Reference Library

Fungal toenails

Toenail fungus or onychomytosis is an infection underneath the surface of the nail caused by fungus. These organisms take hold, the nail often become darker in color and can smell foul. Debris may collect beneath the nail plate, and white marks often appear on the nail plate. An infection is capable of spreading to other nail plates, the skin, or even the fingernails. The resulting thicker nails are difficult to trim and make walking difficult when wearing shoes. Onychomytosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.


Because it is difficult to avoid contact with microscopic organisms like fungi, toenails are especially vulnerable around damp areas such as swimming pools, showers, and locker rooms. Those who suffer from chronic diseases such as diabetes, circulatory problems, and immune deficiency conditions are especially prone to fungal nails.


Toenail fungus is often ignored because the infection can be present for years without causing pain. The disease is characterized by a progressive change in the nail's color and quality. You should visit a podiatrist if you notice any discoloration, thickening, or deformity of your toenails. The earlier you seek professional treatment, the greater your chance of getting your nails to clear. 


Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal toenails. Clean, dry feet resist disease. Here are some tips to prevent fungal toenails:

  • Wash your feet with soap and water, remembering to dry thoroughly.
  • Change socks, shoes, and hosing more than once daily.
  • Wear shower shoes, when appropriate, in public areas.
  • Clip toenails straight across so that the toenail does not extend past the tip of the toe.
  • Wear shoes that fit well and are made of material that breathes.
  • Disinfect instruments used to cut toenails.
  • Disinfect home pedicure tools.
  • Don’t apply polish to nails suspected to be infected.
  • Avoid wearing excessively tight hosiery to decrease moisture.
  • Wear socks made of synthetic material. They wick moisture from the feet faster than cotton and wool socks do. 


A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off followed by an application of an over-the-counter, liquid anti-fungal agent. Even the best over-the-counter treatments may not prevent a fungal infection from coming back. 

Your podiatrist can detect an infection early and culture the nail to form a suitable plan, including topical treatment or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. An anti-fungal approved by the U.S. Food and Drug Administration can also be an affective treatment. In some cases, surgical treatment may be required. Temporary removal of the affected nail can be performed to permit direct application of a topical anti-fungal. Permanent removal of a chronically painful nail that has not responded to any other treatment permits the infection to be cured and prevents the return of a painful fungal toenail. 

New technical advances, in combination with simple preventive measures, mean that the treatment of this lightly regarded health problem can often be successful.

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