Dr. Brian Kiel doesn't mind step-ping on a few toes when discussing foot problems. The Memphis podiatrist, who has been practicing here for 30 years, is dismayed by the advice proffered by a certain syndicated columnist in The Commercial Appeal, who touts the use of Vick's VapoRub for toenail fungus.

"It's dangerous, it's stupid, and it's ineffective," says Kiel. "Fungal infections are in the nail root, the area beneath the nail, and you can't treat that topically. Vick's VapoRub actually breaks down the nail. The only effective medication is a pill, Lamisil, which has a 70 to 75 percent success rate."

Although it sounds yucky, toenail fungus is nothing to be ashamed of. "Bottom line is, everybody will get a toenail fungus infection in their lifetime," says Kiel, "because as we grow older our nails' resistance to bacteria decreases." It doesn't help that our toes' normal environment — namely, stuffed inside shoes and socks — is perfect for fungus. "It's warm, dark, and moist. That's the main difference between problems on the toes and those on the hands. Our hands are out in the sun and air, so fingernails don't have the same problems as toenails."

The symptoms of fungus are obvious: discoloration, thickening, brittle nails, and even a powdery debris that can actually lift the nail off. It's definitely an unpleasant condition, and one that takes a long time to cure even with medication, but it's not particularly dangerous.

That's not always the case with another common toe problem — ingrown toenails. These are not, as most people believe, caused by improper trimming of the nails. Instead, Kiel says most ingrown nails are the result of "repetitive traumas to the end of the nail." Years ago, he would treat patients whose feet had been stepped on by farm animals. Now that's a trauma. Nowadays the most common cause is sports.

"When you play basketball or tennis, there are lots of stops and starts, and your toe continually bumps against the end of your shoe," says Kiel. "The foot sweats, and the skin gets soft and more susceptible to being pushed against the nail. Frequently, it's not the nail growing into the skin, but the skin pressing into the nail."

The result is pain and infection. Over-the-counter products designed to treat ingrown nails "have about as much effect as cutting off the end of your toe," says Kiel.

The best treatment may not be for the squeamish, but it works. Kiel's office first numbs the toe with an anesthetic, then uses a special laser to vaporize a corner of the nail. "It permanently kills that section of the nail, so that is the end of the problem."

Ingrown toenails can be especially dangerous for patients with diabetes or other medical conditions that cause neuropathy, a type of nerve damage that lessens feelings. Those people can develop an ingrown nail that turns into an infection without knowing it. If that infection spreads to the bone, it may result in an amputation of the toe, the foot, or the entire limb.

For that reason, anyone with diabetes should have their toes examined and trimmed every two months. "By finding and treating problems early," notes Kiel, "we can prevent more serious things from happening."

Another issue is a subungal hematoma — the blackening and swelling of the toenail that occurs when anyone drops a heavy object on their foot. "It's actually just a blood blister, but it's trapped beneath the nail so it has nowhere to go," says Kiel. "These can be incredibly painful and need to be treated immediately."

In an emergency room, doctors use a heated probe to poke holes in the nail and drain the trapped fluid. Kiel prefers to use a laser to burn two small holes. "It's a quick and simple solution," he says, "and it's not as painful because it's just a ray of light; there's no actual pressure on the toe."

Kiel doesn't want to alarm anybody, but keep an eye on any dark blood spot that forms beneath a nail. It's probably just a bruise, and it should go away with time. But if it stays put, or expands, see a doctor. "One thing we are becoming more aware of is melanoma beneath the toenail," he says. "It's not something that is terribly common, but it's definitely something we would want to look at."

Other than that, toenail maintenance is fairly simple. Just keep your feet clean and dry, and trim your nails even with the end of your toe.

So what's the point of toenails and fingernails, if all they do is cause problems? "In modern society, it's like your appendix," says Kiel. "You don't really need it. Nails probably served a purpose thousands of years ago, but not so much anymore."