Onychomycosis, more commonly known as toenail fungus is a progressive disease that is oftentimes ignored due to the lack of pain and other symptoms during the initial stages. Typically, it is caused by tinea species (fungi and/or bacteria), but it can also be caused by Candida species (yeasts). Fungal infections are contagious and easily passed from person to person through various routes including physical contact or coming into contact with an area (such as a public shower floor) that allows easy transmission of bacteria or fungi. Studies show toenail fungus doesn’t bother children and adolescents as often as it does adults and older adults. It’s estimated that 50% of people will contract the condition at least once before the age of 70.
The initial stages of a fungus infection can last for years, giving the infection plenty of time to grow and spread. The infection is generally located under the surface of the nail and is caused by fungi. The infection of the toenail fungus can produce foul smells, embarrassment and discoloration. The fungus that grows under the nail eats keratin, which is the main protein that makes our nails strong and hard. Our big and little toes are most prone to developing a fungal infection because they are the toes that come into contact with the sides of footwear more often. There are several risk factors for developing toenail fungus including:
- Having a minor skin or nail injury
- Wearing shoes and socks that do not allow your feet to breathe
- Having psoriasis
- Excessive sweating
- Working or living in moist or humid environments
- Having diabetes, circulation problems or a weak immune system
Toenail Fungus Symptoms
The symptoms of toenail fungus are apparent and include:
- Yellow toenails
- Hardening or thick toenails
- Foul smells rising from toenail
- Toenails that appears to be crumbling
- Splitting of the nails
- Pit marks of the nails
- Tenderness in the toe
- Pain, ranging from mild to severe, or constant to intermittent
- Appearance of debris building up under the infected nail
In cases of white superficial onychomycosis, the infected toenail turns white instead of green or yellow, and the surface softens, dries and turns powdery.
What Causes Toenail Fungus?
Toenail fungus can be caused by many different things. Like athlete’s foot, a person can contract toenail fungus by using public showers, locker rooms, gyms and other warm, damp places, including home showers that are shared by multiple family members. Fungal infections in the nails are typically caused by a group of fungi called dermatophytes. However, yeasts and molds can also cause toenail fungus. Other common things that can cause toenail fungus include:
- Improper footwear, especially shoes that are tight fitting
- Medical conditions such as diabetes and other circulatory conditions
- Toenail polish that is applied in layers
- Hosiery, socks and shoes that do not allow the feet to breathe
- Emery boards not cleaned between uses, especially those found in nail salons
People who suffer from immune diseases and circulatory conditions are at higher risk for contracting toenail fungus and other conditions located in the feet and lower legs. This is another reason why it’s important to have your feet inspected by a podiatrist or foot doctor at the first sign of trouble.
Diagnosing Toenail Fungus
It won’t take much more than a visual exam for your doctor to determine whether or not a fungus infection is present. Your doctor will more than likely ask you an array of questions about your symptoms, personal habits, normal activities, family history and personal medical history. He or she may take samples of the fungi to be examined in a laboratory to help determine what’s causing it and the best treatment solution.
Toenail Fungus Treatment
Your doctor or podiatrist will determine the proper treatment method for you based on the severity and extent of the infection. For milder infections, he or she may prescribe a medicated polish containing the ingredient Penlac, Loceryl or Loprox. You apply the polish yourself, generally twice a week until the infection is gone, which could take up to one year. If the infection is more severe, your doctor may offer you oral antifungal medication such as Sporanox or Lamisil. If these treatment methods fail, your doctor may consider a surgical removal of your infected toenail. This is usually done if the patient can no longer walk around or function on the toe. Typically, removing the infected nail allows a new nail to grow in, but it may take up to a year for this process to complete itself.
A new treatment method, which involves using a laser or photodynamic therapy, is being used to treat nail fungus. Intense light is exposed to the nail after it’s been treated with an acid. Results for this new method are promising, as many cases have been successful. However, this treatment method is not available everywhere. Talk with your doctor about this treatment option.
There are also home remedies you can try to help you rid your nails of fungus. Always consult with your doctor about using home remedies beforehand. Soaking your foot in 1 part vinegar to two parts warm water is one solution. It’s recommended you soak your feet for approximately 15-20 minutes either daily or two to three times per week. This solution is not known to cure nail fungus, but it is proven to prevent the growth of certain bacteria. Vicks VapoRub may also be effective. However, you will need to talk with your doctor about the amount you should apply and when because there is no consensus on how to use it for nail fungus. Still, many people believe it works.
It’s very important a person with a toenail fungus understands the infection will not go away on its own. Allowing the infected part of the nail to grow out may work for a short period of time, but the risk is high that the infection will spread to the new nail growing in its place and the infection will return.
Preventing Toenail Fungus
Here are some tips to help you prevent toenail fungus from developing:
- Avoid thick clothing for long periods of time during warm weather
- Avoid shoes that do not allow your feet to breathe in warm weather. Instead, wear sandals and open shoes
- Change your socks everyday
- Keep your nails short, dry and clean as often as possible
- Use antifungal spray or powder if you are at a higher risk for developing toenail fungus
- Avoid picking or trimming the skin around your toenails, regardless if there is an infection present
- Air your shoes out between uses. If possible, do not wear the same pair of shoes two days in a row or for long periods of time
- Throw out old, worn out shoes and socks
- Do not share towels, bathmats or nail clippers with those known
- Avoid walking barefoot in wet, public places such as locker rooms, pools, gyms and public showers
- Avoid toenail polish during the healing process
- Choose a reputable nail salon for manicures and pedicures. Make sure the salon sterilizes utensils and equipment before grooming you. If you are unsure, bring your own utensils to the appointment
- Talk with a podiatrist about toenail fungus as soon as it develops
Talking to Your Doctor
Here are some questions you may or may not want to ask your doctor about toenail fungus:
- Which over-the-counter products will work best for my toenail fungus? Which products should I avoid?
- Do you think my infection is severe enough for prescription strength medication?
- What do you think caused my toenail fungus?
- How do I avoid spreading my infection to family members who live with me?
- Should I limit my normal activities during the healing process?
- What additional symptoms may begin to develop after treatment begins? If they do, how long should I wait to contact you?
- What should I do if I know someone who has a fungal infection?
- Which home remedies do you recommend?
- Do you have a brochure I can take home with me about toenail fungus?