Toenail Fungus: causes, symptoms and treatment

Updated 4/16/2024
Nail Fungus is treated painlessly with a special laser
Nail Fungus is treated painlessly with a special laser.

What's Toenail Fungus?

Fungal infections of the nail plate (also known as onychomycosis) are the most common nail disease.


Various types of fungi are present everywhere in the environment, and most are harmless until they penetrate the skin.


A fungus can invade through minor cuts or after injury. Repeated irritation to the toes may cause the nail to separate from the bed, making the toes vulnerable.

What are the symptoms of toenail fungus?

The first sign of potential fungal nail infection is when the nail becomes thickened and turns black, yellow, or green in color. After that stage, the nail often becomes crumbly, with pieces breaking off from the toe.


Through time, the skin underneath and around the nail becomes inflamed. You may also notice white or yellow patches on the nail bed, scaly skin next to the nail, and an unpleasant smell. It may be painful due to the thickness of the nail and from the nail plate lifting off the nail bed.


What causes toenail fungal infections?

As we age, blood circulation slows and worsens. Your nails also grow more slowly and thicken, which increases your risk of infection.


Other risk factors include:

  • Excessive perspiration

  • A humid environment

  • Poorly ventilated socks and shoes

  • Going barefoot in swimming pools, gyms, and locker rooms

  • Athlete’s foot

  • Diabetes 

  • Sex (nail fungus tends to affect men more often than women)


Toenail fungus is especially dangerous for diabetics. Diabetics typically can have reduced blood circulation and nerve function in their feet. So, any relatively minor foot condition, including a nail fungal infestation, may lead to more serious complications for diabetic patients.


    What are fungal toenail treatment options?

    At University Foot & Ankle Institute, our podiatric experts choose the least-invasive treatment option whenever possible. In addition, when toenail fungus is caught early, it’s also generally easier to treat.


    How to Treat Toenail Fungus

    Topical treatments

    The first line of defense is typically topical medication. This can be administered as a cream, gel, or nail polish. We can write you a prescription, but some topical toenail anti-fungal agents can be purchased over the counter.


    Oral medication

    Oral antifungal pills may be used for moderate-to-severe or hard-to-treat fungal nail infections. These medicines have shown the most success at approximately 75% clinical cure. However, oral medication may cause possible drug interactions, allergies, and/or systemic effects for some patients.


    Another drawback of ointments and oral remedies for toenail fungus is the extended duration of treatment. Toenails grow slowly. The nail on a big toe can take well over a year to completely replace itself. So the traditional remedies must be administered for a correspondingly lengthy time period.


    During your consultation, we’ll review your medical history to ensure oral antifungals are safe for you.


    Nail Removal

    For severe nail infections, your treatment plan may include removing the infected nail. Performed with a numbing injection, this procedure loosens the skin around the nail and separates the nail from the skin. If only part of the nail is diseased, we’ll only remove the diseased part.


    PinPointe™ FootLaser®  treatment

    The new advent of fungal nail laser treatment has changed the landscape of nail fungus treatment.


    Pinpointe laser treatment effectively resolves underlying fungal infections while preserving the delicate surrounding skin. The mid-infrared laser wavelength penetrates the affected nail and eliminates the destructive fungus at the root of the infection. Clear nail growth will appear over 6 to 12 months as the new nail grows.


    The PinPointe system is painless. Patients report a mild, warming sensation as the laser treats the nail. It’s so accurately targeted that there’s no adverse effect on the tissue surrounding the nail. Unlike oral antifungal medications, which can have side effects and require a long course of treatment, the PinPointe laser treatment poses no systemic side effects and offers a fast procedure time.


    This FDA-approved treatment takes approximately 15 minutes for both feet. There is no downtime following the treatment and patients can immediately return to normal activity. Laser treatment takes one visit, though others may require follow-up treatments depending on the severity of the infection. 


    Studies report a 80% cure rate after one treatment. Patients who weren’t fully cured after the first treatment, experience full resolution with a second treatment. We have found that laser therapy is a very safe and effective method of treating onychomycosis.


    In addition to applying heat-based laser treatments, our physicians apply nail lacquer for optimal results.


    If your fungal infection doesn’t respond to at-home treatments, consult our foot health experts. There are actually multiple infections that can potentially affect your nails and letting them go untreated can lead to more severe problems in the future.


    How to prevent toenail fungus

    Here are effective strategies to help prevent toenail fungus:


    • Keep your feet clean and dry them thoroughly after showering, especially between the toes.
    • Change your socks regularly and use those that wick the moisture away from your feet. Socks with merino wool, bamboo socks
    • Avoid using shoes with plastic, rubber, or certain artificial leathers that do not have “pores” which allow the moisture to evaporate into the environment.
    • Alternate between two pairs of shoes. Wear one pair while the other pair has a chance to “air out.”
    • Once you get home, take off your shoes and socks and let your feet expose themselves to air and light. If your feet continue to stay damp, consider using antiperspirant.
    • Don't walk barefoot in public places to avoid direct contact with surfaces that might be contaminated with fungus.
    • Keep your toenails trimmed. Trim them straight across and avoid cutting them too short. This can prevent fungi from finding easy entry points.
    • Avoid sharing footwear and nail tools.


