Cause of toenail fungus

Contents

Onychomycosis (Fungal Nail Infection)

  1. What is onychomycosis (fungal nail infection)?
  2. Symptoms
  3. Triggers
  4. Diagnosis
  5. Treatment
  6. FAQs

What is onychomycosis (fungal nail infection)?

Onychomycosis (also known as tinea unguium) is a fungal nail infection which can affect the toenails and/or fingernails and which occurs in about 10 percent of adults in the United States. Onychomycosis more commonly affects toenails rather than fingernails.

There are several different types of fungal nail infection, depending on the kind of fungus causing the infection. Onychomycosis or infected nails are most often caused by a type of parasitic fungi called dermatophyte fungi.

Most types of onychomycosis have the same signs of infection: the infected nail usually becomes thick and discoloured. This process generally starts at the tip of the nail and progresses downwards towards the root.

As the infection progresses, the affected nail can become itchy and/or slightly painful. Infected nails may become crumbly, and it is not uncommon for part or all of the infected nail to break off. Treatment usually involves keeping the nail clean and taking a course of topical antifungal (antimycotic) medication.

Symptoms of fungal nail infection

The first signs of a fungal nail infection are usually perceptible changes to the appearance of the infected nail(s). It is uncommon for an infected nail to cause severe pain or permanent disfigurement, but this does occur in some cases. If left untreated, fungal nail infections can cause difficulties with walking, exercising or manual tasks such as typing. The main symptoms of onychomycosis include the nail becoming:

  • Brittle
  • Broken
  • Discolored
  • Thickened
  • Flaky
  • Lifted away from the nail bed
  • Mildly painful
  • Separated from the nail bed

These symptoms could also indicate that an individual is suffering from nail psoriasis, a chronic autoimmune skin disease which can affect the skin under the nail. Nail psoriasis is more common in the fingernails than the toenails and can co-occur with fungal infections of the nail. If you think you may be experiencing the first signs of nail psoriasis or a fungal nail infection, get a free symptom assessment by downloading the Ada app.

Good to know: In people with diabetes, fungal toenail infections can increase the likelihood of developing ulceration and other complications, so medical attention should always be sought if a fungal nail infection is suspected.

Types of onychomycosis

Onychomycosis or tinea unguium is usually caused by a buildup of dermatophyte fungi. These are parasitic fungi infecting the skin and nails, which need to reside in human or animal bodies in order to survive. Fungal infections of the nail are caused when dermatophytes burrow under the nails to breed.

Specific types of dermatophytes which commonly cause fungal nail infections include the trichophyton rubrum, the most common type of fungus to infect the nails, and trichophyton interdigitale fungi. Other fungi which can cause fungal nail infections include yeasts, such as the candida albicans and molds, such as scopulariopsis brevicaulis.

What is proximal subungual onychomycosis?

Proximal subungual onychomycosis is the rarest form of fungal nail infection.

Infection usually involves the trichophyton rubrum fungus. Unlike in other kinds of fungal nail infection, infection occurs, initially, at the proximal nail fold (the base of the nail), spreading up the newly developed nail plate.

The proximal subungual form of fungal nail infection usually occurs in people whose immune system is compromised. Proximal subungual onychomycosis is a clinical marker for human immunodeficiency virus (HIV).

Triggers

Wearing tight-fitting socks and shoes, which cause repetitive trauma to the toenails, is a primary cause of fungal nail infections. Onychomycosis is therefore common in people who play a lot of sport, as well as the elderly and anyone with a compromised immune system.

Moist, damp environments serve as breeding grounds for dermatophytes. Healthy people typically catch nail infections from visiting places such as:

  • Communal showers
  • Nail salons and/or foot spas with poorly-cleaned instruments
  • Public swimming pools, jacuzzis and saunas

Diagnosis

If somebody is suffering from a suspected fungal nail infection, it is advisable to visit the doctor so that they can advise on a treatment plan for the infected nail(s). Fungal nail infections are diagnosed based on the visible symptoms.

Samples of nail clippings are usually sent away for a histopathology examination, the analysis of diseased tissue, in order to identify the presence of dermatophytes and decide on appropriate medication. There is a 30 percent possibility of false negatives when testing for dermatophyte cultures, so it is possible that the test may need to be repeated.

Treatment

Fungal nail infections do not go away on their own, so a course of treatment is always required. This usually involves a combined approach of keeping the affected nails clean to reduce irritation and inflammation, at the same time as following a course of antifungal medication. Onychomycosis is highly infectious, so it is important to begin treatment as soon as possible to minimise the risk of passing the infection to others.

