Fungal toenails, also known as onychomycosis, occur due to an infection of the nail. It is similar to another fungal infections of the foot, such as Athlete’s foot, although they differ in their location and treatment protocol. It is vital to understand these differences when preventing and attending to fungal toenails.
If you believe this may be what you have, continue along as we explore the causes, symptoms, management, and treatment for toenail fungus.
What exactly are Fungal Toenails?
An infection of the nail occurs due to a group of fungi called dermatophytes, with a variety of species causing different presentations in the nail. Fungi enjoy the warm, moist, and often dark environment of the foot and nail and can often affect the skin as well. The major difference with fungal toenails is that the fungus will live under the nail, often making it difficult to treat.
Symptoms of Fungal Toenails
Due to the variations in how fungal toenails present, it can be tricky to determine their presence. However, there are 3 primary factors we use when diagnosing them:
- Colour – The nail may become discoloured, and the pattern of the colour can be irregular and deep as well. This colour can be white, similar to the nail edge we are used to, or even yellow, and potentially brown/black too, depending on the infection.
- Texture – At the early stages, we may see a normal, smooth nail texture. However, if prolonged, we will begin to see changes such as thickening, brittleness, and potentially crumbling of the nail as the fungus eats away at it. This pattern can appear striated in the nail, or as diffuse crumbling.
- Smell – Perhaps the most distinctive factor of nail fungus is its smell. It gives off an unpleasant odour as it progresses. In advanced fungal toenails, the fungus eats away at bacterial disulphide bonds to release sulfur, imitating a smell similar to rotting eggs, creating a unique olfactory profile.
Differentiating Fungal Toenails from Damaged Nails
When we see changes in colour or texture, we often assume fungal toenails, but we want to be careful to rule out other possibilities, such as nails that were damaged due to physical trauma, rather than a biological infection. Using the same factors, we can consider other causes:
- Colour – Although a fungal nail is likely to be yellow, that does not mean every yellow nail is fungal. Discoloration could be due to vitamin deficiencies, smoking, thyroid conditions, and potentially a bacterial infection instead. Some nail polishes can even leave a residue that is similar!
- Texture – Similarly, although fungal nails become thick, not all thick nails are fungal. The most common cause of a thick nail is actually from physical trauma, such as stubbing your toe or dropping an object on it. Long-term standing and walking can build up stress over time to thicken the nail too. However, crumbling and eaten-away patterns are strong indicators for the presence of fungus.
- Smell – As the most distinctive factor, smell can be useful to tell whether or not fungus is present. A nail that simply has physical damage will have no odour barring other factors, while fungal toenails will definitely produce a smell over time.
In the end, the most accurate way to assess for fungal nails is to inquire with your family physician for a lab test and sample. A BioPed Chiropodist or Footcare Nurse can coordinate this with your Doctor or Nurse Practitioner as well.
Treatment for Toe Fungus
Once we have determined nail fungus exists – how do we get rid of it? There are several methods that can be used, and sometimes all at once. The treatment options are:
Prescription Medication
Due to the nature of the fungus living under the toenail, it is more difficult to get rid of than fungus on the exposed skin. A stronger medication is often required:
- Jublia – applied topically, one of the more effective treatments available today.
- Ciclopirox – a topical alternative, if others are not available.
- Terbinafine – taken orally, when topical treatments fail.
Over-the-Counter and Home Remedies
Due to health restrictions or preferences, we may want to go a more holistic route. Some options include:
- Footlogix Nail Tincture – Uses an effective seaweed extract to target microbes.
- Tea Tree Oil – A natural essential oil with antifungal effects, applied topically.
- Vinegar Soak – Dipping the feet into a diluted vinegar bath can be a good home remedy.
Medical Foot Care
Although we can apply products to the nail as listed above, they are simply unable to penetrate the thickness of the nail to get to the fungus underneath. To combat this, the nail will have to be cut short in length and more importantly, depth. A Chiropodist or Footcare Nurse is able to safely do this and clean the fungal nail to allow for any products to work their action.
Preventing Toe Fungus from Returning
Once we have eradicated the fungus, or if we want to be cautious of receiving a fungal infection, there are several techniques to avoid it from occurring:
Proper Foot Hygiene
This may sound as simple as regularly washing the foot and keeping it dry to prevent moisture from building up, but there are several more aspects to this.
- Changing socks regularly – this will help keep feet dry.
- Avoid sharing personal items – e.g. towels, clippers, socks & shoes.
- Use footwear in public spaces – e.g. slippers in showers, pools, or saunas.
Changes to Footwear
The main reason we have microbes and moisture build up on our feet is because of how they are trapped in footwear for most of the day. We can improve this with:
- Breathable footwear – allow more airflow towards the feet.
- Alternating shoes – have several in rotation throughout the week to allow them to dry in between wear.
- Properly fitting footwear – tight shoes creates a cramped/damp environment for toes.
Preventative Products
Should we choose to implement products in keeping our feet dry, some examples are:
- Powder – any powder that absorbs water and creates a dry area, such as baby powder.
- Antiperspirant – if excessive sweating is present, this can be used to reduce moisture.
- Antifungal Sprays/Ointments – tea tree oil on healthy nails.
When to see a Medical Practitioner, such as a Chiropodist, Footcare Nurse, Physician or Nurse Practitioner
Fungal Toenails are more difficult to acquire, but in turn are more difficult to get rid of once infected. Due to this challenge, we recommend seeing someone at any point it is suspected. Although many may be uncomfortable with others seeing their feet, it is imperative to address it quickly to prevent permanent damage to the nail. At BioPed Footcare, fungal toenails are one of the many conditions we treat. Book your appointment today to get the care your feet deserve!