Fungal infections of the toenails, known medically as onychomycosis, are quite common, affecting up to 20% of the population. These infections can occur in people of all ages and genders and are notoriously difficult to treat once they take hold. Dr. Christine Wilson, a foot and ankle specialist, explains the causes of toenail fungal infections, various treatment options, and steps you can take to prevent them.
How Does Toenail Fungus Begin?
Damaged, injured, or loosened toenails provide an ideal entry point for fungi. “These microscopic organisms are ubiquitous, thriving on both indoor and outdoor surfaces, always searching for a new habitat to colonize and reproduce,” explains Dr. Wilson. “Feet, being a warm, moist, and often enclosed part of the body, create the perfect environment for fungi.”
Toenail damage can result from repetitive friction, such as in running, or from injuries. Regardless of how the damage occurs, it opens a pathway for fungi to infiltrate under and between the nail layers. Over time, fungi can even invade the nail matrix, the cells responsible for nail growth.
Additional risk factors for developing toenail fungus include:
- Wearing tight shoes
- Walking barefoot in moist areas like pools, saunas, and public showers
- Poor circulation in the legs
- A weakened immune system
- Other skin conditions, such as psoriasis
- Medical conditions like diabetes and cancer
Symptoms of Toenail Fungus
The initial sign of a fungal toenail infection is often a small white, yellow, or brown spot beneath the nail tip. As the fungus grows deeper, the nail may thicken, become brittle, crumble, and discolor. The infection can eventually spread to adjacent nails.
“While these symptoms may suggest a fungal infection, they are not conclusive,” Dr. Milliman notes. “A sample of the affected nail needs to be examined under a microscope to confirm the presence and type of fungi. This diagnosis helps in determining the appropriate treatment, if necessary.”
For many individuals, toenail fungus is mainly a cosmetic issue. However, you should seek medical advice if any of the following conditions accompany the nail symptoms:
- You have diabetes, an immune disorder, or poor leg circulation
- There is bleeding, swelling, or pain around the affected nail(s)
- You experience difficulty walking
Treatment Options for Toenail Fungus
“Patients often ask if their immune system can clear the infection on its own,” says Dr. Wilson. “I tell them it’s possible but unlikely. The immune system attempts to fight the infection but is often ineffective because it is dealing with other issues,” she adds.
- Oral Medications.
- Topical Treatments.
- Toenail Removal: This is usually considered a last resort.
- Home Remedies: Though largely anecdotal, some home remedies have helped manage toenail fungus for certain individuals.
“There are no guarantees, however,” says Dr. Wilson. “These treatments work for some but not others, and there is no harm in trying them.
As with many conditions, the earlier the treatment starts, the higher the likelihood of success. Treatment options include.
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