Toe nail fungus, also known as onychomycosis, is surprisingly common among long distance hikers and an estimated 3-5% of the US population suffers from this condition (source: Johns Hopkins Health Information Library.) If your toenails are yellow, brittle, or unusually thick, you may be have a case of toe nail fungus and should consult with your physician or a podiatrist about treatment.
Toe nail fungus is an microscopic infection that occurs under toe nails when they are frequently exposed to warm, moist environments, including sweaty hiking boots and trail shoes. Nail fungus is not the same as athletes foot which just affects the skin of your toes, but the two can occur at the same time.
Toe nail infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes. They gain entry under you nail through tiny tears in the nail or the nail bed than can be caused by smashing your toes against the inside of your boots when hiking down steep downhill descents, or other foot related trauma. A small percentage of toe nail fungus cases can also be caused by other types of fungus such as mold or yeast, so an accurate diagnosis should be undertaken to pick the most effective treatment.
Once a nail infection begins and it can persist indefinitely if not treated, and even spread to other toes. There are several different forms of treatment including oral medications and topical lacquers that you paint on your nail, but most require a prescription from your doctor. This is advisable because toe nail fungus can lead to other complications in individuals with diabetes or other immune deficiency disorders. Some oral medications can increase the risk of harmful liver-related side effects in certain individuals, so be cautious about doctors who want to treat you with oral, rather than topical medications.
The best way to prevent toe nail fungus is to make sure that your boots and shoes fit properly and that your toes have plenty of room to move around, even after they've swollen as a normal side effect of hiking: my hiking boots are a full size larger than my normal shoes, for this reason. Try to wash and wear clean socks or liners every day and keep your toe nails trimmed to prevent tears to the nail edges or other trauma such as blackened toes nails, which can increase your risk of toe nail fungus.
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