• Exposure to public places barefoot : Hotel carpets, public showers, and pool decks

• Precursor skin infection (Athletes foot) or tinea pedis usually precedes onychomycosis.

• Foot Hygiene

• Shoe environment : warm, moist

• Microtrauma: pressure on the nail unit allowing penetration of the dermatophyte (fungal organism) into the nail bed

• Repeated exposure to water in wet work compromises nails.

Risk factors: include aging, diabetes, tinea pedis, psoriasis, immunodeficiency, and living with family members with onychomycosis

Symptoms may begin as a mild ache or stiffness in the back of the leg or above the heel after activity. Overtime this pain may increase and occur during/after running, jumping, stair climbing or sprinting.

Most successful treatment involves multiple modalities

• Oral Medication

• Topical Medications

  • skin

  • nail

• Periodic debridement

• Anti fungal shoe sprays

• Improving overall foot hygeine

• Moisture wicking socks

• Laser treatments

• Refraining from nail polish such as gel/acrylic

• Improving nutritional status

• Treating underlying comorbid conditions