Various types of fungi are present everywhere in the environment. The dark, moist surroundings created by shoes and stockings make the feet especially susceptible to fungal infection.

Most fungi are harmless until they penetrate the skin. A fungus can invade through minor cuts, or after injury or repeated irritation to the toes have caused the nail to separate from the bed. Fungal infections of the nail plate and nail matrix are quite common.

Symptoms: Fungus may cause the nail to thicken and become yellow or brownish. As the fungus grows, foul-smelling, moist debris can be seen. Pressure from a thickened nail or the build-up of debris may make the toe painful.

Treatments for Fungal Infections
Treatment is best begun at the early stages of infection. The accumulation of debris under the nail plate can lead to an ingrown nail, or to a more serious bacterial infection that can spread beyond the foot. To reduce pain associated with a thickened, infected nail, the surgeon may reduce its thickness by filing the nail plate down with a surgical burr. Filing will not, however, prevent the infection from spreading.

Oral and topical medications may be prescribed when:
• Only a small portion of one nail is infected
• Several nails are affected
• Keeping the nail is desired
• Medication may or may not completely eliminate the fungus.

* Often, after medication is discontinued, the fungus recurs. Your podiatric surgeon will monitor the results of oral prescriptions carefully, and will explain any possible side effects.

While topical ointments usually do not eliminate the fungus, they may be effective when used directly on the nail bed, after the nail plate has been removed. Eliminating the infection, in some cases, can only be achieved by permanent removal of the nail plate (see "Surgical Treatments for Nail Disorders ").

A very common result of active lifestyles is blood, or a hematoma, beneath the toenail. Hematomas are especially common among people who jog or play tennis, caused by the toes repeatedly rubbing against the shoe.

A hematoma might indicate a fractured bone, especially after an injury (such as dropping a heavy object on the end of the toe). The toe should be examined by the podiatric surgeon, who may take an X-ray to determine the most appropriate treatment.

Hematoma Treatments
If the hematoma is treated within the first few hours of forming, the podiatric surgeon will create a tiny hole in the nail plate using a fine-point drill or scalpel. This releases the blood and relieves pain.

If several days have passed and the blood clot becomes painful, the nail plate may require removal so that the nail bed can be cleaned. Some podiatric surgeons prefer to remove the nail plate whenever blood forms beneath it, because the blood can attract fungi and lead to infection.

The nail may also be removed to treat a bone fracture beneath the hematoma. If the bone has fractured but has not moved out of its normal position, a splint may be used to keep the toe aligned during healing.

Nail plates that have been removed will grow again within three to six months.

Surgical Treatments For Nail Disorders
If the problem is severe or chronic, surgery to remove all or a portion of the nail may be recommended.

Most surgeries are performed very comfortably under local anesthesia, and require less than one hour at the podiatric surgeon's office. Laser surgery, because it requires special equipment, may be performed at a hospital.

Partial Nail Removal
Complete removal of the nail plate is a common remedy for fungal infections and ingrown nails.During this procedure, the nail plate is removed and the nail matrix is destroyed by one of three methods:

Phenol
An acidic chemical called phenol is applied only to the nail matrix. This destroys the growth cells of the nail.

Surgical removal
The nail matrix and bed is cut away. Stitches are only occasionally necessary.

Laser
A form of burning in which laser heat is focused on the matrix cells.

Removal of Bone Overgrowth Bone directly beneath the nail plate may become enlarged, developing a spur or outgrowth that can deform the nail plate or lead to an ingrown nail.Removal of excess bone may be performed concurrently with surgery to partially or permanently remove the nail plate.