Dennis great points. We all need to expand on this

I have expanded on this for a decade or more but the depth of the invasion of onychomycosis as the focus for ugly toenails is both mythological and unproductive in diagnosing and treatment this disease entity.

There is no fungicidal "cure" to ugly toenails, the cure is multimodal.

I am interested in think tanking with like minded researchers and clinicians.

It seems that there are at least three issues of importance besides dx. and tx.:

(1) prevention,

(1.1) who acquires them,

(1.2) do certain individuals/groups have a propensity to acquire them,

(1.3) do certain individuals/groups use successful preventative strategies already and, if so, what are the strategies and success rates.

Also, any RCTs out there and what are the results.

Dennis

Dennis Mazur

Great questions Dennis.

Pedal Onychodystrophy results from pathology within the environment of the shoe and an inability to defend against fungal and other pathogenic invasion from existing flora and fauna.

The current gold standard to “kill the fungus” is too little too late.

Einstein stated “ You cannot solve a problem from the same consciousness that created it. You must learn to see the world anew”.

We are not an individual organism in control of endogenous and exogenous factors. We are an ecosystem that is being challenged endogenously and exogenously. Onychodystrophy is a precursor, canary in a cage, hole in the dyke, alerting us to deeper problems that need addressing. Onychomycosis is almost always a secondary pathogen that manifests when it succeeds in finding a weakened host toenail (usually the 1st and 5th toenails). We must learn to live as a host to trillions of organisms not as their enemy.

1. Who acquires them?

· Those who are hyperhidrotic or work in or around water

· Those who wear civilized/stylish shoes (low and narrow toe boxes)

· Those with underpinning biomechanical pathology (Foot Type Specific)

· Those who are stressing their feet enough to produce clinical signs and symptoms (corns, callus and deformity - other precursors)

· Those with PVD

· Those who are overweight

· Those with Tinea Pedis and unhealthy toenails

2. Do certain individuals/groups have a propensity to acquire them?

· Those with a flexible forefoot functional foot type

· Those with a high forefoot SERM-PERM Interval

· Those with ill-fit and poorly constructed shoes

· Those with poor pedal hygiene

· Those wearing high heeled and tight fronted shoes

· Those with endogenous compromise (Chemotherapy, CA, Aids, Weak Immune System, Diabetes)

· Those with Tinea Pedis

3. Successful preventive strategies

· Acculturating the shoe wardrobe size and fit using Foot Centering protocols

· Keeping shoes dry

· Keeping shoes sanitary

· Establishing a maintenance program for toenails (maintaining toenail health)

· Proper toenail, foot and leg inspection by podiatry, dermatology or MD

· Improving pedal support, stability, strength, symmetry and balance (Biomechanics)

· Dx and Txing Tinea Pedis

· Establishing a healthy and functional immune system

· Maintaining general health