Conway McLean, DPM, Journal columnist

By Dr. Conway McLean, DABFAS, FAPWHc

Fungal organisms get blamed for a lot. After all, what’s causing that mold on your bread? What about that brown spot on your toenail? Is that fungus? Many assume so, spending millions of dollars on topical potions and lotions. How common are these changes? The answer depends on who you ask, with estimates varying tremendously.

Some claim as many as a half of the US population will experience nail changes over the course of their lives. Notice “fungal” wasn’t used in that sentence. If you, like so many Americans, believe that all nail changes are due to a fungal infection, it shows you haven’t done your research. The textbooks and the studies agree: only half of nail changes seen are due to a fungus. Oft quoted is 14 percent of Americans have a fungal nail infection at this time (aka onychomycosis). That likely explains the abundance of fungal nail products, proclaiming all manner of cures and miracles.

So, if it isn’t fungus, what else could it be? From reduced arterial circulation to bad shoes, there are many causes for an alteration in their appearance. Statistically, if not fungal, the next most likely explanation is trauma, but this doesn’t have to be a single traumatic event. Certainly, when some kind of blunt force to a nail unit occurs, more than just the current nail may be affected, future growth as well, when there is a disturbance of the nail root. Once the root is damaged, the nail will never be normal. Seen more often are gradual changes to a nail due to more subtle but recurrent pressure to a nail. These changes can be easily mistaken for those of a fungal infection.

Numerous causes exist for recurring pressures to these structures, scientifically referred to as “micro-trauma,” such as when someone wears a shoe which is too small. Because this is a frequent occurrence, many individuals are walking around traumatizing their toenails. As with a fungus infection, the changes frequently develop first in the big toe since it is, as the name implies, bigger, resulting in the nail getting more impact. A hammertoe deformity can lead to recurrent pressure to the end of the nail, driving it back into the nail root, leading to these changes.

Age is a significant factor, likely an accumulation of things, from more micro-trauma (more years of walking?) to reduced circulation. rating oral and topical medications, as well as one of the new laser technologies that have been shown effective. And then treating your environment, shoes and socks, etc.

Hopefully it has become clear there is some reason for your particular nail changes, but that doesn’t mean its fungus. And your health care provider doesn’t know either, not without testing a fragment of nail plate and the debris that is associated. A specialist will be well-versed in the protocol for both diagnosing and treating. But time is of the essence. Too many of us wait too long and live with progressively worsening nails for the rest of our lives. So, take heart and take up arms against the rising tide of onychomycosis! And all the other causes for ugly toenails.

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.