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Foot Care Q&A: Part 1

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

Dr. Smukler: It depends on the cause. If it’s due to a fungal infection, there are some over-the-counter lotions that sometimes work. As for prescription oral medicines, I normally prescribe Lamisil (generic name, terbinafine). I haven’t had problems with side effects from it. I test patients’ blood before they start it and within 30 days to make sure it isn’t affecting their liver.

Dr. Beauchamp: For dry, discolored toenails you need to determine the cause of the dryness and the discoloration. These are two separate symptoms that can be caused by nutritional problems, chemotherapy, systemic diseases including rheumatological disorders of various types, physical trauma, and infections of either a bacterial or fungal nature, to name several.

Dennis Janisse: The oral drugs don’t have a very good reputation and are not usually suggested. If the nail is too troublesome, you can have it removed. There is a 50% recurrence rate with the topical treatments.

4. What can I do for athlete’s foot?

Athlete’s foot is a very common fungal infection of the feet. The scientific name for it is tinea pedis. It can occur on one or both feet. It is contagious, but some people are more susceptible to getting it than others. People with diabetes are up to three times more likely to develop athlete’s foot than people who don’t have diabetes.

Dr. Smukler: Once you have determined that it is in fact athlete’s foot, two things need to be done: treat the foot, and treat the shoe. Athlete’s foot is caused by a fungus infection. Fungus needs three things to be happy: moisture, heat, and darkness. Many times a doctor will give you a medicine to put on your feet twice a day. That will only work for a couple of days. I recommend over-the-counter Lamisil lotion or cream for your feet and over-the-counter Tinactin (tolnaftate) antifungal powder for your shoes. After applying it to your shoes, let them air out for 24 hours before wearing them again. This means you will need to wear a different pair of shoes while treating the first pair, then treat the second pair while wearing the first. It takes a certain amount of fungus before you feel the itch. Therefore, just because the itch has gone away doesn’t mean the infection is gone. I suggest continuing the treatment for two weeks after the symptoms are gone.

Dr. Wu: You can try over-the-counter antifungal preparations first. These preparations should contain one of the following antifungal medicines: terbinafine, miconazole, clotrimazole, or tolnaftate. What most people don’t realize is that the fungus spores can live on their shoes, socks, bathroom floors, and carpets. They may end up infecting the rest of their family. So in addition to using the over-the-counter antifungal medicines, a person should also change his socks often, clean the bathroom floor with bleach after he has showered, and alternate between different pairs of shoes every day, wearing one pair while letting the other pair(s) air out in the sun for at least 24 hours. If the athlete’s foot persists after doing the above, consider paying a visit to the doctor for prescription antifungals. Most people don’t need more than an over-the-counter product.

Dr. Beauchamp: Athlete’s foot is what I refer to as a “garbage can” diagnosis that really describes a fungal infection of the foot. There are several species of fungi that can affect the human foot, and each one of them may cause slightly different skin changes and symptoms. I generally treat these with a broad-spectrum over-the-counter antifungal like Lamisil cream in conjunction with an over-the-counter hydrocortisone applied twice daily. I tell my patients that they really need to be treating their shoes with the antifungal sprays and allowing them to dry between wearings (or utilizing a boot dryer) to reduce reinfection. I also suggest spraying out their showers with a mild bleach solution throughout the treatment period. Usually in about two weeks things are a lot better. For really deep-seated fungal infections that do not respond to this, I will sometimes use an oral medicine such as Diflucan (generic name, fluconazole).

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