Toenail fungus, also known as onychomycosis, is a common condition that affects millions of people. It occurs when fungi infect one or more of your toenails and cause the nail to become discolored, thickened, and brittle. While toenail fungus is usually harmless, it can cause pain, discomfort, and embarrassment. Luckily, podiatrists have several effective treatments to eliminate toenail fungus and get your nails looking healthy again.
What is toenail fungus?
Toenail fungus is an infection underneath the surface of the nail caused by one of three types of fungi classified as dermatophytes, yeasts, or nondermatophyte molds. Dermatophytes, such as Trichophyton rubrum are the most common cause of onychomycosis. These fungi thrive in warm, moist environments and can infect your toenail if it gets exposed to the fungus. Once infected, the nail may become yellow, brown, or green in color as debris accumulates under the nail plate. The nail will become thick, brittle, distorted in shape, and separate from the nail bed. Often times there is an unpleasant odor coming from the infected nail.
Some factors that can increase your risk of developing toenail fungus include:
- Advanced age
- Wearing shoes that promote damp/warm environments
- Injuries to the nail that cause cracking or trauma
- Having athlete’s foot or other skin infections
- Poor circulation
- A weakened immune system
- Excessive sweating
If left untreated, the infection can spread to other toenails. While not inherently dangerous, advanced cases that damage the nail can create openings for bacteria to enter and cause a secondary bacterial infection.
Diagnosing toenail fungus
To diagnose toenail fungus, a podiatrist will first take a medical history and ask about symptoms you are experiencing. They will examine your nails and look for signs of fungal infection, including nail discoloration, thickening, brittleness, and abnormal shape. Often a podiatrist can make a diagnosis simply by the appearance of the nail.
In some cases, especially if the diagnosis is uncertain, your podiatrist may take a nail clipping and send it to a laboratory for a fungal culture. This will identify the exact type of fungus infecting the nail to select an appropriate treatment. They may also perform a potassium hydroxide (KOH) test by placing nail clippings in a KOH solution and examining it under a microscope. The KOH can help dissolve layers of keratin and reveal fungal elements.
Treatment options for toenail fungus
If you have been diagnosed with onychomycosis, don’t worry. Podiatrists have a range of effective antifungal treatments to eliminate the fungal infection. Typical treatments recommended by podiatrists include:
Medications
Oral antifungal medications, such as terbinafine or itraconazole, are commonly prescribed for moderate to severe toenail fungus. These oral drugs help kill fungal cells and are taken continuously for several weeks. Some of the side effects may include headaches, rash, gastrointestinal problems or liver damage. Topical antifungal lacquers, solutions or ointments containing ciclopirox, efinaconazole or tavaborole may also be used for mild cases and work by penetrating the nail to eradicate fungus.
Nail debridement
Podiatrists may thin out and trim back the infected part of the nail using nail clippers or other instruments. This helps remove diseased debris and allows topical antifungals to better penetrate the nail bed. Debridement helps restore a more normal shape and thickness to the nail.
Laser therapy
Laser treatments, such as PinPointe FootLaser, aim focused beams of laser light at the toenail to eliminate fungal organisms. This is a painless in-office procedure that helps restore clear nails after a few treatments. One of the advantages of laser therapy is there are no side effects compared to oral medications.
Surgical avulsion
For severe or recurring cases of toenail fungus, permanent nail removal by surgery may be recommended. This procedure is called surgical avulsion or complete nail plate avulsion. The podiatrist will numb the toe and then use sterile tools to remove the entire infected nail from the nail bed. Often phenol or sodium hydroxide is applied to cauterize the nail bed and prevent recurrence.
Steps you can take at home
In addition to professional treatment, there are some things you can do at home to help combat toenail fungus:
- Practice good foot hygiene by washing your feet daily with soap and water and drying thoroughly.
- Disinfect your nail clippers with alcohol after each use.
- Apply an over-the-counter antifungal powder, spray or cream.
- Soak your feet in vinegar or an antifungal foot soak.
- Use an antifungal or medicated shampoo to wash your feet in the shower.
- Treating athlete’s foot can help prevent reinfection.
- Avoid walking barefoot in public areas.
- Wear moisture-wicking socks and shoes that allow airflow.
- Trim nails straight across to prevent ingrown toenails.
- Disinfect your shoes periodically with antifungal sprays or UV lights.
Prevention tips
You can reduce your risk of developing toenail fungus by taking some preventative steps:
- Wear shower shoes or flip flops when using public showers, locker rooms, or pool areas.
- Choose well-fitting shoes made of breathable materials.
- Don’t share shoes, socks, or nail clippers with others.
- Disinfect your nail tool after performing pedicures.
- Wear clean, dry socks each day.
- Apply antifungal powder inside your shoes.
- Allow your shoes a day to fully dry out between wears.
- Get manicures and pedicures from reputable salons that sterilize equipment.
- See your podiatrist at the first sign of infection for early treatment.
When to see a podiatrist
You should make an appointment with your podiatrist if you notice any symptoms of toenail fungus, including:
- Discolored, yellow, brown, white, or green nails
- Thickening or brittleness of the nails
- Distorted nail shape
- Debris building up under nails
- Nails separating from the nail bed
- Foul odor coming from nails
- Pain or tenderness of the toes
Seeing a podiatrist at the first signs of nail fungus provides the best chance for effective treatment. Untreated nail fungus tends to worsen over time, so it’s best not to delay. Professional treatment helps relieve discomfort and restore the appearance of your nails.
Conclusion
Podiatrists offer several safe and effective treatments to cure troublesome toenail fungus. Oral or topical medications, laser therapy, nail removal, and debridement are commonly used to eradicate fungal organisms and infections under the nail. Good foot care habits at home combined with professional treatments provides the best defense against fungal nails. Paying attention to prevention and seeing a podiatrist at the first sign of infection helps keep nails looking healthy.