Prevention and management

There are various precautions that one can take in order to reduce the risk of spreading fungal nail infections to others and to increase the chances of a quick recovery. To look after one’s nails and prevent the spread of infection, it is recommended that one:

  • Change one’s socks and shoes regularly
  • Dries one’s hands and feet as soon as possible after exposure to water
  • Files one’s nails to keep the edges smooth
  • Moisturise one’s hands, nails and cuticles daily and after contact with liquids
  • Select shoes and socks made of natural materials, such as cotton
  • Treat skin infections like athlete’s foot promptly to avoid the infection reaching the nails
  • Trim one’s nails regularly
  • Use separate scissors or clippers to tend to infected nails
  • Wear clean, comfortable shoes
  • Wear gloves for housework and other manual tasks

Medications

In addition to keeping the site of the infection clean, someone affected by a fungal nail infection may be prescribed topical antimycotics, i.e.antifungal products to apply to the affected area. Topical medications are currently the first-line treatment for fungal nail infections.

Topical medications used to treat fungal nail infections

These include:

  • Amorolfine nail lacquer
  • Tioconazole nail solution
  • Ciclopirox

Always use topical antifungal products according to a doctor’s advice and/or follow the guidelines on the packet.

In some cases, all or part of the infected nail may be removed, in order to give the topical medications the best chance to work. This treatment is usually recommended for severe or persistent nail infections. It can be carried out during a regular appointment at the doctor’s office. If the nail is removed surgically, a local anaesthetic will be applied to the affected area before the infected part of the nail is removed.

An advantage of surgical removal is that it can be carried out in one appointment, and the course of topical antimycotic medication can then be started. Alternatively, a dressing containing urea can be applied to the affected nail. This must be kept dry for 10 days, during which time the urea will soften the nail, so that it can be removed painlessly by the doctor during a follow-up appointment.

After the nail is removed, topical medications can then be applied. The infection is considered to have cleared up when the new, healthy nail starts to show visible regrowth in the nail bed.

Onychomycosis FAQs

Q: Are there oral medications for fungal nail infections?
A: Oral medications will only be prescribed to treat onychomycosis in cases where topical treatments and self-care alone have been prescribed and have not proven effective in curing the infection. Oral medications for fungal nail infections can cause side effects, which include itching, headaches, diarrhea and a decreased sense of taste.

The most common oral antimycotics for onychomycosis are itraconazole and terbinafine, which work by gradually killing the fungi that caused the infection. The doctor will assess a person’s medical history before prescribing these medications, as they may not be suitable for everyone. People who have had liver problems should avoid terbinafine. Itraconazole has been linked to compromised heart function and may react with other medications, including pimozide, quinidine, dofetilide and levacetylmethadol (levomethadyl).

Q: Is it always possible to cure onychomycosis?
A: Onychomycosis can take a long time to treat, and some fungal nail infections can be resistant to antifungal medications. Treating a fungal nail infection can depend on identifying the appropriate medication that is effective against a particular subtype of infection.

Q: Can nail polish cause onychomycosis?
A: Nail polish is a sealant, so it can cause a buildup of moisture behind the nail, potentially creating an environment in which dermatophytes and other microorganisms can thrive. Avoiding nail polish is recommended while undergoing treatment for onychomycosis, as it could reduce the effectiveness of the antifungal medication. Furthermore, the applicator brush could be a vehicle for spreading infectious microorganisms.

Q: What are the main methods for removing a fungal nail?
A: Fungal nails can be removed surgically, using a tool to loosen the skin around the nail and remove the nail after a local anaesthetic is applied to the affected area to prevent pain. If the whole nail is removed, this is called avulsion. If part of the nail is removed, this is called debridement.

Alternatively, the nail can be removed chemically (non-surgically) by placing a dressing containing urea on the nail. This must be kept dry for 10 days after which the nail is softened to the point where it can be removed painlessly by the doctor.

Good to know: It is also possible to treat a fungal nail infection by removing the infected nail using a laser. However, laser treatment for onychomycosis is not usually considered, other than in cases where antifungal medication has been ineffective.

Q: Are fungal nail infections contagious?
A: Fungal nail infections can be passed from one infected nail to another due to direct or indirect contact. For example, toes which are next to one another on the foot may rub together, causing the fungi to spread to skin and infect other nearby nails. A person may also spread their fungal nail infection from one infected nail to other nails by touching it with their hands before touching other areas of the feet or hands and/or through the use of implements which touch multiple fingers or toes, such as nail files or nail polish brushes. People risk catching tinea unguium from one another when they share implements such as these, use public foot-baths or foot-spas, or share shoes or socks.

