Fungal nail infection, a question about nail removal

[motherbird]

Ok so I have recently seen that we have a podiatrist on site, what a bonus ! I'm hoping that they may come along and help with a question that has pecked away at me for a long time....
I have a very lovely and long term client of many years. For all the years I have known her she has had what I'm sure has to be a bad fungal infection in one of her big toenails. The nail is very thickened indeed, badly discoloured and frequently lifting and splitting away and is very misshapen. Quite frankly you wouldn't consider touching it as a beauty therapist for a moment and over the years we've observed it (I don't do this ladies feet and wouldn't). She has been to her GP more than once and clippings have been sent away and returned with a negative result. I was baffled because it's screaming fungal at you ....... Of course in the summer months this lady would like to wear open shoes and she actually does but is very conscious of her toes appearance. She has also seen a podiatrist but seemed to get a vague chat and had the nail trimmed back etc.
Now the main point here is that on being pushier at her GP surgery and forming a rapport with a particular doctor she felt able to press her point about her toe which seemed to have been largely dismissed with the negative clipping result. Her GP is at a loss as to why the clippings are negative for fungal infection as he says it's quite obvious that that is the problem and seems to think that there are many types and only the most likely are tested for.
Unfortunately this lady is unable to take the standard oral medication due to and existing liver function issue so essentially she is stuck and has been for years with this unsightly toe.
Finally my question.......I wondered, if this lady were to have her toenail removed but not permanently, so completely removed but then allowed to grow back, would the new nail be fungus free ?
I don't know whether she would consider this if it were the case even, it's just something that I've often wondered and would love to hear from a foot are professional.

 

[JeanneB]

Hi Motherbird,
The problem with taking nail-clipping is that unless the samples are taken from the correct part of the nail then false negative results will occur. The fungus grows under the nail close to the nail-plate so just snipping a bit off the free edge won't include the fungal tissue. Who has been actually taking the samples ?

The GP won't act unless he get a positive result, and even then he has to make a decision as to whether to prescribe a powerful drug just for one toenail. If the lady has problems with liver function then it would be contraindicated.

Removing the toe nail (without phenolisation to allow re-growth) should remove the fungal infection. However, if the nail is deformed then the new nail wouldn't grow back normally.

" She has also seen a podiatrist but seemed to get a vague chat and had the nail trimmed back etc."

It sounds like that particular Pod wasn't qualified in nail surgery.

I would suggest that she asks her GP for a referral to the NHS Podiatrist, or make an appointment with a private one who is qualified in nail surgery.

HTH

 

[motherbird]

JeanneB thank you so much for your extremely informative reply ! That is so interesting and valuable to know.
I'm not sure whether it was the lady herself who took clippings or maybe practice nurse, I couldn't honestly say, more likely the lady.
Yes with her condition, regardless of positive sample or not, oral meds aren't suitable, and she has been trying over the counter topical treatments for as long as I can remember to no effect.
I will discuss your facts with her next time I see her, though I have a feeling that she may do nothing ! That's her choice but a shame if there were a solution.
Big thanks again for your time and for sharing your knowledge [emoji4]

 

[JeanneB]

JeanneB thank you so much for your extremely informative reply ! That is so interesting and valuable to know.
I'm not sure whether it was the lady herself who took clippings or maybe practice nurse, I couldn't honestly say, more likely the lady.
Yes with her condition, regardless of positive sample or not, oral meds aren't suitable, and she has been trying over the counter topical treatments for as long as I can remember to no effect.
I will discuss your facts with her next time I see her, though I have a feeling that she may do nothing ! That's her choice but a shame if there were a solution.
Big thanks again for your time and for sharing your knowledge [emoji4]

No probs motherbird.

OTC preparations for fungal nails do have a limited use.
They are fungistatic not fungicidal, so they slow down the growth rate of the fungal infection but don't remove it altogether.
The theory is that if the growth rate of the fungus is slowed to less than that of the nail plate, then the nail plate can "grow out" and take the fungus with it.
This may be effective in younger people where the growth rate of the nail plate is faster. In "mature" persons the growth rate slows markedly every decade.

In addition to this the preparation needs to be applied to the correct area. It is important to have the bulk of the nail plate reduced by a Pod until it is quite thin. Then the preparation can be applied and can soak through into the area where the fungus is lurking.

HTH

 

[motherbird]

JeanneB I've learned so much today ! You are indeed the oracle .....much appreciated. Reminds me of years ago when we used to have Super Science Weekends on here when we were just The Nail Geek.....Trinity you will remember those [emoji4]

 

[JeanneB]

JeanneB I've learned so much today ! You are indeed the oracle .....much appreciated. Reminds me of years ago when we used to have Super Science Weekends on here when we were just The Nail Geek.....Trinity you will remember those [emoji4]

Thanks for that, Motherbird, glad to be of use !

 

[Bohemianivy]

Hi I had a client that had a terrible problem with one of her toe nails. To me it looked like a terrible fungus infection but it turned out that she had had an accident when she was younger and a heavy object had hit her directly on the matrix. The so called fungal infection turned out to be extensive damage to the matrix so the nail growth had been perminently damaged. Just a thought.....

 

[JeanneB]

Hi I had a client that had a terrible problem with one of her toe nails. To me it looked like a terrible fungus infection but it turned out that she had had an accident when she was younger and a heavy object had hit her directly on the matrix. The so called fungal infection turned out to be extensive damage to the matrix so the nail growth had been perminently damaged. Just a thought.....

People commonly assume that a thick nail means there's a fungal infection but this is not necessarily the case.

Thick nails are not always fungal, and fungal nails are not always thick!
However, it is more common for thick nails to be infected because they are caused by trauma which damages the nail plate. This allows the fungal infection to gain admittance.

The only sure-fire way to diagnose a fungal infection is to take scraping from the nail and have them sent away for microscopy. But they must be taken from the correct location on the nail otherwise a "false negative" diagnosis will result.

HTH