Onychomycosis or toenail fungus is an infection caused by a group of microscopic organisms called Dermatophytes. The fungus has enzymes that break down the nail plate and allow the organism to penetrate the nail.
While most people seek treatment because they don’t like the way it makes their nails look, toenail fungus is more than just a cosmetic issue. The fungus is highly contagious and can spread in families, become painful over time, spread to other parts of the body, and triple a diabetic’s risk of developing limb-endangering complications like slow-to-heal foot ulcers. Even more frustrating: fungal toenail infections can return despite conservative treatments.
Causes and Prevention of Toenail Fungus
Anyone can get toenail fungus. Today 36 million Americans suffer from this condition. When you understand what causes fungus to thrive, you can take the appropriate steps to make your feet—and shoes—a less hospitable environment for it. Here's what you need to know.
- Fungus loves warm, moist, dark areas. The most common cause of fungal toenail infections is chronic use of tight, non-breathable shoes along with cotton or wool socks that retain moisture. Avoid overly tight hosiery and restrictive shoes; instead, choose synthetic-fiber socks that wick away moisture, and supportive, well-fitting shoes made of breathable materials.
- Proper foot hygiene can reduce your risk for fungal infections. Keep your feet clean and dry. Wash and dry them thoroughly, paying special attention to the areas between the toes. Use a high-quality talcum (not cornstarch) powder to discourage excessive moisture.
- Prevent the spread of fungus among family members. Disinfect home pedicure tools before and after use, avoid sharing towels and wash down your shower or tub with disinfectant after use to prevent spread of fungus in your household (especially important if you think you have it).
- Safe nail care protocols can prevent injuries that encourage fungal toenails. Clip toenails regularly to prevent them from extending beyond the tip of the toe and risking damage. Damaged toenails are more likely to develop fungus.
- Catching a developing infection can prevent it from spreading or becoming a chronic problem. Inspect your feet daily for thick or discolored toenails or cuts or cracks in the skin—all of which can indicate fungus.
- Shared facilities like locker rooms at athletic clubs, swimming pools, yoga and martial arts studios are breeding grounds for fungal infections. Wear flip flops or shower shoes in these areas whenever possible to protect your feet from exposure to other people's foot problems.
- Direct trauma to the toenail (from a stubbing injury, for example) or repetitive microtrauma (from running in restrictive shoes) can damage the nail plate, allowing fungus to invade. Wear clear, dry, well-fitting, and breathable shoes to help prevent toenail injuries.
- Nail salons that don't properly clean their equipment. Learn more by reviewing "10 Hacks to Avoid Toenail Fungus in a Nail Salon".
Other factors like age, diabetes, HIV, and medications that weaken the immune system can also increase your risk of developing a fungal toenail infection.
Are all ugly toenails, fungal nails?
No. Many times ugly, discolored, or misshapen toenails are not caused by fungus. Although nail trauma, aging, illness, and tight shoes often result in nail fungus, sometimes it does not. Dystrophic, distorted nails can sometimes be visually assessed as fungus by a podiatrist, but doctors will often send out toenail clippings to a lab to be analyzed to ensure that nails aren't treated for fungus unnecessarily.
What does it look like and how is it diagnosed?
The most typical presentation is gradual invasion of the nail from the tip extending back, with thickening, brownish to yellowish discoloration, and detachment of the nail. The nail can also be infected from the cuticle outward which is less common and may appear more whitish. It can also appear as a chalky, white, patchy invasion of the whole nail plate. (Here are more photos of nails with toenail fungus.)
In most cases, the diagnosis can be made by your physician’s evaluation. When there’s a question about the clinical appearance, additional testing such as a nail biopsy can be ordered.
Other disorders that can cause nail changes that mimic fungus. Pitting of the toenails can be seen in patients with psoriasis, seasonal allergies or eczema. Severe trauma or microtrauma can also cause a nail to become thickened permanently, with or without fungus.
How is it treated?
The following treatments have been used to treat toenail fungus with varying levels of success.
- Topicals – Medications that are applied to the surface of the nail may slow the growth of fungus, but don't completely eliminate it. These include prescription lacquers, over-the-counter and prescription solutions, and natural substances such as tea tree oil.
- Oral Medications – Lamisil and Sporanox are two medications that are currently prescribed. They have shown to be 75% effective, however, there is a tendency for patients to have recurrence of infection.
- Laser Treatment – A few years ago the FDA approved the use of certain lasers to treat toenail fungus. Laser treatment is painless and has no long term side effects. New clear nail growth can be seen in as little as three months. Nails can be re-treated at one-three month intervals as needed, without systemic side effects that might be experienced with an oral medication.
- Keys to Treatment Success- Find a podiatrist who has a comprehensive treatment program including:
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- laser treatment
- topicals for the nails and surrounding skin
- products for sterilizing shoes
- education to prevent re-infection
Learn more about our Laser Treatment Program.
