Toenail injury: There are two types of injuries that can occur to your toenail. The first is acute trauma where the nail is impacted over and over again as in the case of a runner wearing shoes that don’t fit well. The other thing that can happen is blunt trauma where something falls on your toe such as a heavy object and causes an injury. This injury makes your toenail more susceptible to fungus. It is important in both cases to look after your toenails properly to avoid an infection.
Tinea pedis, also known as athlete's foot or foot fungus, can cause recurrence of fungal nails. Therefore, it is important to manage this condition. One can apply over-the-counter (OTC) antifungal medicines such as clotrimazole (Lotrimin) or terbinafine (Lamisil) cream as directed to affected skin. Keeping footwear and socks clean can be helpful. You can also use portable UV light sanitizers to disinfect shoes.
Fungal nail infections don’t usually lead to serious long-term problems when properly treated, but they may be more serious in certain individuals. This can include people with diabetes or who have a weakened immune system and have trouble fighting off an infection. Even if there is no pain associated with the infection, it is important that you promptly visit your doctor for assessment if you see any abnormal nail changes.
Patience is key, as treatment duration varies from 2-3 months for oral treatments to up to 12 months for topical treatment. Because the nails take a long time to grow (6 months for fingernails and 12-18 months for toenails), it will take some time for the infection to resolve and the nail appearance to improve, regardless of the type of treatment used. Sometimes treatment may not be successful and your doctor may prescribe a different medication.
Treating the feet is not always enough. Once socks or shoes are infested with fungi, wearing them again can reinfect (or further infect) the feet. Socks can be effectively cleaned in the wash by adding bleach or by washing in water 60° C (140° F). Washing with bleach may help with shoes, but the only way to be absolutely certain that one cannot contract the disease again from a particular pair of shoes is to dispose of those shoes.
Because you’re removing the majority of sugars and grains from your diet, in addition to fiber, I also recommend increasing the amount of protein-rich foods you’re eating. Make sure to buy grass-fed meat; organic, cage-free eggs or poultry; raw, unpasteurized dairy; and wild-caught fish — this is key for obtaining enough protein while also reducing toxins in your diet.
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.
No one knows where a specific person catches the fungus, as it is everywhere. However, since the fungus does thrive in warm moist areas (like sweaty feet), there are certain areas one should avoid or use with caution. Shower floors, locker rooms, and swimming pools are suspected of being sources of the fungus, although there are no studies proving this fact. Nail polish and acrylic nails also make the nail less "breathable" and make the nail more susceptible to fungal infection. Fungi are everywhere -- in the air, the dust, and the soil. Hygienic measures such as spraying socks and footgear sound sensible, and perhaps these measures can even help a little bit. However, avoiding tight, nonbreathing shoes or steering clear of athletic facility floors may very well be the best prevention available. Daily washing of the feet and drying between the toes can help to prevent nail fungus. The fungi carried on the coats of pets, like cats and dogs, don't often cause nail fungus. Wearing white socks does not help.
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.
Other risk factors include perspiring heavily, being in a humid or moist environment, psoriasis, wearing socks and shoes that hinder ventilation and do not absorb perspiration, going barefoot in damp public places such as swimming pools, gyms and shower rooms, having athlete's foot (tinea pedis), minor skin or nail injury, damaged nail, or other infection, and having diabetes, circulation problems, which may also lead to lower peripheral temperatures on hands and feet, or a weakened immune system.
Over-the-counter antifungal treatments. Antifungal creams and ointments treat toenail infections while helping to keep new fungus out so new nails can grow. Some treatments must be applied every day, others are applied once a week. It’s a good idea to apply topical treatments to both the foot and nail simultaneously to prevent foot fungus from spreading to the toes. If you trim your toenails well (see above) before applying an antifungal, the medicine can reach deeper into the nailbed.
One way to definitively get rid of toenail fungus is by surgery. Surgical treatment of onychomycosis involves nail removal. However, this often only provides temporary relief, and recurrence is common unless additional antifungal medication (oral or topical) is simultaneously used. However, surgical removal may be warranted when the affected nail is associated with other factors such as trauma and or infection.
Onychomycosis does not necessarily require treatment. The antifungal medication, terbinafine, taken by mouth appears to be the most effective but is associated with liver problems. Trimming the affected nails when on treatment also appears useful. There is a ciclopirox containing nail polish, but it does not work as well. The condition returns in up to half of cases following treatment. Not using old shoes after treatment may decrease the risk of recurrence.
Not all cases of OM require treatment with medication but if your doctor has confirmed you have OM and require treatment, they may prescribe an oral antifungal medication (terbinafine, itraconazole*) based on the type of fungus causing the infection. If you are unable to take oral antifungals or have a mild-to-moderate case of OM, your doctor may opt for a topical therapy (ciclopirox, efinaconazole*) that is applied to the affected nail(s) directly.
One of the best remedies for toenail fungus, apple cider vinegar can be used topically, internally, or both. Mix one part ACV and one part Epsom salts with six parts hot water. Let the water cool so that it is still warm to the touch, but not so hot as to be damaging to your skin. Soak feet up to twice daily for at least thirty minutes to kill fungus. Mix two tablespoons of organic apple cider vinegar with eight ounces of warm water and add a teaspoon of honey to sweeten the beverage.
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% whereas a more recent source claims that fungus is present in 65 to 95 percent of cases. 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. 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.
Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole. Some topical treatments need to be applied daily for prolonged periods (at least 1 year). Topical amorolfine is applied weekly. Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective. Ciclopirox when used with terbinafine appears to be better than either agent alone.
Before taking action and finding the best nail fungus treatment for you, it is important to note that toenail fungus and skin fungus, such as athlete’s foot, often manifest together. For the best results, both should be treated at the same time to prevent an ongoing infection. You can recognize athlete’s foot by the dry, scaling, peeling skin on the bottom of the feet. Your feet may also itch, or exude a noticeable odor.
You may use other antifungal treatments, such as antifungal nail lacquer or topical solutions. These treatments are brushed onto the nail in the same way that you would apply nail polish. Depending on the type of fungus causing the infection, as well as the extent of the infection, you may have to use these medications for several months. Topical solutions are not generally effective in curing toenail fungal infections.