Q: What are the best home remedies to treat a fungal nail infection?
A: No home remedies for fungal nail infections are currently approved by the Food and Drug Administration (FDA). However, many people report success in reducing the severity of their fungal infection, or curing it altogether by using herbal remedies with antifungal properties, including:

Applying products containing tea tree oil to the affected nail plate(s) and surrounding skin Taking herbal supplements and vitamins, as vitamin deficiencies, in particular being deficient in the B vitamin biotin, can lead to fungal nail infections. If you think you may be affected by a vitamin deficiency, assess your symptoms for free by downloading the Ada app Topical creams and rubs containing ingredients such as menthol, eucalyptus oil, camphor and thymol have been found to treat or cure onychomycosis, in particular, ointments which are traditionally used for decongestion. However, their use in the treatment of fungal nail infections is a recent trend and is not universally medically accepted or FDA-approved.

Q: What is the difference between onychomycosis and onycholysis?
A: Although onychomycosis and onycholysis sound similar and are both conditions that affect the nails, these two terms have slightly different meanings:

The definition of onycholysis is the separation of the nail from the skin, which can happen due to a variety of causes, including a single injury or a repetitive trauma, allergic reactions to chemicals such as household cleaning products or nail polish, or as a result of having a fungal nail infection. The definition of onychomycosis is a fungal nail infection. This may or may not eventually result in onycholysis if the infected nail becomes sufficiently damaged that it crumbles and breaks away from the skin.

Q: Do fungal nail infections cause pus?
A: The appearance of pus near the nails is more commonly associated with bacterial infections rather than fungal ones. Pus around the nails may indicate that a person is affected by a condition called paronychia, an infection of the skin beside the nail, most often developing in the nail fold. A bacterium called Staphylococcus aureus is a common cause.

  1. “Onychomycosis: Current trends in diagnosis and treatment.” American Family Physician. December 2013. ↩

  2. “Fungal nail infections: picture of fungal nail infection.” EMedicineHealth. Accessed: 27 August 2018. ↩

  3. “Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study.” Pakistan Journal of Medical Sciences. 2016. Accessed: 27 August 2018. ↩

  4. “Treating Onychomycosis.” American Family Physician. February 2001. ↩

  5. “Fungal infections of the nails.” British Association of Dermatologists. July 2017. Accessed: 15 March 2018. ↩ ↩

  6. “Surgical nail removal for fungal nail infections.” Cigna. 05 February 2016. Accessed: 15 March 2018. ↩

  7. “Fungal nail infection.” National Institute for Healthcare and Excellence. March 2018. Accessed: 08 October 2018. ↩

  8. “Fungal nail infection.” NHS Choices. 19 December 2017. Accessed: 15 March 2018. ↩

  9. “Novel treatment of onychomycosis using over-the-counter mentholated ointment: a clinical case series.” Journal of the American Board of Family Medicine. 2011. Accessed: 27 August 2018. ↩

  10. “Myth or reality? Is VicksⓇ VapoRub effective for mycotic toenails?” Podiatry Today. 29 June 2016. Accessed: 27 August 2018. ↩

  11. “What is onycholysis DermNetNZ. 2003. Accessed: 27 Augusts 2018. ↩

A

Fungal infections of the nail can be difficult to treat. As a previous Ask Well column noted, plenty of remedies exist, but none are certain. And the one considered most effective, the drug Lamisil, is associated with rare cases of liver damage.

So it is no surprise that some people would consider covering up their feet and turning a blind eye to the problem. Most healthy young adults who ignore it will probably not notice any immediate issues. But over time, as the fungus progresses from the tip of the nail toward the cuticle, it can make the nail thick, discolored and brittle, and pain and inflammation become more likely.

In about one out of two dozen cases, the fungus migrates to other parts of the body, like the hands, back and legs, said Dr. Boni E. Elewski, a professor of dermatology at the University of Alabama at Birmingham who specializes in nail disorders. Older people or those taking medications that weaken the immune system, like chemotherapy drugs and corticosteroids, are particularly susceptible.

“If you don’t treat it, you have an organism living in your nail that could spread,” she said. “In most people, it probably won’t go beyond the foot. But there are some people who are at risk of getting it in the fingernails and other places.”

