Fungal Toenails (Onychomycosis)
This series of educational material is a broad overview of foot problems, and not as detailed as an actual podiatrist visit. I recommend you to see a podiatrist for professional evaluation of your foot and ankle problems. This is for educational purposes only.
This material is from my own experiences seeing patients. Other podiatrists may have different recommendations. Each examination has nuances and details too small to mention in this type of presentation.
Onychomycosis is the medical term for fungal toenails. Fungus gets into the nail and turns it yellow and/or brown. Over time the nails can get thick and crumbly. Sometimes a toenail will separate from the nail bed and fall off. In severe stages nails trap moisture underneath and become mushy with a bad odor.
Here you can see a mild-moderate case of nail fungus.
What is Onychomycosis (Fungal Toenails)?
Fungal toenails are caused by fungus getting into the nail. Once inside the nail fungus grows very slowly.
A lot of people ask “Where did the fungus come from? Will avoiding X or washing Y help get rid of it?” The fungal hotspots are nail salons and warm moist environments such as pools and locker room showers. Washing socks and shoes is a good idea for general hygiene but will not help your toenail fungus go away.
Here is my opinion. If you enjoy getting pedicures or taking showers at the gym/pool then keep doing it. Toenail fungus is mainly aesthetic and there is no way to know if you got it from the gym showers, nail salon, or anywhere in the entire world you travelled. Maybe you did get it at the salon or gym. So what? Don’t change your life because your toenail might get some yellow or brown color in it. In my experience the most common patients I see with toenail fungus are genetic (runs in the family), diabetics, elderly, overweight, and people who are generally unhealthy. A healthy young or middle-aged adult with nail fungus is rare and when I see it, presents as a mild form.
Outside of health and genetics a major cause of nail fungus is trauma. A healthy person’s nail gets cracked and fungus jumps in and starts to grow. Keep in mind trauma can also cause nails to change shape, and the discoloration and bad shape may not be fungus at all.
Causes
Symptoms
Toenail Discoloration: yellow, brown
Shape: the nail can become thick and crumbly
Toenails can loosen from the nail bed and periodically fall off.
Treatment
For best results combine topical (ointment or cream) and oral (pill) treatment. There is no reason not to.
Pill Treatment
The pill form of treatment is the most effective. The medication is called terbinafine. It is taken once a day for 90 days. There is a tiny risk of non-permanent liver dysfunction so your doctor may require a liver function test before giving you the medication and again 45 days into the medication. Terbinafine interacts with a lot of other medications so a lot of people are disqualified out for this reason.
If successful at the end of 90 days the first 1/3 of the nail will be clear. The nail will then continue to grow out clear over the next 9 months as an entire new nail grows in. If needed the medication can be extended 180 more days with continued liver function tests.