Foot fungus, it just sounds disgusting and according to podiatrist Pamela Hopper it really is.

"I think this place shouldn't be called a paradise island, it should be called fungal island because I've never seen this amount of fungus in feet, it's disgusting," she said.

Dr. Hopper began a private podiatry practice in Alberta, Canada in 1993. This year she decided she needed a change and accepted a three-month posting at the Bermuda Podiatry Centre. And what did she discover? Foot fungus, foot fungus and more foot fungus.

Dr. Hooper said she treated over 600 patients in Bermuda between June and August and estimated that 90 percent had foot fungus.

She said the high incidence surprised her. "Some days every second patient was fungal and some days it was every patient," she said.

Back in Canada the majority of Dr. Hopper's patients were children and people with sports injuries so when her first few patients in Bermuda had foot fungus she said she didn't think much of it "but then they kept coming and coming", she said.

"I'd ask them 'how come you've got feet like this?'" Dr. Hopper said most patients were nonplussed about their problem.

"I've been really educating the patients. They didn't know half the stuff about feet and fungal nails," she said "They don't know anything about it and they are spreading it all over the Island."

Dr. Hopper said she explained to patients that there are different types of fungus and the one found in nails is called onychomycosis.

"Fungi are microscopic vegetable organisms that can only exist by utilising other organic matter for food," she said.

She explained that certain groups of fungi, classified as dermatophytes, thrive on keratin a protein component of skin. This causes them to grow and proliferate.

"The human nail and nail bed provide a wonderful environment where the dermatophytes can flourish," she said. "Once these fungi establish themselves the condition is known as onychomycosis."

And once the dermatophytes are established under one nail bed they settle in and begin to attack other nails.

"This is highly infectious," said Dr. Hopper. And she said fungal spores are so resilient that they can survive for years in a dark corner just waiting for ideal conditions to emerge and then to take root.

And ideal conditions for fungal growth are warmth, darkness and dampness. Bermuda's high temperatures and humidity are the reason the microbes abound. But despite the environment, Dr. Hopper said Bermudians can both be cured and can prevent fungal nail infections.

Treatment

Dr. Hopper said there are two oral prescription medications that can be used to treat nail fungus.

"But they can be highly toxic to the liver so I do not recommend them," she said. She said patients who use these medications need to have their blood tested once a month to ensure their liver is still functioning well.

There are a variety of topical ointments that she said can work well in the early stages without poisoning the body but she advised that a registered podiatrist should administer them.

"If you apply these creams to thick nails, it will have no effect," she said. In such cases the cream will not come into contact with the fungus. She said a podiatrist must thin the nail down.

While treatment is underway, patients should spray their shoes with antifungal spray or powders and try to keep their feet dry.

While cures exist, Dr. Hopper warned that the treatment could be long. "Sometimes it will take 18 months to cure foot fungus," she said.

And once you're cured it's important to guard against getting re-infected. Dr. Hopper said even the sprayed shoes should be thrown out and new ones bought.

Prevention

Dr. Hopper advised that we never go barefoot. She said she believes this contributes to the high incidence of foot fungus in Bermuda. To illustrate, she pointed out that people walk through a hotel lobby barefoot, while others come through with shoes that have been outdoors. She said if foot skin is completely intact, the person should be fine, but if there's even a pinprick opening, fungi may move in to live and build a family.

She said people should never go barefoot in any communal areas, like hotel rooms, gym showers, spas even around swimming pools and at the beach.

"In the UK right now the kids are not allowed to take swimming lessons unless they have water socks on their feet because they were getting so much fungi and warts that the doctors were sick and tired of treating them," she said.

Additionally Dr. Hopper said people should never share their shoes, towels or socks. "And you should never, never use a hot tub," she said. "And if you want a manicure or pedicure you should take own instruments because you're probably paying them to make you sick."

She said instruments need to stand for at least 24 hours in disinfectant, for them to be clean or be heated, in an autoclave. An autocalve is a pressurised, steam-heated vessel, used for sterilisation.

"You can ask your therapist if they have an autoclave and if they ask you what it is, you know they don't have one," she said.

Absorbent innersoles that soak up sweat and whisk it away from the skin are especially helpful in preventing foot fungus for people with sweaty feet.

How to recognise foot fungus:

1. Nail is thick, is lifting off the nail bed and is often discoloured

2. Skin is scaly

3. Skin may be red and blistered

4. Dead skin between toes can make feet smell bad

Why sweaty feet smell

Podiatrist Pamela Hopper explained that putting absorbent innersoles in shoes can help, especially for those who suffer from sweaty feet.

"If you have sweaty feet that's another way to grow fungus," Dr. Hopper said, explaining that wet feet create ideal breeding conditions for fungus and also bacteria.

"The bacteria grows on the sweat and on the fungi and then you get smells," she said. "If you've ever smelt someone with stinky feet it's gross."

But not only is the smell offensive, the presence of bacteria can lead to bacterial infection. At this stage antibiotics become a necessary treatment.