Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast. I'm your host, Gabby Cinnamon, and today I am very excited to be joined by Dr. Jason Serpe, Podiatrist at Riverside, to talk about common toenail infections. Thank you so much for coming on the podcast today, Dr. Serpe.

Jason Serpe, DPM: gosh, thanks for having me, Gabby.

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Host: So before we get into the podcast, I think this is the first episode you've done with us. Can you tell us a little about yourself and your background and all that?

Jason Serpe, DPM: Absolutely. I've been in town for roughly about 24 years now. I started out after podiatry school. I did my residency between the two hospitals, Riverside and St. Mary's, as well as a small hospital in Streeter and another one in Chicago Heights. And afterwards I joined Riverside and have been happy to be here ever since.

Host: Awesome. Well, we're very excited to talk to you about this today. Can you kind of share what are some of the most common toil infections that you encounter in your clinic?

Jason Serpe, DPM: Absolutely. You know, most commonly we probably see fungal toenails. Those are the thick, hard nails that sometimes people don't really like the look of cosmetically. We also see a lot of ingrown toenails. Those are the nails that sort of curve in and cause some discomfort, infections, redness, pain, and things of that nature.

Host: What causes these common toenail infections? I'm sure there are different things based on the type of infection it is, but can you kind of walk us through that?

Jason Serpe, DPM: Absolutely. Fungal toenails are usually caused by a fungus called tinea rubrum, or sometimes candidae. Those are common fungus that actually cause athlete's foot. Sometimes what happens is people are in shoes quite a bit, and fungus loves a dark, warm, moist environment, which is the inside of a shoe.

Sometimes a patient will slightly traumatize the nail, they'll drop something on it, or they'll stub it, that kind of breaks the seal. And in breaking the seal, that makes it easier for the fungus to get into the nail, and then you'll start to changes gradually take place. The ingrown nails are usually caused from pressure.

Sometimes if you have a shoe that's too tight, or a sock that's too tight, or sometimes if you cut the corner of a nail a little bit too closely, that'll allow the nail to grow into the skin, stabbing into it and causing a problem as well.

Host: Are there certain risk factors, underlying conditions, or activities that are associated with these infections that might cause them?

Jason Serpe, DPM: For sure. Some of our patients that are slightly immunocompromised, some of our diabetics, people with autoimmune diseases, they're going to be a little bit more common, or they're going to have fungal nails a little bit more commonly than other people. As we age, you'll certainly see fungal nails pop up a little bit more commonly as well.

I think there was a study that stated that about about 60 percent of the people over the age of 65 will develop a fungal nail.

Host: Oh wow.

Jason Serpe, DPM: At some point in their life.

In growing nails as well, you'll see that sometimes in younger patients that are playing some sports where there's a kicking, soccer, things like that. Sometimes really fashionable high heeled shoes that women wear, I like to call those practice builders for Those will myself. certainly cause some issues with the toenails as well. Those are some of the more common things that you'll see that can cause this.

Host: I know one thing I always think of just from like, as I was a kid and going to like public pools and things, just my mom is a nurse and a germophobe and so we'd go to public pools and stuff or like, she's like, make sure you always wear shoes when you're walking around by the pool.

Like, you know, the, the ground is gross. Like that's kind of what I think of when I think of like toenail infections and things as well.

Jason Serpe, DPM: And, you know, she's not completely wrong on that. For certain, you do get exposed to it somewhere. We're starting to think that some of this might possibly be genetic for a fungal toenail as well. And the reason that we say that is I have people in my practice that are married and have lived together for years. The husband may have it and the wife may not. Usually, if it was completely something that you could catch, then both should have it. So we think there's probably a pregenetic disposition to that, too. A lot of times people that traumatize the nails repeatedly by dropping things on them or sometimes are runners who lose toenails, those are patients that will more commonly get fungal toenails as well, just from the trauma that you see that causes this.

Host: Yeah, that makes sense. So we're going to take a quick break to talk about primary care at Riverside.

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Now back to our episode with Dr. Serpe. So can you talk about why it's so important to take care of your toenails to help prevent these infections. I know you said there are some things out of your control like genetics, but for those things that are, can you kind of share what we can do to prevent this from happening?

Jason Serpe, DPM: Absolutely. You know, as far as ingrown toenails go, trying to cut a nail straight across, trying not to dig too deeply into a into corner, trying to make sure you use shoes that fit so it doesn't put too much pressure on the nail, or socks that aren't too tight. Those are certainly things that'll help out with that. As far as fungal toenails go, trying to decrease the amount of fungus that might possibly be an issue. So, if you have shoes that you can alternate to wear one pair on a day, another pair the next to let them dry out, that'll help. Simple things like after a shower, making sure you dry your feet thoroughly, using a hair dryer possibly to assist in that to dry between the toes can make a big difference as well.

Trying not to injure the toes or stub them, which is easier said than done of course.

That possibly can help out a little bit with that also.

