Monthly Archives: December 2013

Not All Toenail Fungus Is Created Equal

A patient came into the clinic today with a bad case of toenail fungus. She had seen three other physicians in New York for treatment recommendations prior to making an appointment with me in San Francisco. These recommendations included expensive medications, expensive creams and expensive laser treatments. In spite of the high costs, these treatments are sometimes worth it, depending upon the cause. In her case, though, the particular type of fungus was caused by the continuous use of toenail polish..

Fungus due to frequently polished toenails is called White Superficial Onychomycosis (WSO), and is easily cured with a simple, inexpensive emery board file. Similar to the mold that grows on the surface of cheese, this fungus is easily filed off, leaving the healthy nail below.

WSO_Before_After
Note that salon filing of nails is not rigorous enough to remove this type of surface fungus, so take matters into your own hands and file away WSO before you go in for a pedicure or polish change. This will keep the fungus from getting worse or spreading. It may also save you hundreds of dollars in treatments.

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Spin Class and Forefoot (Sesamoid) Pain

Reader Mary makes a good point of caution:

“I love spin cycling and wore mountain bike cycling shoes in class. I fractured my right sesamoid bone in my foot. I did not clip in–just used the cages. I haven’t been able to go back to spin cycling since the injury.”

Sesamoiditis is a common condition where one of the two bones underneath the big toe become inflamed, injured or fractured. This most commonly occurs when there is repeated, constant pressure or force applied to the sesamoids or during a one-time time traumatic event.

This image shows the anatomy of the sesamoids as they relate to the big toe joint.

Sesamoid_Anatomy

This image is of a weight-bearing x-ray, showing an intact sesamoid next to a fractured sesamoid.

Sesamoiditis

I have treated many cases of sesamoiditis and fracture that happened during spin classes. Typically, this happens when the pedal rests squarely below the forefoot or when the majority of the class is spent out of the saddle.

You may need an MRI to confirm that the fracture is healed before going back, and you will definitely need to modify your cycling form. Less standing and less resistance when you do stand will give your quads more of a workout, and will also reduce the force going through the sesamoids.

For more information regarding sesamoiditis, here’s another blog post I wrote https://drshoereviews.com/2012/01/25/sesamoiditis-2/