Understanding Fungal Toenails

Fungal toenail infections typically begin as a small white or yellow spot beneath the nail but can quickly progress if left untreated. With our feet exposed more in the warmer months, we are at greater risk for acquiring or simply noticing the infection. The fungi thrive in warm, dark, and moist environments, such as sweaty socks, damp shoes, and public areas like swimming pools. Fungal toenails are often mistaken for other nail disorders, so recognizing the signs early can make a significant difference in successful treatment.

Signs and Symptoms of Fungal Toenails

Fungal toenails can present in various ways, but the most common symptoms include:

• Discoloration – The nail may turn white, yellow, brown, or even black, often starting at the tip and spreading towards the nail bed.
• Thickened Nails – As the infection progresses, the nail may become noticeably thicker, making it difficult to trim.
• Brittleness and Crumbling – The nail may become fragile, breaking or crumbling at the edges.
• Foul Odor – Advanced cases may emit an unpleasant smell due to the breakdown of keratin in the nail.
• Nail Separation – In severe cases, the nail may begin to lift away from the nail bed, leading to discomfort or even pain.

Because fungal toenails share symptoms with other nail disorders, it is essential to confirm the diagnosis with a healthcare professional.

Differentiating Fungal Toenails from other conditions

Not every thick or discolored nail is due to a fungal infection. Physical trauma, such as stubbing your toe or dropping an object on it, can also cause nail thickening and discoloration. Here’s how you can distinguish between the two:

• Fungal Toenails – Typically yellow, white, or brown with an irregular pattern. The nail may have a rough texture and emit a foul odor.
• Damaged Nails from Trauma – May appear dark red or black due to blood accumulation under the nail, with no accompanying odor.
• Underlying Health Conditions – Conditions like psoriasis, diabetes, or vitamin deficiencies can also lead to nail discoloration or changes in texture.

If you’re unsure whether you have fungal toenails or nail trauma, or an underlying condition, a Physician, Nurse Practitioner or most BioPed locations with medical footcare services can assess your toenails.

Best Treatment for Toenail Fungus

Once diagnosed, treating fungal toenails requires patience, as the infection can be persistent. Fortunately, several effective treatments exist, ranging from prescription medications to home remedies.

1. Medical Foot Care

Often, simply applying medication to the nail isn’t enough, as thickened nails may prevent medication from penetrating. Professional foot care services, such as those offered by a Chiropodist or Footcare Nurses, can help by trimming and debriding the affected nail, allowing antifungal treatments to work more effectively, and at times entirely removing the infected tissue.

Photo disinfection light therapy can be quite effective at killing the fungal agent within the toenail.  Ask your BioPed clinic if they offer this solution.

2. Over-the-Counter and Home Remedies

For those seeking a more natural or accessible approach, several over-the-counter (OTC) and home remedies may help:

• Formula 3 by Tetra – One of the most potent OTC medications on the market and available at select BioPed locations.
• Footlogix Nail Tincture – An easy to use spray, utilizing Spiraleen® that is widely available at all BioPed locations.
• Tea Tree Oil – Known for its antifungal properties, tea tree oil can be applied directly to the nail daily.

3. Prescription Medications

• Since fungal infections live beneath the nail, stronger antifungal treatments are sometimes necessary. Prescriptions can be obtained by a BioPed Chiropodist or your primary care provider.

Preventing Fungal Toenails from Returning

Once you’ve successfully treated a fungal toenail infection, preventing a recurrence is crucial. Here are some essential prevention strategies:

1. Proper Foot Hygiene

• Wash and dry your feet daily, especially between the toes.
• Change socks regularly, particularly if your feet sweat excessively.
• Avoid sharing personal hygiene items like nail clippers, towels, and shoes.

2. Choosing the Right Footwear

• Wear breathable shoes made from materials that allow airflow.
• Rotate your shoes, allowing them time to dry out between wears.
• Avoid tight-fitting shoes that create a damp, crowded environment for your toes.

3. Using Preventative Products

• Apply antifungal sprays or powders to your shoes and feet regularly. Clean Sweep by Tetra is a safe and effective spray with silver nanoparticles that is available in BioPed clinics.
• Antiperspirants can control excessive foot sweating.
• Consider using foot powders such as baby powder or talcum to absorb moisture and reduce fungal risk.

When to See a Footcare Practitioner

If you suspect you have fungal toenails, it’s best to seek medical advice early. While over-the-counter and home remedies may help in mild cases, severe or persistent infections require professional intervention for treatment of toe fungus. Our Chiropodists and Footcare Nurses can assess the severity of the infection and recommend the most effective treatment plan.

At BioPed Footcare, we assess and treat fungal toenails. Don’t let toenail fungus impact your confidence and foot health—book an appointment today!

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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!

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