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Two of my sons have come home from two-year stays in South America with foot problems: ingrown toenails and athlete's foot. However, you don't have to leave the states to experience both since both are common in the United States. For example, another son, during a ski trip to Alta, had ingrown toenails that became so painful he had to interrupt an enjoyable day of skiing and later required medical attention. Probably most readers of this column have experienced one or the other of these toenail problems or have known someone who has.

Ingrown toenail

The big toe is the one almost always affected. These occur when the edge of a nail grows into the surrounding flesh, causing pain, swelling, inflammation and sometimes an abscess. Most ingrown toenails are caused by a chronic pressure across the soft tissues on either side of the toenail. This often comes about by wearing ill-fitting shoes and cutting the nail too short and/or rounded. On the inside edge of the big toenail, most ingrown toenails result from pressure of the great toe against the second toe. On the outside edge of the big toenail, this problem occurs because of turning (pronation) of the big toe during pushoff. Other things to look for include:

- Outer side of nail most commonly affected.

- Often on both feet.

- Recurrent pain.

- Recurrent infection - with redness, swelling and pus.

How can you treat an ingrown toenail?

1. Soak foot in warm water twice a day.

2. Soft tissue teasing technique: The foot is soaked to make the nail and skin soft and pliable. This allows the victim to push soft tissue away from the nail and "uncover and decompress" the nail edge. Then a small piece ("wisps" not a wad) of cotton is pushed with a toothpick and positioned between the nail and soft tissue to maintain uncovering of the nail. The cotton will slightly lift the nail so it can grow past the tissue it is digging into.

3. Wear wide toe shoes.

4. Do not cut toenails short. Cut them straight across, never in an oval shape.

For an inside edge of toenail:

1. Soak foot in warm water twice a day. 2. Soft tissue teasing technique (described above).

3. Use of several gauze pads between the first and second toe.

4. Wide toe shoes.

5. Do not cut toenails short. Cut them straight across, never in an oval shape.

There are nonprescription products that may soften the nail and the skin around an ingrown toenail. Those with diabetes or impaired circulation should not use them.

When to call the doctor?

Severely ingrown nails require professional attention. Under local anesthetic, the doctor cuts away the nail to relieve the pain. If the nail is infected, antibiotics may be necessary if the treatment proves ineffective, the entire nail may have to be removed.

Athlete's foot

Athlete's foot is a fungal infection of the feet. It's the most common fungal infection of the skin. It is seven times more prevalent in men than women and more common in hot, humid weather. Those whose socks become sweaty because of poorly ventilated shoes and those using school or health club locker room showers are especially susceptible. Athlete's foot does not just affect athletes or only the feet. The fungal family that causes it can infect anyone and many other places on the skin.

Indications of athlete's foot include:

- Irritation between the toes.

- Burning and itching between the toes.

- Some redness, as a result of inflammation.

- Crusting and further infection can take place.

- Smelly feet.

- Cracking of skin, particularly between the toes.

How do you prevent athlete's foot? Since athlete's foot is a fungal infection spread from person-to-person or by contact - for example, by a contaminated towel or mat - prevention measures include:

1. Keep the feet as dry as possible, especially between the toes. Use a blow dryer after bathing and towel drying.

2. Avoid occlusive footwear or synthetic stockings, rubber-soled shoes or plastic insoles.

4. Use shower clogs.

5. Use antifungal cream or powder. Creams are more effective than powders, but powders help absorb moisture.

6. Alternate pairs of sneakers if available.

7. Disinfect shower and bathtubs daily.

When to call the doctor?

If symptoms persist after using a nonprescription remedy for four weeks, a physician can prescribe a different antifungal cream. Consult a physician should the toenails become thickened. This which may indicate that they have been infected.

Anyone can experience the pain of either of these two ailments. Prevention is the key. However, the above mentioned home treatment can be tried before either condition gets severe enough to require a physician's attention.