Toenail fungus can cause an embarrassing discoloration of the toenails. Toenail fungus infections can make toenails change in color becoming whitish, yellow, or even brown. So, it is possible that the brown discoloration is caused by toenail fungus. 

If the brown discoloration is in fact caused by toenail fungus, then yes, the laser treatment may help. But if the discoloration is caused by bruising under the toenail or is the result of surface staining of the nail plate, then no, laser treatment would not help.  

A couple of questions may help determine how likely it is that the discoloration is caused by a fungal infection. 

1. How long ago did the discoloration begin.
2. Have you ever had athlete's foot?
3. Have ever had any trauma to the toenails where they became bruised under the toenail?
 
How Long Have You Had The Discoloration
Generally speaking, the longer the toenails have been infected, the more difficult it is to get rid of the fungus and return the toenails to a normal appearance. Some of this has to do with how much the matrix or root of the toenail has been stretched and or damaged by the thickening of the toenail. In some cases the thickening can become permanent. However the color will typically change significantly and improve after being successfully treated to remove the toenail fungus that is infecting the toenails. But, the toenail may remain thicker, if there has been damage to the matrix or root of the toenail. 

Athletes Foot
Athlete's foot is sometimes caused by the exact same fungus that infects the toenails. Toenail fungus is an infection of fungus in then toenails. Athletes foot is just a toenail fungus infection in the skin on the feet. If you have had athletes foot it s possible that you could have the fungus in your shoes that could lead to a toenail fungus infection.

Toenail Trauma
If you have repeatedly traumatized the nails by stubbing your type, or beating them up in running shoes, you may have bruising under the toenail. If there is bruising under the toenails, it may change the treatment options available to you. For example, if there is a large amount of dried blood underneath the toenail, the dried blood is dark in color and may absorb heat and burn the nail bed underneath the toenail if you were to have the laser toenail fungus removal procedure. In addition, a bruised toenail may look like a fungal toenail, but not actually be infected with toenail fungus. 

If you aren't sure whether or not the brown discoloration in the toenail is caused by a toenail fungus infection you can visit a podiatrist specializing in the treatment of toenail fungus. Another quicker option is to take a picture of the toenails and arrange a free remote email or phone consultation so you can get a better idea of the extent of the problem.

Dr. Christopher Segler is a podiatrist who specializes in the treatment of toenail fungus infections in San Francisco, Oakland, San Rafael and San Jose. He is board certified, American Board of Podiatric Medicine.  If you have a question about discoloration of the toenails that may be caused by toenail fungus you can call him directly at 415-308-0833.

Funky ugly toenails seem to plague runners. Toenail fungus is one cause of thick yellow toenails and it is very common. In fact 14% of Americans have toenail fungus. Based on this, if you are out for a run with six other runners, one of you probably has toenail fungus. 

Although running shoes can put you at risk of toenail fungus there are some simple steps you can take to prevent a toenail fungus infection from your running shoes.

Guns Don’t Kill People...

But flying bullets sure do! Spores are the seeds that give rise to a foot fungus infection. The spores are everywhere. And if they get into your shoes they can grow and multiply. The more fungal spores in your shoes, the more risk of toenail fungus infection. 

Active fungus thrives in any environment that is dark, warm and moist...like the inside of your running shoe. Running shoes are the perfect incubators for toenail fungus! If you get spores in there the active fungus starts to grow and sheds even more spores inside your running shoe. 

The Real Problem...

The worst thing you can do is rush into the house after you finish your run, take off your running shoes and throw them into a dark, poorly ventilated closet. Or if you have been running on the treadmill at the gym you take your shoes and stuff them into your gym bag. 

Your damp running shoes will then sit in the dark and any fungus will thrive in that moisture from your sweaty feet. If you run every day, the running shoes never really completely dry out. These are ripe conditions for toenail fungus. 

The next day you put on your running shoes and head out the door. Not only is there active fungus within your running shoes but you have fungal spores which are basically the seeds for toenail fungus all lining the interior of your running shoes.

