What Is Toenail Fungus?

By Nicole Testani, DPM

Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail that appears dark in color, smells foul, and is often ugly and embarrassing. The infection can spread to other toenails, the skin, or even the fingernails. The resulting thicker nails are difficult to trim and can make walking painful when wearing shoes.

Causes

The toenails are especially vulnerable around damp areas where you are likely to be walking barefoot, such as swimming pools, locker rooms, and showers. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot or excessive perspiration.

Home Treatment

A daily routine of cleansing may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off and should then be treated by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.

Diagnosis and Treatment

Treatments vary depending on the nature and severity of the infection. Your podiatrist can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication and debridement, which is the removal of diseased nail matter.

Newer oral antifungals, approved by the FDA, may be the most effective treatment. They offer a shorter treatment regimen of approximately three months and improved effectiveness. Your podiatrist may also prescribe a topical treatment, which can be an effective treatment modality for fungal nails.

In some cases, temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail that has not responded to any other treatment permits the fungal infection to be cured and prevents the return of a deformed nail.

Prevention

Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails. Clean and dry feet resist disease. The American Podiatric Medical Association suggests visiting a podiatrist when you notice any discoloration, thickening, or deformity of your toenails. The earlier you seek professional treatment, the greater your chance at getting your nails to clear.