woman walking in sand
February 25, 2015 | by Sarah Burns DPM, FACFAS
  • If your toes need some TLC, take steps now to improve the look and health of your bare toes and feet.

    If you step out of your rain boots and look down at your toes, are your feet sandal-ready? Or do you notice some yellowing, thickened toenails that need some attention? If you are noticing nail changes, toenail fungus may be an issue. Toenail fungal infections affect approximateyl 12 percent of people in the United States each year, according to the American Academy of Dermatologists.

    What is toenail fungus?

    Toenail fungus, also known as onychomycosis, can appear as yellow discoloration of the nail, thickening of the nail, and lifting of the nail from the underlying skin of the nail bed. It is often a painless condition initially, which means that it can go for a while without being noticed. A fungal infection of the skin around the toes is known as athlete's foot, and has different treatment recommendations.

    There are other causes of nail discoloration and changes; a visual inspection and possible nail culture may be needed to rule out other nail conditions.

    Toenail fungus is contagious

    Toenail fungus is contagious, you can contract it by walking barefoot in public spaces, especially in public showers and pools. Fungus loves warm, moist environments -- even if it's your own home. If one person in a household has toenail fungus, it can be spread through shared bathrooms and other living spaces.

    Tips to prevent toenail fungus

    • Clean bathtubs and tiled floors with antiseptic. Antiseptic kills fungus and prevents its spred.
    • Replace old or soiled shoes. If this isn't possible, spray an anti-microbial spray inside of the shoe and allow it to dry for 24 hours.
    • Wear flip-flops in public showers.

    Treatment for Toenail Fungus

    Toenail fungus can be very difficult to treat and it can take a long time to see complete resolution. Treatment options range from topicals to pills to laser devices. There is little difference in the treatment of toenail fungus for children and adults. For children, it can be difficult to keep up with daily topical treatment regimens.

    Where to Start

    1. Over-the-counter prescriptions.You can start with some over-the-counter options. I do not recommend soaking your nails in solutions to any of my patients, as this has not been proven to effectively kill nail fungus. I do recommend an over-the-counter topical called tea tree oil. Apply 100% tea tree oil twice daily for six months to see improvement in fungal toenail infection, appearance and symptoms. Most topical treatments will take at least six months to see improvement because an uninfected new nail must come in. Topical application of 100% tea tree oil solution, twice daily for six months, can cure fungal toenail infection in about 18% of people who try it. It can also improve nail appearance and symptoms in about 56% of patients after three months and 60% of patients after six months of treatment. Any topical treatment will take six months or more to see improvement, because an uninfected new nail has to grow in.
    2. Prescription-strength topicals and oral anti-fungal medications. As with any medication, these can have some negative side effects and we do monitor liver function while taking the oral medication. The oral medication has the highest cure rate at 80%, but this is frequently an option left for resistant cases of toenail fungus.

    If Additional Treatment is Needed

    1. Laser Treatment. A newer medical technology is the use of laser treatment for toenail fungus. The results are preliminary, so it's hard to estimate how effective the treatment is (25% to 100% cure rates, depending on what study you look at). It is a fairly painless procedure that can result in quicker clearing of the toenail fungus. The downsides include not being covered by insurance, along with the uncertain results. We do not provide laser treatment in our office at this time, although we may offer it in the future if more studies support its effectiveness.
    2. See a podiatrist. A podiatrist can confirm the diagnosis of toenail fungus and start you on a treatment regimen. If you try over-the-counter treatments, check for improvement in the nail after about two months. If you don’t see any improvement, you may want to make an appointment to be evaluated at that time.