So as you are running your toes hit the inside of the running shoes the fungal spores get wedged in between the toenail and the skin underneath. If you have any trauma to your toenails such as banging the end of the running shoe when you're running up or down hill (or stopping quickly) the fungal spores can actually get into the nail bed and start to develop a toenail fungal infection.

Once that happens the toenail fungus actually grows within the keratin of the nail plate separating all of the layers of the keratin and making the toenail thicker.

All of that separation of layers in keratin of the toenail plate causes light to refract unevenly through the toenail. This is what causes the discoloration and crumbling of the toenail that creates the ugly appearance.

While it is possible to treat the toenail infection and kill the fungus, it is critical that you reduce your exposure to the fungus spores if you want to keep your toenails clear.  Remember, you have to stay out of the line of fire if you don’t want to get hit by the bullets. 

You must prevent the accumulation of active toenail fungus and fungal spores in your running shoes. If you don't, it will just be a matter of time before you get a fungal foot infection.

The best defense for a runner against toenail fungus is to make sure that you dry your running shoes out completely. Leave them somewhere where they will dry near a heating vent or in the sunlight.

If you are a high mileage runner and run on back-to-back days it might be a good idea to buy 2 pairs of running shoes. Alternate the running shoes so that they have a chance to dry out completely. This won't be any more expensive because the running shoes will last twice as long.

It is also important to make sure that your running shoes fit correctly. If your toes are bumping the end of the shoes (as evidenced by discoloration such as bruising or dark spots under the toenail) you might actually be traumatizing the toenails when you run. This trauma to the toenail puts you at enormous risk of developing toenail fungus.

If you had athlete’s foot or toenail fungus in the past you have to kill of all the fungus in your running shoes. The easiest way to do this is to use an ultraviolet shoes sanitizer. Ultraviolet light will actually kill all of the fungus without any odor or toxic chemicals. The other alternative is to spray the inside issues with chemical disinfectant. If you use a disinfectant spray to kill the fungus in your running shoes make sure that it dries out completely before you wear them again.

As long as you keep the fungus out of your running shoes and allow your shoes running shoes to dry completely after your workouts you should be able to prevent your toenails from turning yellow as the result of a toenail fungus infection.

Hi My Running Doc,


A couple of days ago I accidentally kicked the wall with my right foot. My foot still hurts and it is bruised.  I read on your website that bruising can be a sign of a metatarsal fracture. How can I tell if it is just bruised or if my foot is actually broken? I would love to have your expert opinion!


Thanks!
David, Houston, Texas.



Hi David, 

Bruising is a Bad Sign

It is true that bruising is a bad sign when it comes to foot and ankle injury. When you actually fracture a bone, the bone cracks and bleeds quite a lot. That blood diffuses throughout the soft tissue under the skin. What you see is a bruise. That is part of the reason that a bruise can be so concerning for a fracture in the foot. 

In fact the sort of bruising pattern that the picture of your foot shows is often indicative of a fracture or broken bone in the foot. Given your pattern of bruising it is more likely that you have a metatarsal fracture or a fracture in one of the bones in the little toe such as the proximal phalanx phone.


Myths about Foot Fractures

1.  If you can walk on the foot, it can’t be broken.  FALSE!

This may be one of the most widely perpetuated myths about foot injury on the Internet. I have seen many patients with serious fractures that are walking on the foot. Some patients are limping and obviously in a tremendous amount of pain while other patients with fractures or broken bones barely feel any discomfort at all. This is not a reliable indicator of whether or not you have a broken bone in your foot.

2.  There is nothing you can do for a broken toe.  FALSE!

This is also absolutely not true. While it is true that most fractures in the toe will heal uneventfully, there are things you can do to speed healing and decrease your risk of complications. Fractures of the bones in the toe can move if not properly stabilized. Certain shoes will speed healing. Taping the toes to provide stability and immobilize the fracture will also help. But some toes should never be taped together. 

Without the proper treatment of a broken toe, the fracture can fail to heal leading to what physicians refer to as a nonunion. A fracture that never heals correctly can lead to pain, disability and interfere with your ability to run or even walk without pain.  Occasionally patients that take the approach that “nothing can be done for fractured toe” just end up in surgery later.  For the most part this is avoidable if the toe treated correctly.