Host: For sure, so let's say someone listening thinks, you know, oh gosh, I might have a toenail infection, that kind of thing, or, you know, just thinking about maybe if it happens in the future, are there things that people can do over the counter or does it, you know, at what point does someone reach out for medical help?

Jason Serpe, DPM: Absolutely. You know, it's become a big business to treat toenail fungus over the counter, and it's mostly because everybody has it, and cosmetically it's not pleasing, and when people want to wear open toed shoes and sandals, they want those toenails to look good. The problem is a lot of the over the counter meds unfortunately don't work as well as we'd like them to.

The reason for that is they just can't really penetrate the nail, and a lot of the funguses within the nail are underneath it. A lot of the over the counter medicines use similar antifungal properties. It's just, they all work about the same, which unfortunately isn't as good as we would like it to be.

There are some prescription strength topical medications that you can use as well. They work better cause some of those are in a vehicle that can go into the nail a little bit better, but even those unfortunately don't always work as well as some of the other things that can be done for patients.

Host: If someone's been trying these home remedies, but they're still not working, that's when they should probably seek help from a podiatrist like yourself?

Jason Serpe, DPM: Ideally, if they see anything as far as what might look like a bacterial infection like redness, swelling, drainage or pain; we definitely want them to come in take a look, or if they see any type of a color change to the skin around the nail, it's worth it to have it looked at. There are things that are prescription strength for fungal toenails. There are oral medications, both Lamicell and Sporinox, that are pills that you would take for about 90 days.

Host: Oh, wow.

Jason Serpe, DPM: Yeah, it's a long, drawn out unfortunately, it requires a little bit of legwork. Usually, you would have to do some blood work prior to taking the medication. These medicines are cleared by the liver, so if we're going to put a patient on a liver for that length of time, we like to make sure that the liver and kidneys are healthy, so sometimes it requires some blood work.

Those medicines do not work overnight. What happens is you actually have to grow the nail out. It does nothing for the fungus that you currently see in the nail, so it takes about eight months to grow the nail out. So nail it's, if you start in the fall, you'll hopefully see changes in the summer. Those meds aren't a hundred percent cured or cure.

They don't have a hundred percent cure rate. It's probably closer to about 70%. So unfortunately there's a chance that you could do this and it still may not work as well as we'd like it to. For ingrown toenails, there's procedures we can do in the office that are really pretty slick. They're pretty easy.

We can anesthetize a toenail. It's a couple of quick shots in the toe, but we can help to make those shots a lot less painful by using cold sprays and other things. And then we can remove the ingrown portion of the nail and we can put a chemical to the portion to prevent it from ever growing back.

So that really rid a problem. Some people spend months trying to do bathroom surgeries to get rid of that get ingrown nail. And it's something we can usually fix in like 10 minutes. So it's something pretty straightforward and easy to do. You can even permanently remove a fungal toenail. In some patients, when the nails become extremely disformed, thickened and painful, we can anesthetize the toenail in the office and remove it.

And as it heals, it'll just have flat skin that actually grows in place of the nail bed, and then you can actually paint the skin things of that nature after it heals and camouflages it pretty well, it can do okay for people. Yeah.

Host: So, overall, what I'm hearing is, don't wait too long to get help, obviously, because with a lot of things, it probably gets worse, and, you know, don't put that off and you could develop another problem, and, of course, don't try doing your own toenail procedures at home.

Jason Serpe, DPM: Absolutely. There's some really simple things we can do to help people along with that, for sure.

Host: Awesome. Are there any lifestyle changes people with the, that have chronic toenail infections can make to prevent recurrence? I know you kind of talked about the too tight of shoes, but are there other things people can do?

Jason Serpe, DPM: Unfortunately, this is sort of one of those things where if some of these changes are going to progress, it's just what's going to happen. Trying to just pay attention to the feet. If you see some of these problems, trying to come in as early as you can. The earlier we can catch a toenail infection, the better we are at treating it.

You don't have to live with these things, there's things that are available to us. Lifestyle changes in general, it's difficult. We think We some of these will happen potentially because of genetics. You can try to remove some of the factors like tighter shoes and things that'll help to a degree.

Host: Yeah, that's good to know. So how does someone listening who maybe thinks they have a toenail infection or other general, you know, foot issue, how do they schedule an appointment with you or a member of our podiatry team?

Jason Serpe, DPM: Absolutely. They can call us at the Riverside Orthopedic Office. Our phone number is 815-802-7090. And we'd be happy to see them.

Host: Awesome. We are very fortunate to have a great group of podiatrists like Dr. Serpe here. Is there anything else you would like to add before we go?

Jason Serpe, DPM: Thanks for your time. If there are any other foot problems, even besides toenail issues, we'd be happy to see you. So, thank you.

Host: Well, thank you so much, Dr. Serpe, for coming on the podcast today.

And thank you listeners for tuning in to Well Within Reach, brought to you by Riverside Healthcare. To learn more about podiatry at Riverside, visit riversidehealthcare.org. Also, make sure to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you listen to podcasts.