Toe Nail Fungus

Who Gets It

In the U.S., as many as 90% of elderly people have toe nail fungus, also called onychomycosis. It's seen much less often in children, affecting fewer than 3% of people under age 18.

People with diabetes or circulation problems are especially prone to toe nail fungus.

What It Looks Like

Toe nail fungus isn't pretty. Nails may look thickened and yellow, whitish and crumbly, or a combination of these. The tip of the nail might peel away from the nail bed.

Toe nail fungus doesn't always hurt, but it can be painful. Sometimes, the area around the nail gets red and swollen, too.

How to Avoid It

Toe nail fungus can be transmitted from person to person through shared towels, wet locker room floors, common shower stalls, and so on. The fungus also likes to grow in warm, damp places. That's why athletes, whose feet get sweaty inside their shoes, and people who wear heavy work boots all day are at risk for this infection.

Here are some tips to help you avoid toe nail fungus:

• Don't wear the same shoes every day. Let shoes dry thoroughly before putting them back on.
• Dry feet carefully. Dry between your toes and make sure feet aren't wet when you put your shoes and socks on.
• Don't go barefoot. Protect your feet by wearing flip flops or shower shoes in the gym locker area and showers.
• Avoid synthetic socks. 100% cotton socks are a better choice. Synthetic materials may trap moisture.
• Don't use nail polish. By preventing air from circulating around the nail, polish can encourage fungus to grow.
• Try antifungal powder. These powders, available at the drugstore, don't cure the fungus, but they may help prevent it.
• Wear shoes that fit. Tight shoes that push the toes together can make infection more likely.
• Don't let it spread. Avoid sharing towels, shoes, or grooming products. If you have one infected nail, don’t use the same grooming products (such as clippers or files) on uninfected nails.
• Take precautions with pedicures. Bring your own tools and make sure foot baths are thoroughly disinfected.

Finding a Cure

Nail fungus can be very difficult to cure. Most doctors will tell you that you'll need prescription medicine to make the fungus go away. However, some people may have success with drugstore preparations.

• Anti-fungal creams. Creams designed to treat athlete's foot will sometimes help with nail fungus. You'll need to apply it twice a day for several weeks. If you don't see growth of unaffected nail within a few weeks, you may need something stronger.
• Nail lacquer. Special nail "polishes," which contain antifungal medicine, are available. Again, they take time to work and won't work for everyone. These lacquers are different from ordinary nail polish.
• Tee tree oil. Tee tree oil is often found with organic products or supplements. Painting infected nails with 100% tea tree oil twice a day for six months may help the infection go away.

At the Doctor's Office

Your doctor can prescribe anti-fungal pills to treat the infection. Choices include itraconazole (brand name: Sporanox), fluconazole (Diflucan), and terbinafine (Lamisil). Treatment can take three months or more.

Unfortunately, not everyone can use these medicines. People with heart failure should not use itraconazole. People with liver and kidney problems should avoid terbinafine. Flucanazole can also cause liver and kidney trouble and should be used with caution in people with certain heart problems.

When All Else Fails

When over-the-counter and prescription treatments all fail, surgery may be an option. Removal of the nail, with treatment of the nail bed, can get rid of stubborn toe nail fungus and allow new, healthy nail to grow in. Removal can be done mechanically, by cutting the nail away, or with chemicals. Pills or treatments applied directly to the skin may be used at the same time.

Not everyone is a good candidate for surgical treatment. People with diabetes or poor circulation may not heal well. In any case, nail removal should always be done by a doctor, never at home.