Q: My primary care doctor tells me that a fungal infection causing my big toenail to get thick and brittle is “purely a cosmetic issue.” But it hurts to wear shoes sometimes, and I have a hard time trimming that nail, so I get an occasional ingrown toenail. Is there anything I can do for this toenail fungus? What are the causes and best cures?
A: In the scheme of things, it’s true that toenail fungus is a minor health issue. But it’s clearly more than a cosmetic issue if your toenails have become brittle and hard to cut, if it hurts to wear shoes, and if you’ve got ingrown toenails. Unfortunately, a toenail fungus won’t just go away by itself, and if you don’t treat it, there is a very good chance it will get worse.
Who Gets Toenail Fungus?
The Cleveland Clinic estimates that onychomycosis, or an infection under the surface of the nail caused by a fungus, affects nearly one in every five people. It has a tendency to run in families, it’s contagious, and it’s a serious (and common) condition for people who have diabetes.
In addition to inherited tendencies, the fungus may develop from damage to the nail, tight-fitting shoes, and going barefoot in public places with damp surfaces, such as swimming pools and locker rooms. In fact, it’s the same fungus as the one that causes athlete’s foot between your toes and on the skin of your feet, which you can also get by walking barefoot on damp surfaces.
The first signs of infection will become obvious when your nail or nails start to get yellowish in color, thick, deformed, crumbly, or dull and streaky. Your feet may also smell bad. But before you spend time and effort trying to treat yourself with home remedies, be forewarned: this is a stubborn fungus that’s hard to cure. In addition, the Podiatry Network warns that “most podiatrists have treated at least a handful of patients that have used home remedies that have led to skin burns or irritation. We recommend that you seek professional treatment.” To that I would add: the sooner you get help for toenail fungus, the greater your chance of clearing the infection.
Toenail Treatments
When you see a podiatrist, a course of action will likely include removing the infected debris under the nail, trimming your toenails, and treating ingrown toenails if you have them. Your podiatrist may also prescribe a topical medication, but if your nail is very thick, topical medications aren’t easily absorbed. They may also cause side effects such as itching, swelling, and burning, so use caution with this prescription.
If the infection is deep, your podiatrist may also suggest simply removing all or part of the nail. It will grow back in about a year, while you apply cream to completely clear the nail bed of the fungus.
I did mention diabetes above, but let me reiterate this point. If you do have this disease, don’t waste any time trying to clear up a nail fungus on your own. See a podiatrist right away before it gets any worse or leads to other problems with your feet.
Fungus Follow-up
Once you are fungus-free, prevention is the name of the game so you don’t get re-infected. Here’s what you need to do:
- Wash your feet with soap and water every day, and dry them thoroughly.
- Wear shower shoes in public areas where you might be tempted to go barefoot — such as near swimming pools, bathrooms, and locker rooms.
- Wear socks made of synthetic fiber, not cotton or wool, to wick moisture away from your feet.
- Change your socks every day, or more frequently if you have sweaty feet.
- Wear shoes that fit well and are made of materials that breathe.
- Trim your toenails straight across.
- Be aware that most nail polish is damaging to toenails.
Toenail fungus can start off as a cosmetic problem if your notice your toenails becoming discolored or thick. But once your toenails become deformed or cause pain when you walk, it’s a much more stubborn problem. Call me (973.256.2166) if you’ve got toenail fungus so I can help you get back on your feet.
– Dr. Shier