The other problem with ignoring nail fungus is that the fungus creates cracks and openings in the skin where bacteria can sneak in and cause infections. For people who have nerve damage and poor circulation — someone with diabetic neuropathy, for example — this can have serious consequences.

“Podiatrists frequently cite this as a cause of diabetic amputations,” Dr. Elewski said. “The fungus paves the way for bacteria, and it can definitely be a problem.”

If the side effects of Lamisil are your concern, Dr. Elewski said, then alternatives are on the horizon. Two promising new topical treatments — Efinaconazole and Tavaborole — are expected to be released next year. Nail lacquers can also be effective but require regular application. And it is better to begin treatment early.

“The longer you wait,” Dr. Elewski said, “the harder it is to treat.”

The Dangers of Ignoring Toenail Fungus Infections

The Dangers of Ignoring Toenail Fungus Infections

Fungal nail infections are becoming a common nail problem, especially if you frequent public bathrooms, gym, saunas, or spas. People often dismiss nail fungus because it generally does not give any discomfort and the first signs are often hard to detect. Brown or black spots and white streaks may signify an infection in your nail. It may later on progress to more evident changes wherein the nail thickens or have a rougher surface. Although not bothersome, leaving a fungal nail infection untreated can make it harder and more frustrating to cure in the end.

Total dystrophic onychomycosis, or severe nail fungal infections, is the end-stage of this nail disease. Fungus has started to infect larger portions of the nail causing it to become deformed, brittle, and weak. More often than not, it starts to become painful and even emit some type of foul odor. There is increased possibility for permanent damage to the nail. The infection may also spread to other parts of your body and create more serious illnesses.

Complications from Severe Nail Fungal Infections

Inevitably, dismissing a nail problem can lead to more serious effects to our health. There are several complications that arise when nail fungal infections are left untreated.

Foot Pain and Discomfort

Generally, nail fungus is painless which can lead it to being ignored and left untreated. Nail fungal infections make the nails thickened and deformed. Initially, they might not seem worrying, but ignoring a nail fungus can become painful overtime. The pain begins when the thickening of the nail causes a hindrance when wearing certain footwear. There might be difficulty in walking, and change in footwear may be deemed necessary.

Nail Fungus May Spread to the Skin and Other Nails

Nail fungal infections are highly contagious, and it is possible that they may spread to other healthy nails surrounding it. Fungus does not only infect nails. It may also result to the contamination of the foot’s skin. This condition is more commonly known as athlete’s foot and it makes the skin on your feet red, itchy, and cracked. People who wear heavy footwear and sweaty socks all day are more susceptible to the spread of nail fungal infections to the other areas of the feet.

Nail Fungus Can Cause Other Forms of Body Infections

Other body infections are a huge risk when a nail fungal infection is ignored. As mentioned, nail fungal infections may contaminate the surrounding skin. When the skin becomes cracked and open, bacteria can easily enter and create a widespread infection all over your body.

A simple fungal nail infection can lead to cellulitis. This condition produces swollen, red, tender skin and demands immediate treatment with antibiotics. Severe cellulitis can also enter the bloodstream and become life-threatening.

Loss of Nails

The growth of fungus causes the separation of the nail from its nail bed. In the late stages of a nail fungal infection, the nails become thick, hard, weak, and brittle. This makes it easier for the nail to crack, chip, and break. If you continually dismiss this, the cracking can lead to severe nail damage and loss of your nails. In some occasions, the loss of nail can be permanent.

Special Groups At Risk for Complications In Severe Onychomycosis

Delaying the treatment of a nail fungus until its late stages can be excruciatingly challenging. For some people with other diseases/conditions, avoiding the onset of severe onychomycosis is essential. The dangers that involve the end-stage nail disease can lead to an even more harmful situation for them.

Diabetes

Studies have shown that 22% of patients with diabetes develop toenail onychomycosis. Diabetes can lead to neuropathy (nerve loss) and peripheral arterial disease, which increases a diabetic’s susceptibility for fungal nail infections. In addition, the poor wound healing effects of diabetes make treatment more nail fungal infections very difficult.

HIV/AIDS

Fungal infections are opportunistic infections and affect people with weak immune systems. HIV/AIDs is an example of a disease condition that suppresses one’s immunity, putting them at greater risk. For those with HIV/AIDs, treatment should be ensued as early as possible to prevent something serious and life-threatening, like fungal meningitis.

