Our feet are incredibly sensitive. (One of the most feared tortures in the Spanish Inquisition was bastinado—whipping the soles of the victim’s feet. Glad you asked?)

So it’s curious that a fungal toenail infection is so often a painless, and therefore unnoticed, condition. Yes, it can be relatively benign, but no, it should not be ignored. If you’re diabetic, or have a fragile immune system or circulatory problems, you’re more vulnerable to serious infection. Even in relatively healthy people, things can get serious enough to require surgery.

Symptoms Of Toenail Fungus

It’s important to get in the habit of regularly inspecting your toenails. See if they are:

• Turning yellow or white, sometimes with white spots
• Getting thicker
• Crumbling and splitting
• Separating from the skin under the nail (the nailbed)
• Giving off a foul odor

These are symptoms of a fungal toenail infection. Again, it’s not often serious if you’re healthy, but there can be very unpleasant outcomes.

Minor discomfort can become real pain. Thickened toenails can make walking in shoes—or wearing shoes at all—painful or impossible. Finally, onychomycosis (the medical term) makes the nail or the skin under the nail (the nail bed) vulnerable to permanent damage and to secondary infections, almost always including fingernail infection.

How Fungi Invade

Fungi can get under your nails through the space between your nail and nail bed, through openings in your skin so small you can’t even see them.

Something else you can’t see: the microscopic fungi themselves.

The invasion usually begins in a warm, moist, or wet environment, where fungi thrive. The gym and the swimming pool are well-known invasion sites. If you walk barefoot in a public shower room, you’re inviting attack.

Your Podiatrist Gets To The Bottom of It

Visit the moment you even suspect an infection. The longer you let it go, the longer it takes to get rid of it. Your podiatrist has several ways to help you.

Diagnosis: Is it, in fact, a fungal infection? If not, is it some other medical issue that your podiatrist should address?

Analysis: If it is an infection, your podiatrist can identify what types of fungi are active, to devise treatment specific to your problem. (80% of toenail infections are caused by dermatophytes (Trichophyton rubrum), for example.)

Cleaning: Infections often leave dead and diseased skin around or under your nail. Your podiatrist can clean them away, giving healthy skin the “breathing room” it needs to heal.

A Choice of “Weapons” for treating fungus

Your podiatrist can recommend treatments ranging from classic home remedies, like snake-root extract, vinegar, baking soda, and tea tree oil, to high-tech laser treatments. A little research can give you a sense of which home remedies might be best for you.

The next level of treatment may be choosing one of the many over-the-counter (OTC) anti-fungal creams and ointments available. Depending on your condition, your podiatrist may recommend one or more.

Finally, if self-care and OTC treatments aren’t indicated or haven’t worked, prescription drugs and other approaches are indicated. There are upsides (they work) and downsides (they’re expensive and take a long time) to these. Work with your podiatrist to determine what’s right for you.

Medications For Toenail Fungus

Oral antifungal drugs. These drugs help a new, infection-free nail to slowly replace the infected one. Treatment duration is typically 6 – 12 weeks, with final results seen when the entire nail has grown back, in four or more months.

These drugs can have side effects ranging from rash to liver damage. They’re not recommended if you have liver disease, congestive heart failure, or are taking certain medications.

Medicated nail lacquer. This relatively new treatment, applied like nail polish (but daily) usually gets good results. You may need to use this type of medication for a year.

Medicated nail cream. Your doctor may prescribe an antifungal cream, which you rub into your infected nails after soaking. These creams may work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.

Surgical or other procedures

Nail removal: In cases of a severe or very painful infection, one option is to surgically remove the nail. A new one should grow in its place. But it’s a slow process that can take up to a year. Some doctors recommend surgery combined with other treatment(s) to treat the nail bed.

Laser and light-based therapies: These relatively recent interventions show promise but need more study. The caveat: they’re Laser and light-based therapies are not widely available, cost a lot, and often are not covered by insurance.

Your podiatrist will advise the best treatment for you. Meanwhile, whether you have an infection or want to avoid one, you should always be aware of the best preventive practices.

How to Prevent Toenail Fungus

The surest way to prevent a fungal infection is clear and simple: keep your feet clean and dry. Please make these practices a habit:

• Wear shower shoes in public areas
• Change shoes, socks, or hosiery more than once daily
• Before going to sleep, wash feet with soap and water and dry thoroughly
• Clip toenails straight across so they don’t extend beyond the tip of the toe
• Wear shoes that fit well and are made of materials that breathe
• Avoid wearing tight hosiery to decrease moisture
• Wear socks made of synthetic fiber that “wicks” moisture away from your feet faster than cotton or wool
• Disinfect home pedicure tools and instruments used to cut nails
• Don’t apply cosmetic polish to nails suspected of infection (those that are discolored, for example)

As fungal toenail infection doesn’t announce its presence as clearly as many other conditions, and treatment can take up to a year, I recommend you inspect your toes regularly. (Put a note reminding you to LOOK DOWN on your bathroom mirror.) The sooner you catch the infection, the faster and easier the cure.

Last Updated: June 24, 2021
Originally Published: December 24, 2014