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.

Onychomycosis (toenail fungus) is an infection of the nail and sometimes surrounding tissue. It is extremely common with 20 percent of the general population and 75 percent of people over 60 years old affected. Frequently the problem causes cosmetic concerns, but many patients also experience pain. Sometimes toenail fungus can allow more serious infections to develop.
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.
Athlete’s foot appears as a scaly red rash on the bottoms or sides of the feet often accompanied by itching, dry or cracked skin, stinging, and odor. You can also have moist, raw skin between your toes. Though athlete’s foot is fairly easy to treat with over-the-counter anti-fungal creams or sprays, this foot fungus is quite contagious and may easily spread to your toenails.

Orange essential oil is another natural anti-fungal that can be applied daily to toenails in order to cure an infection.  Apply a drop of Plant Therapy Orange Oil on nails and between toes.  Let the oil soak in for at least one hour.  Orange oil may be too strong for people with sensitive skin.  If you find this is the case for you, dilute the oil with an all-natural carrier such as olive oil.  Also, because citrus allergies are somewhat common, it is recommended to test orange oil on a spot of healthy skin before applying it to infected nails.  (Many health and wellness stores have open ‘testers’ of their products for just such a purpose.)


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.

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.


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.
There are several preventive foot hygiene measures that can prevent athlete's foot and reduce recurrence. Some of these include keeping the feet dry, clipping toenails short; using a separate nail clipper for infected toenails; using socks made from well-ventilated cotton or synthetic moisture wicking materials (to soak moisture away from the skin to help keep it dry); avoiding tight-fitting footwear, changing socks frequently; and wearing sandals while walking through communal areas such as gym showers and locker rooms.[8][13][28]

In other words, the combination of urea and bifonazole got rid of nail fungus in an extra 10 participants. But there was no difference between the two groups six months after treatment. Also, the fungal infection returned in many participants, so it’s likely that neither of the two treatments can increase the chances of getting rid of the fungus in the long term.
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An active substance in olive leaf extract, oleuropein, is thought to have antifungal, antimicrobial, and immune-boosting abilities. You can apply olive leaf salve directly to nail fungus or ingest in capsule form. According to this review, taking one to three olive leaf capsules with meals twice daily is more effective than olive leaf salve in treating toenail fungus. Drink plenty of water throughout this treatment. Find olive leaf extract capsules or oil on Amazon.

Efinaconazole (Jublia) is a medication that was approved in 2014. It is a topical (applied to the skin) antifungal used for the local treatment of toenail fungus due to two most common fungal species affecting nails (Trichophyton rubrum and Trichophyton mentagrophytes). Once-daily application is required for 48 weeks. The most common side effects of Jublia are ingrown toenails and application site dermatitis and pain.

A number of different types of fungus can cause onychomycosis including dermatophytes and Fusarium.[3] Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function.[3] The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.[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.
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.
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.
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.
Ultra-high heels force the feet into a position that puts stress on the ball of the foot. At this critical joint, the long metatarsal bones meet the pea-shaped sesamoid bones, and the toe bones (phalanges). Too much pressure can inflame these bones or the nerves that surround them. Chronic stress to the foot bones can even lead to hairline fractures.
Caprylic acid, one of the medium-chain fatty acids in coconut oil, has the ability to penetrate the durable cell wall of candida and other fungi.  Without its protective coating the cells of the fungus dissolve, effectively destroying the infection.  Apply a thin layer of coconut oil to infected areas and let it soak in for at least fifteen minutes.  Coconut oil is great for skin health, so there is no limit to how often you can use this treatment.  Just make sure you aren’t allergic to coconuts before applying this product to sensitive tissue.
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.
Oral antifungal therapy has a high cure rate, depending on the medication. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works, the fungus may come back. Currently, an oral antifungal therapy is considered the best treatment for toenail fungus because of higher cure rates and shorter treatment duration compared to topical therapy.
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.
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