Early Treatment Is Key To Preventing Severe Onychomycosis

Nail fungal infections are best treated in its earliest stages. Once you spot any of the mentioned early signs and symptoms, seek the advice of your health professional. Usually, for early onychomycosis, treatment may simply be in the form of topical anti-fungal solutions. EmoniNail is a perfect example of a topical treatment that contains safe and effective ingredients, such as undecylenic acid and tea tree oil, that will likely kill fungi and improve the nail’s overall health.

Treating onychomycosis in recent times has advanced and the availability of surgical treatments, laser therapies, and other oral anti-fungal medications are now out in the market. Although not necessary in early onychomycosis, they also prove to be successful in eliminating fungal nail infections. These types of treatments are best recommended under the supervision of your doctor. Visit your physicians to know what treatment works best for you.

Conclusion

Nail fungal infections are generally not life-threatening. The early signs and symptoms do not give any type of discomfort, which makes it easy to dismiss. Although it may not seem to be bothersome, leaving nail fungus untreated can lead to serious complications. Foot and nail pain, spread of fungal infection to surrounding nails and skin, risk for other body infections, and permanent nail loss are few things that one should be concerned of when a nail fungus becomes severe. Diabetics and HIV/AIDs patients are more at risk when complications of nail fungus happen. They may lead to even more serious conditions.

Nail fungus should be treated as soon as early signs and symptoms are present. Currently, topical anti-fungal solutions, like EmoniNail, prove to be effective in killing fungus and improving the nail’s overall health. Other treatment options are also possible. Consulting a physician is best to know what treatment suits your condition because combating nail fungus isn’t the same for everyone.

My Toenail Fell Off, Now What?

Injury

Simple foot injuries can cause you toenail to fall off. Car accidents, sports, and dropping something on your foot can all damage your toenail.

If you injure your toenail, it might look black or purple under your toenail. This is due to something called a subungual hematoma, which causes blood to collect under your injured toenail. As blood builds up under your nail, it may separate from your nail bed. It can take several weeks for your toenail to completely fall off.

Contact your doctor if the subungual hematoma covers more than a quarter of your toenail. If you feel throbbing or intense pain near the hematoma, your doctor can use a heated needle or wire to make a small hole in your toenail to relieve the pressure.

Otherwise, you can treat your injured toe at home by:

  • soaking it in cold water for 20 minutes
  • elevating it
  • clipping any sharp or jagged edges of the remaining nail
  • cleaning any exposed part of your nail bed and applying an antibiotic ointment
  • applying a fresh bandage daily for the next 7 to 10 days, or until the skin hardens
  • taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), to help with the pain

Depending on which toenail fell off, it can take anywhere from six months to two years for the nail to completely grow back. Make sure to closely trim the rest of your toenails and wear well-fitting shoes to prevent any future injuries.

Fungus

Fungi can grow between your nail bed and toenail, eventually making your toenail fall off.

Symptoms of a fungal toenail infection include:

  • noticeably thicker toenails
  • white or yellowish-brown discoloration on your toenails
  • dry, brittle, or ragged toenails
  • foul smell coming from toes
  • unusual toenail shape

If you have athlete’s foot, it can turn into a fungal toenail infection. Diabetes also increases your risk of a fungal infection in your toenail due to poor circulation in your feet.

As you age, your nails become dry. This can also make them more likely to crack, allowing fungus to enter your nail bed.

Fungal toenail infections can be hard to treat, depending on how severe the infection is. In mild cases, the infection will usually clear up on its own. If you have diabetes, it’s important to tell your doctor about any type of infection in your feet because reduced circulation can make the problem worse.

Treating fungal toenail infections usually involves oral or topical antifungal medications. Depending on the severity of your infection, your doctor may prescribe both. Oral antifungal drugs are usually much more effective than over-the-counter topical treatments. They also reduce the risk of your new toenail getting infected as well.

You may need to take medication for up to 12 weeks. You won’t see results until your new toenail has completely grown in. Oral antifungal medications can produce many side effects, so tell your doctor about any unusual symptoms you have while taking them, such as a rash or fever.

You can also try home remedies to treat a fungal toenail infection. In rare cases, you may need surgery to permanently remove the affected toenail.

You can prevent fungal toenail infections by:

  • keeping your feet dry
  • changing your socks often
  • wearing breathable shoes
  • keeping your nails neatly trimmed
  • disinfecting your nail clippers
  • wearing shoes in damp communal areas, such as spas or locker rooms

Psoriasis is an autoimmune condition that causes the skin cells to build up. While it often appears on the skin, it can affect the toenails as well. Many cases of nail psoriasis are mild and don’t cause many problems. However, sometimes the buildup of skin cells in your nail bed can cause your toenail to fall off.

