Help my unsightly toes! Do my toenails have fungus?

Unsightly toenails and toenail fungus are some of the most common complaints that come into my office leading into the summer season and sandals weather. And this complaint is not limited to just women; many of my male patients are concerned about the look and condition of their toenails as well. While there are many different ads on TV and online that advertise quick remedies to completely eliminate nail fungus, there are some general facts about nail and foot fungus that I tell all my patients to help them avoid frustrations.

Things to know:

  • Fungus lives on our feet ALL THE TIME. It’s a natural part of life and does NOT mean you have poor foot hygiene. Fungus is an organism that is trying to survive like any other, and it just happens to really enjoy dark, damp and warm environments (much like the insides of our shoes and socks). This makes feet prone to harboring fungus. That said, just because you have gotten rid of foot or toenail fungus, does not mean it will never come back. Periodic treatment of your feet with antifungal creams will be necessary to keep the fungal load down
  • Topical antifungals are less effective than we would all like, but there is a good reason for that. The fungus actually lives under your toenails, using the nail itself as a barrier for protection from your attempts at treatment. One key technique in treatment using topical antifungals is the filing down of the top of the nail to create pores down to the nail bed. This allows the topical creams or lacquers to get down to where the fungus lives.
  • Laser treatment for toenail fungus involves emitting a concentrated beam of light that is specifically targeted at the infected area. The laser penetrates the toenail and directly impacts the fungus living underneath, without causing damage to the nail or surrounding skin. The heat from the laser kills the fungus by increasing the temperature to a level that disrupts its cellular structure and inhibits its ability to grow and reproduce. This treatment is considered a safe and effective method for eliminating toenail fungus, often requiring several sessions to completely eradicate the infection and allow a healthy nail to grow back.
  • Oral antifungals are much more effective than topical treatments, however these medications are hard on your liver. Your physician will need to order blood tests to evaluate your liver function before you start the medication and halfway through your treatment. The oral pill is taken daily for 3 months.
  • Nails take a long time to grow out! Toenails can take up to one full year before there is much noticeable difference in your nails appearance. Make sure your expectations are reasonable; don’t plan on the nails looking great after just 3 months of treatments.
  • Make sure your shoes fit. One of the common ways fungus gets under the nails is from the tips of the toes/toenails hitting the inside of the shoes when walking. This causes the nails to lift from the nail bed just enough for fungus to get under there.
  • Use foot sprays in your gym shoes/ hiking boots. Any shoes you wear that cause your feet to sweat will harbor more fungus. It is imperative to spray out these shoes and allow them to dry after each use.
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