While toenail fungus is not the most glorious topic for us to cover, it is such an important one. Toenail Fungus, otherwise known as onychomycosis, is more common than you might realize and gets even more common as with aging. While nail fungus can appear under fingernails, it is more common to appear underneath the toenails. 

What is toenail fungus and how does it occur?

It is a condition in which a type of fungi appears underneath the toenail and feeds off of the keratin that lives in that area. Keratin is a protein that makes up your skin, hair and nails, and this protein fuels the fungi that find their way under your nails. The most common fungi in this situation are dermatophytes which is a group of fungi that require keratin to grow. They are fungal microorganisms that are microscopic, meaning they cannot be seen with the human eye. These fungi can be spread by close contact with other people, by animals, or even by soil. You might have gotten infected by direct contact with another person who had it, or by touching an infected surface. 

Here are just a few common ways that you can get toenail fungus:

• Walking around wet surfaces
• Walking near a swimming pool
• Walking barefoot in a public locker room or shower
• Walking barefoot in a public area like a waterpark

Diagnosis and Treatment 

Toenail fungus is often yellow or white and discolors your nail. Your nail might be thick, and begin to crumble depending on how long you have had untreated toenail fungus. Even if toenail fungus is not causing any pain or discomfort, you should treat it. Left untreated it can cause further issues, and even treated toenail fungus can come back. For diagnosing purposes, common symptoms may include:

• A rancid smell
• Brittle, crumbling nails
• White or yellow discoloration or spots
• Thickened toenails
• Distorted toenail shape

If your doctor needs to diagnose your condition, they may take a nail clipping or some of the debris so they can send it to a lab to be examined and identified. This may be necessary if your doctor thinks you might have psoriasis instead, which can often look and act just like toenail fungus. Psoriasis is a skin disease that causes red, itchy patches.

There are three stages or types of toenail fungus:

• Benign toenail fungus: This is the beginning stages of toenail fungus and is the mildest case. These cases can often be treated with over-the-counter creams or medication.
• Mid-level toenail fungus: This case of toenail fungus has progressed a little and is causing pain and discomfort. This is when you should talk with your doctor about it.
• Dangerous toenail fungus: This fungus has spread and is causing pain and also causing your nails to break and brittle. Depending on past medical history, like if you have diabetes, dangerous cases can lead to surgery. 

For treatment options, the first step (for benign to mid-level fungus) is usually self-care and over-the-counter options, as long as your case is not too severe. Your doctor might recommend these medications:

• Oral antifungal drugs: This form of medication is taken orally and works to clear the infection and help the nail regrow, free of infection. These medications are usually taken for weeks, but results may not show themselves until the nail completely grows back
• Medicated nail cream: Also known as an antifungal cream, medicated nail cream is rubbed into the affected nails after they are soaked in water. Oftentimes, doctors will suggest that you thin the nails before this cream is used on them
• Medicated nail polish: Ciclopirox (Penlac) is a type of medicated nail polish that is used on infected nails and surrounding skin. This medication can be used up to an entire year and is often used daily for seven days a week.

If these medications don’t work, the next treatment option might be surgery. This may be a temporary nail removal or a permanent nail removal, based on how aggressive the fungus is. Surgery is often suggested if the pain has begun and is increasing. While surgery isn’t super common, it can be necessary if your fungus refuses to go away, or if it returns again and again after being eliminated. Your doctor may need to remove the entire nail or only the infected piece of it. Your nail should slowly come back, but it may take up to 18 months to do so. 

Risks

Leaving toenail fungus untreated, or even while you work on treating it, toenail fungus can come with a lot of risks. Here are some of the major and most common risks related to this condition:

• Pain: Foot pain caused by toenail fungus is a big risk, and it can even make it difficult to walk or go about your daily life.
• Spreading: If you leave it untreated, it can easily spread to other toenails or possibly even your fingernails. You can even spread it to the people around you.
• Infection: Especially for those who have diabetes or other unrelated health issues, infections are a huge deal. Bacteria can potentially make its way into the skin and can cause other kinds of infections such as cellulitis.
• Nail loss: Whether due to having to undergo surgery or the nail cracking off, toenail fungus can lead to the loss of the entire nail. Nails take a long time to grow back, and the empty nail bed will often be tender and fragile to the touch. While this solution isn’t super common, it can happen and is not the most ideal for patients.

Feel free to contact us if you need help resolving your toenail fungus infection. Along with providing care for everything related to feet, we also offer comprehensive orthopedic care.