How to Treat Fungal Toenails

Fungal toenail infections, medically known as onychomycosis, are a common condition that can cause the nails to become discoloured, thickened, and brittle. Caused by various fungal organisms, this condition not only affects the appearance of the nails but can also lead to discomfort and pain. This blog post by Manly Cove Podiatry aims to demystify fungal toenail infections, providing readers with a comprehensive guide on how to identify, treat, and prevent them. 

What Causes Fungal Toenail Infections?

Fungal toenail infections are primarily caused by a group of fungi called dermatophytes, though yeasts and moulds can also be responsible. These organisms thrive in warm, moist environments, making toenails particularly susceptible. Factors that increase the risk of infection include wearing tight-fitting shoes, frequent exposure to damp communal areas, such as gyms and swimming pools, and having a history of athlete’s foot.

Identifying Fungal Toenail Infections

The most common signs of a fungal toenail infection include nail discolouration (nails may turn white, black, yellow, or green), thickening of the nail, brittleness, and separation of the nail from the nail bed. In some cases, the infection can cause pain, especially when wearing shoes or walking.

Risk Factors for Fungal Toenail Infections

Several factors can increase your risk of developing a fungal toenail infection, including age (older individuals are more susceptible due to decreased blood circulation and slower nail growth), a weakened immune system, diabetes, and a history of athlete’s foot. Additionally, genetic predisposition can play a role in one’s susceptibility to fungal infections.

How Fungal Toenail Infections Affect Your Nails and Health

Fungal toenail infections can lead to significant changes in the appearance and structure of the nail, potentially causing pain and discomfort. If left untreated, the infection can spread to other toenails, the skin on the feet, or even the fingernails. Moreover, for individuals with diabetes or a weakened immune system, fungal toenail infections can lead to more serious complications, including secondary bacterial infections and ulcers.

The Psychological Impact of Fungal Toenail Infections

Beyond the physical symptoms, fungal toenail infections can also have a psychological impact, affecting individuals’ self-esteem and confidence. The appearance of the infected nails may lead to embarrassment and reluctance to participate in activities that require showing the feet, such as swimming or wearing open-toed shoes.

Treatment Options

The approach to treating fungal toenails is multi-faceted, involving both medication and sometimes physical removal of the affected nail. The choice of treatment depends on the severity of the infection and the patient’s overall health.

Over-the-Counter (OTC) Treatments

For mild to moderate fungal toenail infections, OTC antifungal creams, ointments, and nail lacquers can be effective. These treatments require diligent application, often over many months, as the infection resides under the nail, which is difficult for topical treatments to penetrate. Medicated nail polishes, for example, need to be applied daily and can take a year or more to clear the infection. It’s crucial for users to follow the application instructions carefully and consistently for these treatments to have a chance of success.

Prescription Treatments

When OTC treatments are not effective, or in cases of more severe infection, prescription medications may be necessary. Oral antifungal medications, like terbinafine or itraconazole, are typically prescribed for a course of 6 to 12 weeks. These medications can promote the growth of a new, uninfected nail, but they come with a risk of side effects, including liver damage, so patients must be monitored through blood tests. Prescription topical treatments can also be more potent and effective than their OTC counterparts, with some capable of penetrating the nail to reach the fungus underneath.

Advanced Treatments

For persistent infections or those that significantly affect the nail’s structure, advanced treatments may be recommended. Laser treatment has emerged as a promising option, with studies showing it can effectively reduce fungal infection with minimal side effects. The procedure involves using laser light to heat and destroy the fungus while preserving the surrounding nail and skin. In severe cases where the nail is painful or the infection is resistant to other forms of treatment, removing the nail may provide relief and allow for the direct application of antifungal treatments to the nail bed.

Prevention and Management

Preventing and managing fungal toenail infections effectively hinges on a few key practices focused on maintaining optimal foot hygiene and exercising caution in environments conducive to fungal growth:

  • Daily Foot Hygiene:
      • Washing: Clean your feet with soap and water every day.
      • Drying: Thoroughly dry your feet, paying special attention to the spaces between your toes.
      • Impact: These practices significantly lower the risk of fungal infections.
  • Footwear Considerations:
      • Material: Opt for shoes made from breathable materials.
      • Fit: Ensure shoes fit well but are not tight, allowing air circulation.
      • Change Frequency: Regularly changing shoes can prevent the buildup of moisture.
      • Socks: Use moisture-wicking socks to keep feet drier.
  • Protective Footwear in Communal Areas:
      • Usage: Wear sandals or shower shoes in public showers, locker rooms, and around pools.
      • Purpose: This prevents direct contact with surfaces where the fungus may be present.
  • Nail Care:
    • Trimming: Cut nails straight across, avoiding cutting too close to the skin.
    • Filing: Gently file down thickened areas of the nail.
    • Tool Sharing: Avoid sharing nail care tools to prevent spreading the fungus.

When to See a Doctor

Recognising when to seek medical intervention is critical for the successful treatment of fungal toenail infections, particularly for infections that are severe or do not improve with initial treatment efforts:

  • Signs of Severe Infection:
      • Symptoms: Look out for significant discolouration, thickening, or deformation of the toenail.
      • Action: These symptoms necessitate consulting a healthcare professional as they may indicate a severe infection requiring specialised treatment.
  • Professional Diagnosis and Treatment:
      • Diagnostic Process: A doctor may take a nail sample to identify the specific fungus causing the infection.
      • Treatment Options: Based on the diagnosis, prescription-strength medications, either oral or topical, may be recommended.
  • Special Considerations:
    • Underlying Conditions: Individuals with diabetes, peripheral vascular disease, or other conditions affecting foot blood flow should seek immediate medical advice upon noticing signs of a fungal infection.
    • Risk: These conditions heighten the risk of serious complications, such as ulcers or more severe infections, which could endanger the limb.


Fungal toenail infections pose a common yet challenging condition, impacting both nail appearance and overall quality of life through discomfort and pain. Successfully managing and overcoming these infections hinges on understanding their nature, utilising a range of treatment options—from over-the-counter remedies and prescribed medications to advanced procedures—and implementing effective preventive measures. Emphasising patience and consistency in treatment, alongside preventive practices like maintaining foot hygiene, selecting proper footwear, and protecting feet in communal spaces, can markedly diminish recurrence risks and prevent the condition from escalating.