Sunday, September 24th, 2017

Ask A Doc: Flip Flops

by Arun Nagpaul, M.D

Doc, I love my flip flops! Over time, my big toe’s nail has become thick, discolored, and distorted. I am embarrassed to wear my flip flops. What can I do to get my toe in flip flop shape for this summer?

Flip flops are named for the sound that is made as they slap between the sole of the foot and the floor when walking (an example of onomatopoeia my 12 year old tells me!). This casual foot wear dates as far back as 4000 BC, but the modern flip flop is a descendent of the Japanese zori, a casual footwear brought back to the United States by soldiers returning from WW II. Flip flops are an embedded part of American culture now. Flip Flop sales are estimated at 20 billion dollars by some and in 2006 flip flop sales for the first time exceeded those for sneaker sales! Seen everywhere from casual beach outings to outfitting feet at formal events, the Northwestern University’s national championship lacrosse team stirred a minor controversy in 2005 while attending the White House wearing flip flops. (They did some public relations recovery and a good deed by later auctioning off their flip flops to raise money for a young cancer patient.)
I can understand your desire to get your feet in shape to return to your flip flops, be warned, the lack of support provided by flip flops can lead to turning in of your foot (over pronation) resulting in significant foot injuries including flat feet, tendonitis, cuts, and even fractures. In the United Kingdom at a cost of 40 million pounds, the British National Health service reported that there were 200,000 flip flop injuries treated in hospitals in 2010.

Your toe description sounds like a fungal infection of your nail (onychomycosis). Such fungal infections are usually asymptomatic, but can become painful, portals of entry for bacterial infections or they can simply be a cosmetic issue. Fungal infections may be picked up by walking barefoot in the locker room or may be the result of having a less than sanitary pedicure. The fungus thrives in warm, dark, moist environments. Those who have poor circulation, diabetes, or weak immune systems are more prone to onychomycosis. There are other causes of a thick, discolored nails, so, it is always best to have your doctor confirm the diagnosis prior to starting any treatment.

Due to the circulation and slow growing nature of the nail, treatment when successful (20% of treatments may not succeed) often takes months and may take up to a year. Topical antifungal medications may be applied to the nail, but take a prolonged period of time to work and are not as effective as oral medicines. Oral antifungal medications offer the best chance for a cure; however, they require close monitoring of side effects that may include skin rashes and liver toxicity. If you are started on an oral medication, your doctor will monitor your blood work periodically. More invasive treatments include removal of the nail or laser treatment to the nail. If you want to start with treatments that have few side effects, but note also less proven benefit, you may choose to apply Vicks vapor rub, Australian tea tree oil, grapefruit seed extract or vinegar to the nail.

After treatment, be sure to take precautions to prevent a fungal nail infection from developing again. Keep your feet clean and dry, change your socks daily, wear shower sandals in public areas, stop smoking, and choose a reputable hygienic spa for your pedicures.

May the treatment you choose be successful. I might suggest during this time that you research and purchase a new pair of flip flops that may limit your chance of injury. Invest in a flip flop with thick cushioned sole, one that comes back to the ankle and one that has a slight heel to support the arch of your foot. The last thing your toe needs is a flip flop injury to the foot to keep it out of the upcoming flip flop season.

Stay healthy and remember the quote by Publilius Syrus, “You cannot put the same shoe on every foot.”