Toenail Fungus: causes, symptoms and treatment

Updated 8/30/2022
Nail Fungus is treated painlessly with a special laser
Nail Fungus is treated painlessly with a special laser.

What's Toenail Fungus?

Various types of fungi are present everywhere in the environment and most fungi 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 which makes the toes vulnerable.

Fungal infections of the nail plate, also known as onychomycosis and nail matrix, are the most common nail disease.

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 brittle, 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 secondary to the thickness of the nail and from the lifting of the nail plate off the nail bed.


What Causes Toenail Fungal Infections?

As we age, blood circulation is diminished, the fungus has had many years to grow, and nails grow slower and thicken, giving way to possible infection.  Nail fungus tends to affect men more often than women.

Other risk factors include:

  • Excessive perspiration

  • A humid environment

  • Poorly ventilated socks and shoes

  • Going barefoot in public pools, gyms, and shower rooms

  • Athlete’s foot

  • Diabetes 


    Toenail Fungus Treatment Options

    How to Treat Toenail Fungus


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



    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 medicine may cause possible drug interactions, allergy, and/or systemic effects for some patients.


    Nail Removal

    For severe nail infections, your doctor may recommend removing the infected nail during an office visit. Performed with a numbing injection, your doctor will loosen the skin around the nail and separate the nail from the skin by using a tool under the nail. If only part of the nail is diseased, only the diseased part is removed.


    Q-Clear™ laser treatment

    The new advent of a fungal nail laser has changed the treatment options.


    Q-clear™laser treatment effectively resolves underlying fungal infections while preserving delicate surrounding tissue. The mid-infrared laser wavelength penetrates the toenail and eliminates the destructive fungus at the root of the infection. Clear growth will begin to appear as the revitalized nail grows out.


    The treatment takes approximately 15 minutes for both feet and patients report a mild, warming sensation as the laser treats the nail. There is no downtime following the treatment and patients can immediately return to normal activity. Laser treatment takes one visit, with an occasional touch-up.


    There are reports of cure rates from 77% to 95% in the literature after one treatment with the laser. In many cases, patients who did not obtain a cure went on to 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 the heat-based laser treatments, our physicians apply nail lacquer for optimal results.


    Other types of nail infections


    Paronychia occurs when the skin around your fingernails and toenails becomes infected. This type of infection is usually caused by Bacteria or a type of yeast called Candida, 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 and lasts for weeks and often comes back.


    Home treatments are often very successful in treating mild cases. Soak the infected area in warm water several times per day and dry it thoroughly afterward. If the infection is more severe or isn't responding to home treatment, your doctor may prescribe an antibiotic.


    Blisters or abscesses might need to be drained of fluids to relieve pain and speed healing. This should be done by your doctor in order to avoid spreading the infection. 


    Chronic paronychia is more difficult to treat and home treatment isn’t likely to work. Your doctor will probably prescribe an antifungal medication and advise you to keep the area dry. 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. This can develop when the nail is kept in a damp and cramped environment — for example, 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 doctors take a cutting-edge approach to your nail problems. Whether the solution is as simple as an over-the-counter drug or taking advantage of laser technology, we care about your feet.




















    Frequently Asked Questions about Toenail Fungus

    Q: 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 the 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.


    • Foot and Ankle Surgeon at University Foot and Ankle Institute
      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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