Fungal nails (onychomycosis) may be caused by many species of fungi, but the most common is Trichophyton rubrum. Distal subungal onychomycosis starts as a discolored area at the nail's corner and slowly spread toward the cuticle. In proximal subungal onychomycosis, the infection starts at the cuticle and spreads toward the nail tip. Yeast onychomycosis is caused by Candida and may be the most common cause of fungal fingernail.
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Topical treatment (polish or cream) isn’t likely to get rid of a fungal nail infection. Treatment with tablets is considerably more effective and takes less time. But some people can’t take tablets because of the very rare, yet serious risks. How you feel about the pros and cons of the different treatment options is a personal matter. You can also discuss the options with your doctor.
Athlete’s foot is one of the most common foot infections. It can be easily acquired, especially by people who often use communal showers and pools, such as those in college dorms or gyms. It grows in warm, damp places like public showers, locker rooms, and pools. It is also common with shoes that are too tight or socks or shoes that are damp. Athletes foot is contracted from getting pedicures with not properly sanitized equipment.
The ease with which the fungus spreads to other areas of the body (on one's fingers) poses another complication. When the fungus is spread to other parts of the body, it can easily be spread back to the feet after the feet have been treated. And because the condition is called something else in each place it takes hold (e.g., tinea corporis (ringworm) or tinea cruris (jock itch), persons infected may not be aware it is the same disease.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Use tea tree oil. Tea tree oil is a natural anti-fungal. One study showed that tea tree oil may be effective for nail fungus. 18% of patients who used tea tree oil twice daily for 24 weeks were cleared of the infection.[13] To treat nail fungus with tea tree oil, use a 100% solution because lower concentrations have not been proven to be effective for this particular infection.[14]
Following effective treatment, recurrence is common (10–50%).[2] 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.[31] Infection of the bone is another rare complication.[6]
Globally, fungal infections affect about 15% of the population and affects one out of five adults.[2][21] Athlete's foot is common in individuals who wear unventilated (occlusive) footwear, such as rubber boots or vinyl shoes.[21][23] Countries and regions where going barefoot is more common experience much lower rates of athlete's foot than do populations which habitually wear shoes; as a result, the disease has been called "a penalty of civilization".[35] Studies have demonstrated that men are infected 2–4 times more often than women.[2]
Removal of the nail can reduce symptoms rapidly, but regrowth of the nail can take one year during which time local treatment for fungus can be used. Oral medications include terbinafine (Lamisil), itraconazole (Sporanox), and griseofulvin (Fulvicin). Treatment regimens vary and can last between six weeks and one year. Side effects of systemic treatment include gastrointestinal disorders, liver toxicity, skin rash and other hypersensitivities. These medications should not be taken during pregnancy or if there is a chance you will become pregnant because of effects on the fetus.
If the fungal infection has spread to the toenails, the nails must also be treated to avoid reinfection of the feet. Often, the nails are initially ignored only to find the athlete's foot keeps recurring. It is important to treat all of the visible fungus at the same time. Effective nail fungus treatment may be more intensive and require prolonged courses (three to four months) of oral antifungal medications.

Ingrown toenails are caused by the growth of the toenail into the surrounding nail fold. Symptoms and signs include toe pain, swelling, redness, and yellow drainage. Treatment at home involves soaking the affected foot in diluted white vinegar or Epsom salts, elevating the foot, and trimming the nails straight across. Surgery is also an option for severe cases. Prevent ingrown toenails by wearing shoes with a wider toe box and avoiding repeated injury to the toenails. Avoid curving or cutting the nails short at the edges.
To get rid of foot fungus like Athlete's Foot, start by applying an over-the-counter antifungal ointment, spray, powder, or cream to the affected area. You can also try taking an over-the-counter medication like butenafine or clotrimazole, but see your doctor for a prescription medication if your case is severe. If you're interested in a homeopathic solution, apply 100% tea tree oil to the affected area 2-3 times per day. To prevent the fungus from returning, wash your feet with antibacterial soap and dry them thoroughly, especially between your toes!
Following effective treatment, recurrence is common (10–50%).[2] 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.[31] Infection of the bone is another rare complication.[6]

Walking barefoot in public places: Sure, taking your shoes off may feel great but it can also lead to toenail fungus. Toenail fungus starts when moisture gets trapped under the nail. This can easily happen when you walk barefoot.It is also easy to pick up toenail fungus from walking in public places as fungus can survive for up to 6 months on surfaces. The most common public places where you can pick up toenail fungus include swimming pools and public showers. Protect yourself by wearing sandals in public pool areas and public showers.

