Patient Background and Symptoms
A 50-year-old male presented at Leading Edge Podiatry with a fungal nail infection in both his big toes. He reported that the infection had been present for over 20 years and had gradually worsened over time. He had been working in the construction industry but recently started taking a step back from onsite duties. He was working as consultant and no longer required to work long days with Steel cap boots. He was otherwise healthy and did not take any medication. He has over the years tried topical antifungal nail paints such as Rejuvenail, Loceryl, and Tea Tree Oil. He also recently tried laser therapy but did not have any success. He was keen to travel and go to the beach without shoes on.
Patient’s Symptoms
The patient reported that the nails on both big toes was thick, discoloured, and brittle. The nail was also lifting off the nail bed. The patient described the nail as unsightly and embarrassing.
Examination and Assessment
The podiatrist carried out a thorough examination. The patient’s foot was examined for signs of fungal infection; the nail was thick and discoloured. 100% of the nail was infected. The skin also had signs of redness and peeling. The skin appeared dry at the consultation. The patients’ socks were thick and Steel cap boots worn out.
Diagnosis and Treatment Plan: Terbinafine for Fungal Nail Infection
The podiatrist diagnosed the patient with a fungal nail infection. A nail scraping was completed which confirmed fungal nail infection (Trichophyton rubrum). The podiatrist recommended a course of terbinafine to treat the infection. He was advised success rate of 70-80% and the possible side effects. The patient had blood tests to check his liver and kidney function. The patient was advised to keep the area clean and dry and to avoid wearing thick socks or steel cap boots for prolonged periods. He was advised on how to maintain excellent foot hygiene and his toenails were reviewed every 6-8 weeks.
Results: Progress and Recovery Over 10 Months
After 12 weeks of treatment, the patient noticed over 25% of healthy nail was growing.
After 10 months the nail was complete healthy with no visible discolouration. The patient was able to visit the beach with thongs or bare feet without feeling embarrassed.