Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Treatment: Nail fungus is a difficult condition to properly treat due to the average time before seeing results and the general lack of understanding regarding topical treatments. Fungus grows underneath the nail bed, making it extremely difficult to target. Certain nail fungus products, like topical ointments, contain nail penetrating ingredients that treat fungal nail infections underneath the nail bed where it grows.
Tea tree oil, also called melaleuca, is an essential oil with antifungal and antiseptic abilities. According to the National Center for Complementary and Integrative Health, some small-scale clinical studies showed that tea tree oil might be effective against toenail fungus. To use, paint the tea tree oil directly onto the affected nail twice daily with a cotton swab. Find therapeutic-grade tea tree oil on Amazon.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Nail infections occur more often in men than in women, and the infections are found in adults more often than in children. If you have family members who often get these types of fungal infections, you’re more likely to get them as well. Older adults are at the highest risk for getting fungal infections of the nails because they have poorer circulation and their nails grow more slowly and thicken as they age.
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.
Your physician may perform a simple test called a potassium hydroxide (KOH) preparation for microscopic fungal examination in the office or laboratory. This test can be used to confirm the presence of a fungal infection. This test is performed by using a microscope to examine small flakes of skin from the rash. Many dermatologists perform this test in their office with results available within minutes. Rarely, a small piece of skin may be removed and sent for biopsy or fungal culture to help confirm the diagnosis.
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.
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.
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.
What triggers candida in the first place? This overgrowth of yeast can develop from a number of factors, including antibiotic use, poor digestion, low immune system function, a high sugar and grain diet, stress or hormonal changes. All these create an acidic environment that encourages yeast growth and the presence of candida. Many people opt for over-the-counter anti-fungal creams or even medications, but they only treat the symptoms, not the environment that allows candida to flourish.
Treatment: Nail fungus is a difficult condition to properly treat due to the average time before seeing results and the general lack of understanding regarding topical treatments. Fungus grows underneath the nail bed, making it extremely difficult to target. Certain nail fungus products, like topical ointments, contain nail penetrating ingredients that treat fungal nail infections underneath the nail bed where it grows.
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%.[32][33] Prevalence was observed to increase with age. In Canada, the prevalence was estimated to be 6.48%.[34] Onychomycosis affects approximately one-third of diabetics[35] and is 56% more frequent in people suffering from psoriasis.[36]
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.
If the fungal nail infection is severe, tablets can be used in combination with nail polish or cream. For example, if the nail is very thick, urea cream can be used (in addition to taking tablets) to gradually remove or partially file off the affected nail. Combining these treatments may also be an option if there are large collections of fungi beneath the nail. Another option for severe fungal nail infections is professional medical footcare. If the nail is filed off, it’s important to ensure good hygiene and disinfect the area, because the removed nail tissue could contain infectious fungal spores.
Research suggests that fungi are sensitive to heat, typically 40–60 °C (104–140 °F). The basis of laser treatment is to try to heat the nail bed to these temperatures in order to disrupt fungal growth.[37] As of 2013 research into laser treatment seems promising.[2] There is also ongoing development in photodynamic therapy, which uses laser or LED light to activate photosensitisers that eradicate fungi.[38]
When visiting a doctor, the basic diagnosis procedure applies. This includes checking the patient's medical history and medical record for risk factors,[11] a medical interview during which the doctor asks questions (such as about itching and scratching), and a physical examination.[11] Athlete's foot can usually be diagnosed by visual inspection of the skin and by identifying less obvious symptoms such as itching of the affected area.
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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!
All high heels boost the risk of an ankle sprain. The most common problem is a lateral sprain, which happens when you roll onto the outside of the foot. This stretches the ankle ligaments beyond their normal length. A severe sprain may tear the ligaments. A sprained ankle should be immobilized and may need physical therapy to heal properly. The risk of developing osteoarthritis rises with a severe sprain or fracture of the ankle.

Scratching infected areas may also spread the fungus to the fingers and under the fingernails. If not washed away soon enough, it can infect the fingers and fingernails, growing in the skin and in the nails (not just underneath). After scratching, it can be spread to wherever the person touches, including other parts of the body and to one's environment. Scratching also causes infected skin scales to fall off into one's environment, leading to further possible spread.
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.

Onychomycosis does not necessarily require treatment.[3] The antifungal medication, terbinafine, taken by mouth appears to be the most effective but is associated with liver problems.[2][4] Trimming the affected nails when on treatment also appears useful.[2] There is a ciclopirox containing nail polish, but it does not work as well.[2] The condition returns in up to half of cases following treatment.[2] Not using old shoes after treatment may decrease the risk of recurrence.[3]
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]
Nail infections occur more often in men than in women, and the infections are found in adults more often than in children. If you have family members who often get these types of fungal infections, you’re more likely to get them as well. Older adults are at the highest risk for getting fungal infections of the nails because they have poorer circulation and their nails grow more slowly and thicken as they age.
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