Toeing the Line Our years and our activities leave their footprints on our nails.


After a prolonged period of flashing me serious side-eye about my distressed, alien-like toenails (Fu Manchu-long, thickened, growing in varying directions, the right big one a sickly purple), my wife finally told me, “You need professional help.” Given that repeated attempts to trim the nails with conventional clippers had failed miserably—
the nails just laughed at the effort—
I conceded that she had a point.

A few weeks later, I visit Dr. Zachary Chattler, a podiatrist with MedStar Health, who examines my feet, noting that I have good circulation, good pulse. Then he produces medical-quality clippers—available online, incidentally—that resemble wire cutters, and proceeds to effortlessly snip the offending nails straight across, placing the mottled purple one (“this puppy,” he says, holding it aloft with tweezers) in a sealable plastic envelope for testing. Fungus present? Maybe, maybe not. An office assistant then smooths the rough nail ends with 
a small drill-like tool that also dispenses a refreshing spray.

“Nails can thicken and discolor for many reasons,” the avuncular Chattler explains. “The most common is just trauma. As we go through life and bump our toes and stub our toes and people step on our toes and we drop things on our toes, that repetitive damage will 
injure the nail root and cause a thickening, discolored distortion.” Another cause: fungal infection. “An organism can get into the nail and begin growing and multiplying. If you live an active life and live long enough, your nails change.”

Mild consolation: While not especially active, I’ve certainly lived long enough to develop the condition. As for active types—people who run, play racquetball, basketball, tennis and other sports—Chattler says what avid runner/author Jim Fixx called “runner’s toe” in his 1977 best-seller The Complete Book of Running remains a common occurrence.

Meanwhile, a culture of my purplish big toenail reveals the presence of Trichophyton rubrum, a common organism that infects nails. Various fungi and bacteria normally inhabit our skin, Chatler points out, including Trichophyton 
rubrum, but when a nail develops a crack, these pesky residents can creep in and reproduce wildly.

Curiously, topical antifungal ointments and creams that prove effective on skin fail miserably when applied to toenails.

“Nails are dead protein,” Chattler says, “and these topicals are not actively metabolized into the nail plate, so they can’t kill the fungus. At the drugstore, you can find any number of over-the-counter antifungals and a few prescription antifungals, but I’ve yet to see any 
of them work on nails.” Ditto home remedies such as tea tree oil, Vicks VapoRub and vinegar.
Instead, he recommends oral antifungals, which enter the bloodstream and vanquish the fungus at the nail’s root, composed of living tissue: “They’re the only ones out there that are really going to clear a fungus; I’ve had success with them.”

In truth, though, only in rare cases do these fungi thicken and deform a nail to the point of causing pain. “Most of the time,” Chattler explains, “it’s more like a cosmetic situation, and if it doesn’t bother you, then you don’t necessarily have to begin dealing with it.” Accordingly, I have elected to let my purple nail reign.

Still, I wonder aloud how a person can decrease the likelihood of developing thickened and discolored nails.

“Live in a bubble,” Chattler deadpans. “As long as there are people who drop things on our toes and people step on our toes, and people who want to be active athletically, more likely than not they’ll get a thickened or discolored nail or even possibly a fungal nail. I can’t remember the exact quote, but getting back to Jim Fixx, he said something like, ‘Better to have a healthy heart and mind and not worry about an ugly nail.’”

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