Diabetes related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
Toenail fungus, also called onychomycosis, is a common fungal infection of your toenail. The most noticeable symptom is a white, brown, or yellow discoloration of one or more of your toenails. It may spread and cause the nails to thicken or crack. Sandal season or not, toenail fungus typically isn’t what you want to see when you look at your feet. Luckily there are many treatments you can try.
As both an antiseptic and fungicidal remedy, tea tree oil is a great remedy for onychomycosis.  First clean areas on and around the infection with rubbing alcohol then apply undiluted 100% pure tea tree oil (such as this Plant Therapy Tea Tree Oil) directly to the affected nails and let it soak in.  After about ten minutes, gently scrub the nail with a soft bristle toothbrush.  When applying tea tree oil directly to skin, consider mixing the oil one-to-one with an all-natural carrier, like olive or almond oil.  Repeat daily until the new healthy nail grows out completely, then continue treatment for two to three more weeks to prevent regrowth.

Flip-flops offer very little protection. The risk of getting splinters or other foot injuries is higher when the feet are so exposed. People with diabetes should not wear flip-flops, because simple cuts and scrapes can lead to serious complications. In addition, many flip-flops provide no arch support. Like ballet flats, they can aggravate plantar fasciitis and cause problems with the knees, hips, or back.
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
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.”
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Making a few simple lifestyle changes can help prevent a fungal infection of the nails. Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent infections. You should also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an extended amount of time, you may want to wear rubber gloves.
Fungal athlete's foot may cause a rash on one or both feet and even involve the hand. A "two feet and one hand" pattern is a very common presentation of athlete's foot, especially in men. Hand fungal infections are called tinea manuum. Fungal athlete's foot may also be seen along with ringworm of the groin (especially in men) or hand(s). It is helpful to examine the feet whenever there is a fungal groin rash called tinea cruris, or jock itch. It is important to treat all areas of fungal infection at one time to avoid reinfection. Simply treating the soles and ignoring the concurrent fungal infection of toenails may result in recurrences of athlete's foot.
You may first notice a fungal toenail infection as a small white or yellow spot on the tip of your toenail, especially the big toe. As the infection progresses, the toenail can become yellow, brittle—even crumbly—and thick and uneven-looking. In the worst fungal infections, the toenail separates from the nail bed. This is called onycholysis. As fungal infections worsen, the nail beds can be tender to the touch and quite painful. Sometimes women try to pretend the pain is “normal” and ignore it altogether.
A band of tissue called the plantar fascia runs along the bottom of the foot. It pulls on the heel when you walk -- and it works best with the proper arch in your foot. Walking barefoot, or in flimsy shoes without sufficient arch support, can overstretch, tear, or inflame the plantar fascia. This common condition can cause intense heel pain, and resting the feet only provides temporary relief.

Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole.[19][20][21] Some topical treatments need to be applied daily for prolonged periods (at least 1 year).[20] Topical amorolfine is applied weekly.[22] Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective.[2][20] Ciclopirox when used with terbinafine appears to be better than either agent alone.[2]


Select shoes that fit right –  Choosing the correct footwear is a must if you want to avoid toenail fungus. Shoes should not touch your toenails at all. Don’t jam your feet into shoes that are too big either – this will cause you to jam your toenail into the front of the shoe causing damage. According to the American Academy of Physicians, the best shoes have a wide toe box.
Making a few simple lifestyle changes can help prevent a fungal infection of the nails. Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent infections. You should also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an extended amount of time, you may want to wear rubber gloves.
The fungi (molds) that cause athlete's foot require warmth and moisture to survive and grow. There is an increased risk of infection with exposure to warm, moist environments (e.g., occlusive footwear—shoes or boots that enclose the feet) and in shared humid environments such as communal showers, shared pools, and treatment tubs.[17] Chlorine bleach is a disinfectant and common household cleaner that kills mold. Cleaning surfaces with a chlorine bleach solution prevents the disease from spreading from subsequent contact. Cleaning bathtubs, showers, bathroom floors, sinks, and counters with bleach helps prevent the spread of the disease, including reinfection.