Fungal nail infections can be difficult to treat. Talk with your doctor if self-care strategies and over-the-counter (nonprescription) products haven't helped. Treatment depends on the severity of your condition and the type of fungus causing it. It can take months to see results. And even if your nail condition improves, repeat infections are common.
Modern medicine addresses toenail fungus with topical treatments, oral anti-fungal medicine, and in some cases surgical removal of the nail.  Side effects of these medications may possibly include trouble breathing, swelling of the mouth or face, hives, rashes, blisters, headaches, dizziness, nausea, loss of appetite, liver damage, weight gain, fatigue, heart problems, fever, diarrhea, and more pain – all just to get rid of fungus on your toenails.
Walking barefoot in wet, dark areas frequented by many other individuals like indoor swimming pool decks, communal showers, and locker rooms result in frequent exposure to pathogenic fungi (dermatophytes) that cause athlete’s foot. Wearing occlusive footwear is thought to play a significant role in the increased frequency of tinea pedis. Exposure to moisture either from excessive sweating or from an external source is a risk factor. Wearing the same shoes and socks for an extended period may damage the skin. Patients with diabetes are predisposed to develop tinea pedis. Some believe that eczema (atopic dermatitis) can predispose one to tinea pedis. It appears that many more men have tinea pedis than women. Pedicure performed in contaminated environments can spread disease.
Physical exam alone has been shown to be an unreliable method of diagnosing fungal nails. There are many conditions that can make nails look damaged, so even doctors have a difficult time. In fact, studies have found that only about 50% of cases of abnormal nail appearance were caused by fungus. Therefore, laboratory testing is almost always indicated. Some insurance companies may even ask for a laboratory test confirmation of the diagnosis in order for antifungal medicine to be covered. A nail sample is obtained either by clipping the toenail or by drilling a hole in the nail. That piece of nail is sent to a lab where it can by stained, cultured, or tested by PCR (to identify the genetic material of the organisms) to identify the presence of fungus. Staining and culturing can take up to six weeks to get a result, but PCR to identify the fungal genetic material, if available, can be done in about one day. However, this test is not widely used due to its high cost. If a negative biopsy result is accompanied by high clinical suspicion, such as nails that are ragged, discolored, thickened, and crumbly, it warrants a repeat test due to the prevalence of false-negative results in these tests.
Since some people are simply more prone to fungal infections, they are also prone to repeated infection. Preventive measures include keeping your feet clean and dry, avoiding prolonged moist environments, using socks in airport security lines, removing shoes, and allowing the feet skin to "breathe," avoiding walking barefoot, especially in public areas like swimming pools and gyms, avoiding contact with known infected people, and avoiding soaking and contaminated tool usage at nail salons. Weekly applications of a topical antifungal foot cream or sprinkling of antifungal foot powder (Zeasorb Foot Powder) into shoes may also be helpful.
Topical agents such as amorolfine (Loceryl 5% nail lacquer; applied once or twice a week) and ciclopirox (Penlac 8% nail lacquer; applied daily) are usually prescribed for mild forms of the disease, but the treatment periods are long and their efficacy is somewhat limited due to poor nail plate penetration. These medications kill fungi by interfering with their cell membranes, which leads to their death.
There are several doctors who can provide nail fungus treatment. Your primary care provider, a dermatologist, or a podiatrist can treat nail fungus. Any one of these doctors can provide proper diagnosis and prescribe medications specific to fungal infection. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.
Modern treatments made surgery a last resort. “Before we had these 21st century medications, we didn’t have a good choice in how to deal with toenail fungus,” said Dr. Hinkes. “Oftentimes patients would come in, and out of frustration and lack of any real significant clinical cure with medication, they would ask for their nails to be permanently removed.”

The medical name for fungal athlete's foot is tinea pedis. There are a variety of fungi that cause athlete's foot, and these can be contracted in many locations, including gyms, locker rooms, swimming pools, communal showers, nail salons, and from contaminated socks and clothing. The fungi can also be spread directly from person to person by contact. Most people acquire fungus on the feet from walking barefoot in areas where someone else with athlete's foot has recently walked. Some people are simply more prone to this condition while others seem relatively resistant to it. Another colorful name for this condition is "jungle rot," often used by members of the armed services serving in tropical climates.
Satchell, A. C., Saurajen, A., Bell, C., & Barnetson, R. StC. (2002, July 19). Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: A randomized, placebo-controlled, blinded study [Abstract]. Australasian Journal of Dermatology, 43(3), 175–178. Retrieved from http://onlinelibrary.wiley.com/doi/10.1046/j.1440-0960.2002.00590.x/full

High heeled shoes push too much body weight toward the toes and then squeeze them together. Over time, the result can be hammertoe (early stage, lower right), abnormal bends in the toe joints that can gradually become rigid. Surgery is sometimes needed to relieve the pain of severe hammertoe. Crowding can cause other toe deformities, along with continuous shoe friction, leading to painful corns and calluses.
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.

Dr. Kyoung Min Han is a podiatrist (foot and ankle specialist) practicing in Southern California. Dr. Han completed her undergraduate education at the University of California, San Diego, and went on to the New York College of Podiatric Medicine to pursue her medical training. She returned to her native Southern California to complete a three-year foot and ankle surgical residency, followed by subspecialty training in a sports medicine fellowship.
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