ease tired, swollen feet.
  • Nail clippers.
  • Emery board in case of broken nails or rough edges.
  • Sunscreen to prevent sunburn.
  • Aloe vera or a similar cream to relieve sunburn.

In case of a serious problem, seek the aid of a podiatrist – doctors who are specially trained to diagnose and treat ailments of the feet and lower extremities. You can find a podiatrist in your area by visiting APMA’s website,

“No one wants to spend their vacation with sore feet – or worse yet, at the doctor’s office,” Caporusso says. “Taking care of your feet while traveling can help ensure your vacation stays on track and the only things you bring home are great memories and souvenirs.”

One of the most imprtant things to remember is that diabetes affects many parts of your body.  Foot care is paramount in preventing diabetic complications.

Diabetes & your feet

Diabetes can cause nerve damage (also known as diabetes peripheral neuropathy - DPN) and poor blood flow or circulation to the legs and feet (also known as peripheral arterial disease - PAD). As a result, people with diabetes are less likely to feel a foot injury, such as a blister or cut. Diabetes can make these injuries more difficult to heal. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications.

Daily foot care

As always, prevention is the best medicine. A good daily foot care routine will help keep your feet healthy.

Start by assembling a foot care kit containing nail clippers, nail file, lotion, and a non-breakable hand mirror. Having everything you need in one place makes it easier to follow this foot care routine every day:

  1. Wash your feet in warm (not hot) water, using a mild soap. Don’t soak your feet, as this can dry your skin.
  2. Dry your feet carefully, especially between your toes.
  3. Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.
  4. Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin.
  5. Trim your toenails straight across and file any sharp edges. Don’t cut the nails too short.
  6. Apply a good lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don’t put lotion between your toes, as the excessive moisture can promote infection.
  7. Wear fresh clean socks and well-fitting shoes every day. Whenever possible, wear white socks – if you have a cut or sore, the drainage will be easy to see.

Best advice


  • Wear well-fitting shoes. They should be supportive, have low heels (less than five centimetres high) and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professionally fit your shoes.
  • Buy shoes in the late afternoon (since your feet swell slightly by then).
  • Wear socks at night if your feet get cold.
  • Elevate your feet when you are sitting.
  • Wiggle your toes and move your ankles around for a few minutes several times a day to improve blood flow in your feet and legs.
  • Exercise regularly to improve circulation.
  • Inspect your feet daily and in particular, feel for skin temperature differences between your feet.


  • Use over-the-counter medications to treat corns and warts. They are dangerous for people with diabetes.
  • Wear anything tight around your legs, such as tight socks or knee-highs.
  • Ever go barefoot, even indoors. Consider buying a pair of well-fitting shoes that are just for indoors.
  • Put hot water bottles or heating pads on your feet.
  • Sit or cross your legs for long periods of time.
  • Smoke. Smoking decreases circulation and healing, and significantly increases the risks of amputation.
  • Wear over-the-counter insoles - they can cause blisters if they are not right for your feet.

Your health-care team

Make the most out of your visit with your health-care professional by asking these three questions:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Members of your foot care team can include:

  • Chiropodists or Podiatrists: Specialize in treating foot diseases, disorders and dysfunctions
  • Diabetes Educators: Provide education on diabetes, including foot care
  • Doctors: Assist in diabetes management, and some have specialized training in foot care
  • Nurses: Some have specialized training in foot care
  • Orthotists/Prosthetists: Specialize in orthotic and prosthetic devices
  • Pedorthists: Specialize in orthotics, footwear and footwear modifications

Doctors warn that the swelling and fluid accumilation in the feet and legs are possible signs of heart problems. Congestive heart failure occurs when the heart is no longer able to effectively pump the fuid volume out of the heart and into the reat of the body.

Cardiologists warn that if you are witnessing swelling in your feet, ankles and leg you need to watch out, it might be the beginning of your heart problem.

Swelling of the legs and ankles is caused by fluid accumulation in the body, which can be a sign of heart problem. Heart failure happens when the heart cannot pump enough blood effectively out of the heart to other parts of the body. It is when the heart fails to meet the body's requirement. This can be caused by a number of reasons which includes weak cardiac muscles, narrowed heart valve, heart-valve leakage, or both. The body needs more blood and the heart cannot supply enough, such as in people with anaemia or those in shock.

Speaking to dna, Dr Yogesh Kothari, senior consultant, interventional cardiology and electro physiology, Apollo Hospitals said, "Swelling of feet is one of the main symptoms of heart failure and this would be accompanied by difficulty in walking and breathing problem. It is more commonly seen among elderly people, those above 65-years-old. Around 30% of elderly people and 5% of young people face this problem. It is also noted that these kind of cases have been slightly increasing. Everyday I am seeing about two-three patients coming with complaints of swelling of legs and ankles and on examination they are diagnosed to have cardiac problem."

"It is important to understand the cause. Most of it will be due to poor blood pressure control, diabetes, genetic, untreated heart disease, lifestyle change and poor dietary habits. Once you observe the symptoms of swelling feet and ankles it is advisable to undergo the tests and go for preventive measures, followed by prescribed medication", he added.

Yet another city based cardiologist, Dr Rajpal Singh, interventional cardiologist, Fortis Hospital further stressed on saying that swelling in your feet, ankles and legs should not be ignored. Once it comes to your notice, it should be checked immediately. He said: "The legs and ankles swells up when the heart cannot pump enough blood effectively out of the heart to other parts of your body. When this gradually progresses it leads to difficulty in walking and breathing problem."

If the symptoms persists, one needs to check the salt intake and the fluid content in your body. To be on safer side it is advisable to undergo cardiac MRI, ECG and follow up with medication immediately, Dr Rajpal added.

Diabetics with foot ulcers need to be more aware if the increased risk of premature death from vascular and nonvascular complications according to a recently published study.

Researchers obtained data for patients who attended a secondary care diabetic foot clinic or a general diabetes clinic between 2009 and 2010. The control group consisted of a clinic cohort of patients with diabetes and no history of diabetic foot ulceration (DFU). Researchers recorded cause-specific mortality during a median follow-up of 3.6 years. They evaluated the association between DFU and all-cause mortality by Cox regression, while the association between DFU and cardiovascular mortality was determined by competing risk modeling.

Overall, researchers recorded 145 events of all-cause mortality and 27 events of cardiovascular mortality among 869 patients with diabetes. Study results showed DFU was associated with cardiovascular disease and all-cause mortality after adjustment for potential confounders. Researchers found similarities in the proportion of deaths attributable to cardiovascular disease between the groups.

For more information:

Brownrigg JRW. J Vasc Surg. 2014;doi:10.1016/j.jvs.2014.04.052.

Contact Us


Please do not submit any Protected Health Information (PHI).

West Toronto Foot & Ankle Clinic Inc.

781 The Queensway, Unit NToronto, ON M8Z 1N4