Nail Fungus (Onychomycosis)

Fungusl infection of the toenails, or onychomycosis, is a common foot problem. A majority of sufferers don't seek treatment, perhaps not even recognizing the existence of a problem. One reason that people may ignore the infection is that it can be present for years without causing pain. Its prevalence rises sharply among older adults.

The disease, characterized by a change in a toenail color, is often considered nothing more than a mere blemish -- ugly and embarrassing. It is apparently assumed that since white markings or a darkening of the nail are minor occurrences, the change represents something minor as well, even when the blemish spreads.

In many cases, however, that change in color is the start of an aggravating disease that ultimately could take many months or years to control. It is an infection underneath the surface of the nail, which can also penetrate the nail. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in or around the nail plate.

What is Nail Fungus?

Onychomycosis is an infection of the bed and plate underlying the surface of the nail caused by various types of fungi commonly found in the environment. Fungi are parasitic plant organisms, such as molds and mildew, that lack chlorophyll and therefore do not require sunlight for growth. A group of fungi called dermatophytes easily attack the nail, thriving on keratin which is the nail's protein substance.

When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate. The infection is capable of spreading to other toenails, the skin, or even fingernails.

Other contributory factors may be a history of athlete's foot, improper cleansing, anxiety and excessive perspiration.


Because fungi are everywhere (including the skin) they can be present months before signs of infection appear. By following certain precautions, including proper hygiene and regular inspection of the feet and toes, chances of the problem occurring can be significantly reduced.

Clean and dry feet resist disease. A strict regimen of washing the feet with soap and water is the best way to prevent an infection. Shoes and socks should be changed daily.

It is very unlikely that a few exposures to an unclean environment will cause a fungal infection. Walking barefoot once or twice in a public shower will not generally spread the infection. Similarly, it is also unlikely that a single visit to a pedicurist will cause the infection. Lengthy exposure to a contaminated environment is often required in order to contract the fungal infection although individuals may be more susceptible to fungal infections than others.

Socks made of high percentage of merino wool are best. Synthetic fibers (such as acrylic, polyester or nylon), or cotton socks tend to create a moist environment that is the perfect breeding ground for toenail fungus.

Artificial Nails and Polish

Moisture collecting underneath the surface of the toenail would ordinarily evaporate, passing through the porous structure of the nail. The presence of an artificial nail or polish impedes evaporation.


Depending on the nature and severity of your infection, treatment may vary. Most over-the-counter treatments are minimally effective at best, and none of them have produce a permanent treatment. The main reason for these poor results is that the fungal infection resides deep within the nail or nail bed, and the topical medications have great difficulty in penetrating to this depth. A fungus may work its way through the entire nail, penetrating both the nail plate and the nail bed.

Podiatric Medical Care

We can diagnose a fungal infection, culture the nail if necessary, and form a suitable treatment plan. The most effective method of treating toenail fungus is with the use of a laser.

The two most common oral medications are Lamisil and Sporonox. These medications are very similar in most respects, and are about 60% effective. The medication is taken daily for three months. A total of approximately nine months is required to see new healthy nail growth.

A topical medication is Formula-3. This medication is generally less effective than the oral medications, and is best used with a limited fungal infection. Formula-3 needs to be applied twice per day for approximately six months.

In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed. If there is no response to other treatment methods, permanent removal of a chronically painful nail may become necessary.

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All information on this site © 2011 Joshua Kaye, DPM.

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