Toenail Fungus: Treatment and Prevention


A thick, yellowish nail with splotchy white areas is a classic presentation for a fungal toenail. In the early stages the toenail is only slightly discolored, or slightly thickened. In the late stages the nail can become very thick and has a tendency to "grow up" more than in grows out. The nail will be very discolored, typically dark yellow-brown and will start to change shape and crumble. In some cases the nail becomes very loose and many will lose the nail, only for it to regrow with the fungus.

The medical term for toenail fungus is "onychomycosis," pronounced on * EE * ko * my * ko * sis. The prevalence in America is about 2-3%, but some have reported it as high as 13%. Toenail fungus affects men twice as often as it affects women and the prevalence among elderly individuals and diabetics is 25%. In the 1800s, fungal toenails were very rare. The increased prevalence is linked to the increased exposure to fungus through the use of showering facilities in gyms, the use of hot tubs, saunas and public pool areas. There has also been an increase in the number of individuals participating in sporting activities and wearing occlusive footwear. More individuals have diabetes and there has been an overall increase in age of the general population, both of which are associated with a less than optimal immune system. It is no surprise that the risk factors for developing toenail fungus are increasing age, male gender, nail trauma, sweaty feet, poor circulation, poor hygiene, foot fungus and a compromised immune system. Athletes will also have a higher risk.

Combination therapy can help increase the effectiveness of the treatment. If you choose to take an oral medication, make sure you use a topical anti-fungal agent as well. Nail removal is also an option. Once the nail is removed, the topicals can reach the nail bed and they become more effective. The nail will grow back in over a period of 8-10 months. Permanent nail removal is reserved for those with chronic ingrown nails, ulceration under the nails or pain from the fungal nails.

1. Place an anti-fungal powder or spray in the shoes to help fight off the fungus.

2. Make sure you rotate your shoes often and keep them in a cool dry place.

3. Change your insoles frequently, and make sure they dry out between use.

4. Bleach out the shower on a weekly basis.

5. Wash your shower mat regularly in hot water.

6. If you belong to a gym or health club, wear sandals in the locker room and don't walk around barefoot.

7. Don't keep your shoes in the gym locker where they cannot dry out.

8. Make sure your athletic shoes fit well to prevent jamming at the toes. Jamming at the toes leads to microtrauma at the nails and increases the chance for fungal infection.

9. If your feet sweat excessively, try using an antiperspirant spray on your feet before your workout.

10. Cut your toenails straight across. Don't cut too short and cause breaks in the skin. This will increase the chance for fungal infection. Don't let the toenails grow too long or they will jam against the shoe and cause bleeding under the nail, again increasing the chance for fungal infection.

The bottom line is that prevention is easier than treatment. Treating toenail fungus is very difficult and will take months regardless of the type of treatment you choose. If you have fungal toenails that cause pressure, pain or infection, consider talking to your doctor about prescription medications or nail removal. If your fungal toenails are only unsightly and don't cause any discomfort, consider topical therapy for treatment. The last option is to prevent the nails from becoming worse or becoming a problem. Try a weekly application of an over the counter topical along with methods to prevent re-infection.


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