    Other types of nail infections

    Paronychia (bacterial or yeast infection) 


    Paronychia occurs when the skin around your fingernails and/or toenails becomes infected. This type of infection is usually caused by bacteria, Candida (yeast), or a combination of the two.


    Acute paronychia comes on quickly and is often the result of damage to the skin (from biting the skin around the nail, hangnails, or other physical trauma). Chronic paronychia generally comes on slowly, lasts for weeks, and often comes back.


    Blisters or abscesses may need to be lanced and drained by a medical professional to speed healing. We may prescribe antibiotics or antifungal medication to resolve the infection. In severe cases, you may need surgery to remove part of your nail. 


    Green nail syndrome

    Green nail syndrome (GNS), also known as chloronychia, is an infection in the nail that leads to green-black discoloration of the nail bed. The nail is usually not painful, but the skin around the nail may be tender, swollen, or red.


    GNS can occur when there is an overgrowth of the Pseudomonas bacteria which can develop when the nail is kept in a damp and cramped environment — for example, when wearing snug athletic shoes and exercising for extended periods.


    Treatment for GNS includes topical antibiotics, cutting the detached portion of the nail, keeping nails dry, and avoiding trauma to the nail.


    University Foot and Ankle Institute, the Best Choice for Onychomycosis Treatment

    Our podiatrists take a cutting-edge approach to your nail problems. Whether the toenail fungus treatment is as simple as an over-the-counter drug or taking advantage of laser technology, we care about your feet.


    You can be assured that you are being truly cared for by University Foot and Ankle Institute, with decades of experience and state-of-the-art techniques. Our nationally recognized foot and ankle specialists specialize in an array of conditions, including bunions, hammertoe, plantar fasciitis (heel pain), neuromas, and ankle sprains.


    To schedule a consultation or for general inquiries, please call (877) 736-6001 or make an appointment online now.


    University Foot & Ankle Institute podiatry clinics are conveniently located throughout Southern California and the Los Angeles area, as diabetic foot doctors near me are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, El Segundo, Santa Barbara, Westlake Village, and Valencia California, to name a few.




















    Frequently Asked Questions about Toenail Fungus

    How effective is laser treatment compared to taking meds to kill the toenail fungus? And which helps prevent re-occurrences better?

    Firstly, neither method guarantees that they won’t get infected again. If this is something a person is susceptible to, the odds are higher that it could come back no matter what they do. Both methods work very well to clear the toenail fungus.


    The downside to oral meds is the pills can upset the liver in some cases and have side effects for some people. The laser does not have any such side effects. Certainly, if you have liver issues, your doctor thinks the oral meds would not be best for you, or if you tried the oral meds and it came back, you might be best-trying laser treatment.


    How effective are laser devices for nail fungus treatment?

    Clinical studies reported a success rate of 83.7% among the patient population who had infections that affected at least two-thirds of the nail.


    How effective are topical antifungal creams in the treatment of onychomycosis? 

    Topical antifungal creams can be effective in treating mild to moderate cases of onychomycosis


    However, their effectiveness can be limited by several factors:


    • Infection severity
    • Nail thickness
    • Treatment duration
    • Reinfection rate


    How long does it take for the new nail to grow following a laser treatment session? 

    Because the nail grows slowly, it can take approximately 6-12 months for the new nail to replace the old infected nail.


    Is laser treatment for toenail fungus covered by insurance? 

    In many cases, laser treatment for toenail fungus is considered a cosmetic procedure, which means it might not be covered by insurance. This is because toenail fungus, while unsightly and potentially uncomfortable, is often viewed as a cosmetic issue rather than a medically necessary condition.


    However, certain healthcare insurance plans might provide coverage for the treatment, particularly in cases where other antifungal therapies have not yielded effective results.


    What's a mycotic nail?

    "Mycotic nail" is a term commonly used to describe a known as mycosis of the nail, or nail fungus. It's a more clinical or medical term for what is widely known as a fungal nail infection.





    Gupta A.K., Simpson F. Newly approved laser systems for onychomycosis. J. Am. Podiatr. Med. Assoc. 2012;102:428–430. doi: 10.7547/1020428. [PubMed

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      Dr. Justin Franson, DPM, University Foot and Ankle Institute, Foot and Ankle Surgeon

      Dr. Justin Franson, DPM, is a Board Certified Podiatric Foot and Ankle Specialist and Diplomate of the American Board of Podiatric Surgery. He attended the School College of Podiatric Medicine in Chicago, graduating in 2001. Dr. Franson then accepted a three-year residency program at the Greater Los Angeles VA and UCLA County Hospital. 


      Dr. Franson specializes in several areas including total ankle replacement and sports medicine. Treating athletes and weekend warriors like himself brings him a lot of joy. Dr. Franson keeps active with running marathons, triathlons, hiking, basketball, and golf.

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