Toenail fungus (onychomycosis) is caused by a group of fungi known as dermophytes. This group thrives on skin and on keratin, the main component of hair and nails. The fungus gets under the nail and begins to grow, damaging the nail so it discolors, becoming white, brown or yellow. Eventually, the nail might thicken, harden, become brittle and even fall off.
One way to contract athlete's foot is to get a fungal infection somewhere else on the body first. The fungi causing athlete's foot may spread from other areas of the body to the feet, usually by touching or scratching the affected area, thereby getting the fungus on the fingers, and then touching or scratching the feet. While the fungus remains the same, the name of the condition changes based on where on the body the infection is located. For example, the infection is known as tinea corporis ("ringworm") when the torso or limbs are affected or tinea cruris (jock itch or dhobi itch) when the groin is affected. Clothes (or shoes), body heat, and sweat can keep the skin warm and moist, just the environment the fungus needs to thrive.
The possible side effects of itraconazole include headaches, dizziness, stomach and bowel problems, and rashes. Itraconazole can also interact with a number of other drugs. These include cholesterol-reducing and blood-sugar-lowering medications, as well as certain sleeping pills. It is therefore important to let your doctor know about any medication you take. Itraconazole is not an option for people with heart failure (cardiac insufficiency). It also isn’t suitable for women who are pregnant or breastfeeding.
​The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor. 
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.
To get rid of toe fungus, apply 100% tea tree oil to the affected area with a cotton swab twice a day. You can also try applying Vick's VapoRub to your toe every night before you go to sleep, which may make the fungus go away. Another home remedy you can try is snakeroot leaf extract, which may clear up the fungus if you apply it to the affected area every 3 days. If home remedies aren't helping, talk to your doctor about getting an oral or topical antifungal medication.
In some cases of suspected nail fungus there is actually no fungal infection, but only nail deformity. A 2003 source gives a figure of 50%[17] whereas a more recent source claims that fungus is present in 65 to 95 percent of cases.[18] Avoiding use of oral antifungal therapy (e.g. terbinafine) in persons without a confirmed infection is a particular concern because of the possible side effects of that treatment.[17] However, according to a 2015 study, the cost in the United States of testing with the periodic acid–Schiff stain (PAS) was about $148. Even if the cheaper KOH test is used first and the PAS test is used only if the KOH test is negative, there is a good chance that the PAS will be done (because of either a true or a false negative with the KOH test). But the terbinafine treatment only cost $10 (plus an additional $43 for liver function tests). In conclusion the authors say that terbinafine has a relatively benign adverse effect profile, with liver damage very rare, so it makes more sense cost-wise for the dermatologist to prescribe the treatment without doing the PAS test. (Another option would be to prescribe the treatment only if the potassium hydroxide test is positive, but it gives a false negative in about 20% of cases of fungal infection.) On the other hand, as of 2015 the price of topical (non-oral) treatment with efinaconazole was $2307 per nail, so testing is recommended before prescribing it.[18]
Select shoes that fit right –  Choosing the correct footwear is a must if you want to avoid toenail fungus. Shoes should not touch your toenails at all. Don’t jam your feet into shoes that are too big either – this will cause you to jam your toenail into the front of the shoe causing damage. According to the American Academy of Physicians, the best shoes have a wide toe box.
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.
I can tell you my own mother struggled with toenail fungus on her big toe for over 10 years, and the reason why she originally got it and then continued to struggle with this fungus was the chemotherapy she went through when diagnosed with breast cancer years ago. After going through chemo, she had systemic yeast and candida issues and then developed the toenail fungus. The exact treatment I detail below is what we used with her to successfully erase her fungus.
Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole.[19][20][21] Some topical treatments need to be applied daily for prolonged periods (at least 1 year).[20] Topical amorolfine is applied weekly.[22] Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective.[2][20] Ciclopirox when used with terbinafine appears to be better than either agent alone.[2]
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.
Medications in tablet form are much more effective at fighting nail fungus than topical treatments are, but they aren’t guaranteed to work and also have more side effects, long treatment durations and possible interactions. (7) Another downside is that they are like putting a Band-Aid on the problem — they’re not addressing why the fungus developed in the first place.

Yeast onychomycosis: This type is caused by a yeast called Candida and not by the Trichophyton fungus named above. It is more common in fingernails and is a common cause of fungal fingernails. Patients may have associated paronychia (infection of the cuticle). Candida can cause yellow, brown, white, or thickened nails. Some people who have this infection also have yeast in their mouth or have a chronic paronychia (see above) that is also infected with yeast.
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.
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.
Besides being exposed to any of the modes of transmission presented above, there are additional risk factors that increase one's chance of contracting athlete's foot. Persons who have had athlete's foot before are more likely to become infected than those who have not. Adults are more likely to catch athlete's foot than children. Men have a higher chance of getting athlete's foot than women.[25] People with diabetes or weakened immune systems[25] are more susceptible to the disease. HIV/AIDS hampers the immune system and increases the risk of acquiring athlete's foot. Hyperhidrosis (abnormally increased sweating) increases the risk of infection and makes treatment more difficult.[26]

Before buying new shoes, have a professional measure the length and width of your feet at the end of the day, while you're standing. For unusually flat feet or high arches, an exam by a podiatrist may be warranted. These conditions can increase the risk of osteoarthritis. Early treatment and use of proper footwear may help to avoid unnecessary wear and tear on the joints of the foot.
For more severe cases, oral antifungal medications might be required. These include fluconazole (an antifungal agent also commonly used to treat thrush), terbinafine (a broad-spectrum antifungal) and griseofulvin (usually used for skin infections). The latter is a very old drug and carries the risk of causing damage to the liver. Terbinafine is most effective and therefore is the preferred oral treatment. A 12-week course cures 70-80% of cases by causing the fungi’s cells to leak and die. It can, however, cause gastrointestinal side effects and depression.
Healing time depends on the type of treatment used. Prevention of a new infection is important. Orthopaedic foot and ankle specialists recommend good foot hygiene with frequent changing of stockings and rotating pairs of shoes to allow them to completely dry between uses. Also, avoid going barefoot in locker rooms and around swimming pools. If you have a pedicure, make sure the nail salon uses sterilized instruments.
Making a few simple lifestyle changes can help prevent a fungal infection of the nails. Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent infections. You should also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an extended amount of time, you may want to wear rubber gloves.
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