Today we're going to discuss a common issue that makes many of my patients self-conscious about their feet discolored, thick, brittle, and sometimes misshapen fungal toenails. In this video, I'll discuss what causes fungal toenails, the best comprehensive treatment for this condition, and how to prevent it from coming back.

Why Toenail Fungus Is Problematic

Like most of my patients, you probably want to get rid of your fungal toenails as quickly as possible, and I can't blame you. Toenail fungus is unsightly, but a fungal toenail infection isn't just embarrassing.

  • It can also spread to other people in your family
  • It can cause pain
  • Lead to complications in diabetic patients. For example, it can triple a diabetic's risk of developing foot ulcers, which can lead to amputation if not caught early.

Fortunately, you've come to the right place for expert care. We've been treating toenail fungus for over four decades and have used laser and other potent therapies for over 10 years.

Risk Factors for Toenail Fungus

Fungal toenails, also known as onycomycosis, are caused by a highly contagious fungal infection. Risk factors include:

  • Chronic exposure to environments this fungi love. Fungi thrive at warm, moist, and dark environments.
  • Prolonged use of tightly closed shoes and cotton socks that return moisture are the most common causes of fungal toenail infections. While you can get fungus on your fingernails, it's much less common for that reason.
  • Nail trauma. Both direct trauma like stubbing and repetitive microtrauma, such as running in tight shoes can damage the nail plate, providing an easy entry point for fungus to get under your nail bed.
  • Lack of protective footwear. It's important to wear shower shoes, flip flops, at swimming pools, and in other situations such as yoga studios. Barefoot feet increase the risk of exposure to fungus.
  • Getting older. As we age, nail trauma and opportunities for exposure to fungus increase.
  • Certain health conditions like diabetes or HIV can decrease the immune system response and increase the risk of developing fungal nail infections.

Now, how do we treat fungal toenails to ensure the best possible outcome?

Testing Your Toenails To Be Sure It's Fungus

A fungal infection isn't the only condition that can cause toenail problems. Often patients come in with nails that are discolored, thickened, distorted, or what we call dystrophic, and that can be also caused by trauma to the nail. These patients are rock climbers, hikers, or runners who've experienced a lot of microtrauma to the tips of their toes.

Other patients have dropped something heavy on their toenails at home or on the job.

In addition, certain health conditions such as psoriasis and eczema. eczema can cause pitting and thickening of the nails that mimic fungus. Of course, toenail fungus can also accompany other problems, so I send nail clippings to the laboratory.  It's crucial to confirm that before we start treatment. Once we know if your toenails are affected by fungus, I'll work with you to develop a treatment plan.

How To Most Effectively Treat Toenail Fungus

After many years of treating patients with toenail fungus, we've developed a comprehensive treatment plan that has an 80 to 90% success rate.

What do I use to treat fungal toenails?

1. Laser treatment

Because fungus lives under the nail, topicals alone are usually not effective in clearing an infection. That's why in 2012 I started using Pinpoint FootLaser. This laser can penetrate the nail to destroy the fungus that lives underneath it.  It has no side effects and clear nails can be seen in as little as three months. We provide three treatments with this laser as part of our treatment package over those three months.

2. Topicals

It's another crucial component. We use Tolcylen, a topical you apply to your nails and the surrounding skin daily. This product not only reduces fungus but improves the appearance of the nail. Because it can travel under the nail, Tolcylen is more effective than other topicals we've used in the past.

3. Oral medications

We recommend a short course of oral medications to improve treatment success. Some patients have concerns about side effects of taking this type of medication, but the risk is greatly decreased because we give it for such a short time period.

4. Ultraviolet shoe sanitizer

To keep the shoes free of fungus during the treatment we provide our patients with an ultraviolet shoe sanitizer.

Our comprehensive treatment takes three months, and like any treatment for toenail fungus, it can take up to a year to see its full effect. That's because it usually takes 12 months for your nails to grow out.

Maintenance and Prevention of Toenail Fungus

Fifth is a maintenance program. While we know, you never want your toenail fungus to come back. It can. Toenail fungus is a chronic condition. It's very similar to plaque on your teeth. Like plaque, some people build it up faster than others, some people are more susceptible to a recurrence of toenail fungus. Just like brushing your teeth and flossing, you'll need to be vigilant to keep your toenail fungus at bay.

Here are some ways to prevent it from coming back.

  • Wear the right shoes and socks. Wear synthetic socks that wick away moisture and shoes that aren't too short or too tight. Reduce sweating.
  • If your feet tend to sweat a lot change your shoes and socks daily.
  • Use high-quality talcum powder or foot spray, such as Gordon's number five.
  • Practice good hygiene, clean between your toes.
  • Clip your nails straight across. Keep them short so they don't hit the top of your shoe.
  • Be sure your nail salon is properly cleaning instruments.
  • Only use nail polish without toxic chemicals to prevent your toenails from becoming weak.
  • Keep using an ultraviolet shoe sanitizer in your shoes to keep down the amount of fungus you're exposed to.
  • Keep using the Tolcylen topicals on your nails and skin or use Tolcylen foot soaks. This will help to keep the fungus at bay.

No matter how vigilant you are, your fungus may still come back, and if it does, you may need additional treatment in the future.

In conclusion, if you think you have toenail fungus, don't wait to get it treated. Here at the Foot and Ankle Center of Lake City, we bring 40 years of experience to tackle this common and often plaguing problem. Our comprehensive treatment plan combines the best of all fungal treatments, including laser, Tolcylen, and a short cost of oral medications, and the use of the ultraviolet sanitizer. Eighty to 90% of our patients experience success with this program, so come in today to learn how we can help you.


Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.