Toe infections sound scary, but they’re infections of the nails, most commonly caused by ingrown toenails. The toenail grows into the side of the toe, into the soft tissue there, and the skin begins to grow over it. It can get infected very quickly and is most commonly seen in big toes. This condition is painful, and an infection can be a serious problem.
A 2003 survey of diseases of the foot in 16 European countries found onychomycosis to be the most frequent fungal foot infection and estimates its prevalence at 27%. Prevalence was observed to increase with age. In Canada, the prevalence was estimated to be 6.48%. Onychomycosis affects approximately one-third of diabetics and is 56% more frequent in people suffering from psoriasis.
Recognize the signs. Before you can treat toenail fungus, you need to know what to look for. Nail fungus does not necessarily have consistent symptoms. The most common sign that you have nail fungus is tenderness or pain in the nail. Signs of a fungal infection include changes in your nail, such as color changes. The nail will usually get yellow or white streaks on the side of the nail. There is usually due to a buildup of debris under or around the nail, a crumbling and thickening of the outside edges of the nail, a loosening or lifting up of the nail, and nail brittleness.
Take oral medication. The most effective way to get rid of nail fungus is systemic treatment with oral prescription antifungals. Treatment with oral medications can take 2-3 months or longer. Oral antifungal prescription medications include Lamisil, which is usually prescribed with a dose of 250 mg a day for 12 weeks. Side effects can include rash, diarrhea, or liver enzyme abnormalities. This medication should not be used if you have liver or kidney issues.
If the diagnosis is uncertain, direct microscopy of a potassium hydroxide preparation of a skin scraping (known as a KOH test) can confirm the diagnosis of athlete's foot and help rule out other possible causes, such as candidiasis, pitted keratolysis, erythrasma, contact dermatitis, eczema, or psoriasis. Dermatophytes known to cause athlete's foot will demonstrate multiple septate branching hyphae on microscopy.
Following effective treatment, recurrence is common (10–50%). Nail fungus can be painful and cause permanent damage to nails. It may lead to other serious infections if the immune system is suppressed due to medication, diabetes or other conditions. The risk is most serious for people with diabetes and with immune systems weakened by leukemia or AIDS, or medication after organ transplant. Diabetics have vascular and nerve impairment, and are at risk of cellulitis, a potentially serious bacterial infection; any relatively minor injury to feet, including a nail fungal infection, can lead to more serious complications. Infection of the bone is another rare complication.
Starts at the ends of the nails and raises the nail up: This is called "distal subungual onychomycosis." It is the most common type of fungal infection of the nails in both adults and children. It is more common in the toes than the fingers, and the great toe is usually the first one to be affected. Risk factors include older age, swimming, athlete's foot, psoriasis, diabetes, family members with the infection, or a suppressed immune system. It usually starts as a discolored area at a corner of the big toe and slowly spreads toward the cuticle. Eventually, the toenails will become thickened and flaky. Sometimes, you can also see signs of athlete's foot in between the toes or skin peeling on the sole of the foot. It is often accompanied by onycholysis. The most common cause is T. rubrum.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
Snakeroot extract is an antifungal made from plants in the sunflower family. A 2008 study showed that the remedy is as effective against toenail fungus as the prescription antifungal medicine ciclopirox. For the study, snakeroot extract was applied to the affected area every third day for the first month, twice a week for the second month, and once a week for the third month. You can find snakeroot extract online.
Multiple fungi species can infect the nail. Fungus grows well in warm, moist environments such as showers. Fungus infection is one of the few foot problems that affect more men than women, perhaps because more men walk barefoot in locker rooms. Age is a factor, too. Half the sufferers are people older than 70. Other risk factors include having certain medical conditions such as diabetes, vascular insufficiency and malnutrition.
Vicks VapoRub is a topical ointment. Although designed for cough suppression, its active ingredients, camphor and eucalyptus oil, may help treat toenail fungus. A 2011 study found Vicks VapoRub had a “positive clinical effect” in the treatment of toenail fungus. To use, apply a small amount of Vicks VapoRub to the affected area at least once a day.