Diagnosis and Treatment Options

If you are suspicious that there might be a broken bone in your foot (or in one of your toes) it is best to figure out whether or not it is actually broken.  The best option is to have an in-person evaluation by a sports medicine specialist such as a sports podiatrist.  The second option is to have a remote consultation with a sports podiatrist via webcam. A third option is an attempt at self-diagnosis. This video on YouTube can show you how to perform self-diagnosis of metatarsal stress fractures. This same video would apply in your case if the pain is located where you’re bruising is in the foot.

If you see a physician in person or via webcam or you perform your own self-diagnosis and think that you probably have a fracture then you should get x-rays. X-rays will not only confirm (or rule out) a broken bone in the foot but it will also give you an idea of the severity of the problem. There are some fractures that absolutely must be treated surgically. Others simply need a fracture walking boot in order to stabilize the fracture and allow it to heal. And occasionally it is necessary to use crutches. 

But not all fractures are the same. So if you have pain and bruising after this sort of injury and suspect that you have a fracture in your foot it is important to determine whether or not there actually is a broken bone, and treat it appropriately. As long as you treat the fracture correctly you should be able to heal and then get back to running.

Dr. Christopher Segler is a San Francisco based podiatrist and is board certified, American Board of Podiatric Medicine.  His practice provides house calls to people who are just too busy to sit in traffic or a doctor's office. He sees patients in their own homes to treat their toenail fungal infections with one of the newest lasers available. We do house calls in San Francisco, Oakland, Berkeley, San Rafael, Mill Valley, San Mateo and San Jose. If you have a question about toenail fungus and wonder whether or not the laser fungus removal treatment will help you have clear toenails again, you can call and ask a toenail expert by calling 415-308-0833.  And yes, you will actually get to speak with the doctor. 

Barefoot running has increased in popularity in recent years. In fact, Dr. Segler recently lectured at a medical conference on the topic of barefoot running trends. Part of the appeal in barefoot running technique is to increase your efficiency by using more natural running biomechanics in order to hone your running form.

The American Podiatric Medical Association has a position statement declaring that barefoot running is an unsafe activity and is not recommended by podiatrists. Of course not all podiatrist agree with this position. I happen to be one of those dissenting physicians.

Toenail fungus is common among runners. In fact all fungal infections are common among runners. Particularly athlete's foot. Athlete's foot is nothing more than a fungus infection of the skin on the foot. A toenail fungus infection is actually caused by the same organism that causes athlete’s foot.

When you run your feet sweat, moisture collects in your shoes and the ideal environment for fungal growth is created. If you run on back-to-back days the problem is compounded because your running shoes never completely dry out.

If you happen to develop a case of athlete's foot, the fungus is growing between the layers of the skin. As the skin peels it sheds fungal spores into your shoes. These spores of course are the seeds from which fungus grows.

If you are running, doing hill repeats or some other strenuous workout, and you repeatedly bumped the toes and the end of of the toenail on the inside of the running shoe, the fungal spores can get between the toenail and the underlying nail bed. The fungal spores begin to grow and develop into a fungal toenail infection.

However when you run barefoot, you not have any risk of bumping the toenails repeatedly against an inside of a running shoe that is ripe with fungus. So in that respect, running barefoot is actually much lower risk for developing a toenail fungus infection as compared to running with running shoes.

The risk is mainly related to the potential for fungal spores to collect in your shoes and then have trauma where those spores are actually in contact with the toenail in such a way that they can become embedded in or underneath the toenail and start to grow. If you are wearing minimalist running shoes such as the Vibram Five Fingers without socks the risk of developing one of these toenail infections actually increases significantly. 

If you start to notice discoloration such as white or yellowish spots where the toenail seems to be changing and getting thicker it could be a fungal toenail infection. Treating these infections is not really a big deal. Our podiatrist can actually bring a laser to your home or office in order to directly kill the fungus and help your toenails returned to their normal clear and healthy state.  For more information on discount toenail fungus laser treatment andlas er toenail fungus removal treatment visit http://www.lasertoenailsanfrancisco.com/