Toenail Fungus 101: Causes, Symptoms, and the Best Ways to Treat It
Jun 18, 2025
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Toenail fungus, medically known as onychomycosis, is a common, often-persistent fungal infection that starts as a white or yellow spot under the nail tip and can spread deeper, causing discoloration, thickening, and crumbling. Fungal nail infection can lead to pain, discomfort, and serious complications, especially for individuals with certain health conditions.
Yet despite its prevalence, toenail fungus is often overlooked, and many people will delay treatment, hoping it resolves on its own. However, this condition rarely disappears without intervention and tends to worsen.
Read this comprehensive guide to toenail fungus, so you can better understand this stubborn infection and learn when to seek professional help from a podiatrist.
Toenail fungus is primarily caused by fungal organisms thriving in warm, moist environments. The most common are dermatophytes, fungi that also cause athlete's foot. Yeasts (like Candida) and molds can also cause infections. These microscopic organisms invade the nail through tiny cracks in the nail or surrounding skin.
Fungi are everywhere in the environment, and certain areas are hotbeds for their spread, like public pools, locker rooms, showers, tight or non-breathable footwear, and nails with trauma or injury. Certain factors increase susceptibility, including:
● Age
● Diabetes
● Poor circulation
● Athlete’s foot
● Weakened immune system
● Excessive sweating
Early signs of toenail fungus to look out for include:
● White or yellow spots under the nail tip.
● Thickening or crumbling nails
If untreated, the infection can progress, leading to the following advanced symptoms:
● Discoloration (brown, green, or black)
● Distorted nail shape
● Foul odor
● Nail separating from the nail bed (onycholysis)
Discoloration (brown, green, or blacDistorted nail shape Foul odor Nail separating from the nail bed (onycholysis
Also Read: Wound Healing and Diabetes: When to See a Diabetic Foot Specialist
Accurate diagnosis is crucial, since various other nail conditions can mimic toenail fungus. A foot specialist or dermatologist will typically begin with a thorough visual examination of your nails and feet, assessing appearance and inquiring about symptoms and medical history.
A definitive diagnosis may require laboratory testing. Your doctor may take:
● Nail clippings: Examined under a microscope for fungal elements.
● Cultures: A sample culture to grow the specific fungus, aiding in medication selection. Lab testing is important because conditions like psoriasis, bacterial infections, or trauma can cause similar nail changes.
Treating toenail fungus often requires persistence and a multi-pronged approach. The best toenail fungus doctor near you will tailor a treatment plan that may include one or more of the following solutions:
These are often the first line of defense for mild to moderate infections. OTC products with clotrimazole, miconazole, or terbinafine are effective for very mild, superficial infections.
Stronger, prescription antifungal lacquers (e.g., ciclopirox, efinaconazole) are applied daily to penetrate the nail.
Topical treatments work best for superficial infections not affecting the nail matrix. They require consistent, long-term application over several months as the healthy nail grows out.
For more severe or persistent infections, oral medications are often necessary. Terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan) are commonly prescribed. These work systemically, reaching the fungus via the bloodstream.
Oral treatments typically last 6-12 weeks, with full effect seen after 6-12 months as the nail grows. Side effects can include liver problems, skin rashes, or GI issues. Your doctor will monitor you with blood tests.
Oral medications are considered when topical treatments fail, the infection is widespread, involves the nail matrix, or causes significant pain.
Nail fungus laser treatment is a newer, popular option for stubborn infections. Laser therapy uses focused light energy to penetrate and heat fungal organisms, destroying them. Laser therapy for nail fungus is a non-invasive procedure with minimal discomfort and no systemic side effects. Multiple treatment sessions are required, spaced weeks apart.
In very severe or painful cases, partial or full nail removal may be considered. Surgically removing part or all of the infected nail allows topical medications to reach the nail bed or alleviates pain.
The procedure is reserved for cases causing significant pain, highly resistant to other treatments, or severely damaged/disfigured nails. It's often followed by antifungal treatment to prevent recurrence.
Many turn to home remedies, but their effectiveness is often limited. Popular home remedies for toenail fungus include tea tree oil, vinegar soaks, and Vicks VapoRub. They may offer temporary relief or work for very superficial cases, but often fail to penetrate the nail.
If your infection is persistent, spreading, causing pain, or if you have underlying health conditions like diabetes, consult a podiatrist for toenail fungus. Delaying professional treatment can worsen the infection.
● Signs It’s Not Improving with OTC Options: If OTC treatments show no improvement after several weeks, or if the infection worsens, seek professional help.
● Recurrent Infections or Spreading Fungus: If the fungus keeps returning or spreading, a specialist can offer stronger treatments.
● Toenail Pain, Swelling, or Discharge: These indicate a more severe or secondary bacterial infection, requiring immediate medical attention.
● Underlying Health Conditions: If you have diabetes, compromised circulation, or a weakened immune system, any toenail issue warrants a prompt visit to a podiatrist.
Toenail fungus (onychomycosis) is a common, treatable condition that should not be ignored. Early recognition of toenail fungus symptoms and prompt treatment can improve outcomes and prevent spread. Fortunately, a variety of effective treatments are available, from topical and oral antifungal medications to advanced nail fungus laser treatment. Don't let myths or hesitation keep you from seeking help.
If you suspect you have a fungal nail infection, or if your current treatment isn't working, consult a podiatrist for toenail fungus.
Our foot specialists at Advanced Foot and Ankle Specialists in Elk Grove Village can provide a personalized diagnosis and treatment plan to help you regain healthy, clear nails. Request an appointment today.
Advanced Foot and Ankle Specialists has three additional locations in Elgin, Huntley, and Montclare - Chicago to better serve you.