Symptoms of psoriasis on your toenail include:

  • pitting
  • thickening
  • unusual nail shape
  • yellow or brown color
  • chalky buildup under nail

Try to avoid removing extra skin under your nail with a sharp object, which can make your toenail more likely to detach. Instead, soak your feet in warm water and smooth the edges of your remaining toenail with a file. Keeping your toenails and feet moisturized can also help. Find a great selection of moisturizers here.

Your doctor may prescribe topical steroids to rub into your toenail and cuticle. They may also suggest phototherapy. This treatment involves exposing your affected toes to UV rays. In rare cases, you may need to have the rest of your toenail removed.

Nail psoriasis and nail fungus can look very similar. Here’s how to tell them apart.

Super sore? Once your bandage and Neosporin are on, soak your foot for 10 minutes in warm water and Epsom salts, suggests Fullem. “This will help draw out some of the soreness.”

Related: 7 Types of Bumps and Blemishes You Should Never Try to Pop

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“Often, after repeated micro-trauma, the nail may fall off without any bleeding or open skin lesion underneath, which can be left alone,” says Ward. Band-Aids and Neosporin are good options here, too, for an added layer of protection against infection.

If you’ve got a blister, to boot? Fullem suggests sterilizing a needle with alcohol and draining it.

Watch a hot doc explain why your feet are peeling:

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Repeat after us: Don’t. Pull. It. Off. Doing so can cause avoidable pain as well as unnecessary additional trauma.

Instead, trim the loose nail as short as you can so that it doesn’t snag on a sock or shoe (ow!), says Ward. Also: Don’t tape it back down. As Fullem puts it: “It will not re-attach.”

Unfortunately, you’ll just have to practice your patience for this one. “Each nail is a separate entity which takes six to nine months to grow,” he says. You’ll start to see a new nail growing in in about six weeks.

Related: 8 Weird Things That Can Happen to Your Fingernails—and What They Say About Your Health

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If you notice an uptick in pain, red streaking up your toe, swelling, or any smelly drainage, it’s time to make an appointment with a podiatrist, as those are all signs of infection.

Says Fullem: “The nail sits very close to the bones of our toes, and if an infection starts in the skin surrounding the nail it can easily travel to the underlying bone and cause a severe infection if left untreated.”

Cassie Shortsleeve Freelance Writer Cassie Shortsleeve is a skilled freelance writer and editor with almost a decade of experience reporting on all things health, fitness, and travel.

The Lowdown on Toenail Fungus

Toenail fungus is probably the topic that readers have asked us most about over the years. That’s not surprising since it is so common, so unpleasant, and so hard to treat. The fungus causes the toenail, particularly on the big toe, to thicken and discolor; the end may separate from the nail bed. Often, the nail is so thick you can’t cut it. In severe cases, the nail may detach and fall off.

Medically known as onychomycosis, toenail fungus is increasingly common, possibly because of lifestyle changes and an aging population. Though estimates vary, about 10 percent of Americans have it, and this increases to about 20 percent in people over 60 and up to 50 percent of those over 70. More men than women get it.

Diabetes, vascular problems, and impaired immunity are risk factors. About one-third of people with diabetes have toenail fungus. Smokers are at increased risk, too. It may be related to being sedentary, poor foot hygiene, nail trauma, family history, and genetics. There’s also a strong link between toenail fungus and athlete’s foot. Moist socks and shoes present an ideal environment for fungi, which helps explain why toenail fungus is less common in societies where people don’t wear shoes. On the other hand, going barefoot in damp areas also increases the risk.

Though usually just a cosmetic issue, toenail fungus can cause pain and difficulty walking, not to mention self-consciousness when wearing sandals or going barefoot. The diseased nails can cause ulcerations or breaks in the skin, which, by serving as an entry for bacteria, can result in serious infections (for example, cellulitis). This can be especially problematic in people with diabetes, who are already predisposed to foot problems and infections.

Toenail fungus is notoriously difficult to cure and rarely goes away on its own. Standard treatments are only moderately effective and, even when they work, the fungus may return. Which treatment you choose depends on the severity of the condition, the cost and other medical conditions you may have.

Preventing Toenail Fungus

Take three smart steps to keep your toenails free of fungus.

Mainstream toenail fungus treatments

Prescription oral antifungal drugs. Terbinafine (Lamisil) is more effective and safer than other oral antifungals, but it still has potential side effects, including stomach upset, rash, headaches, and, rarely, liver damage (thus, periodic blood tests are usually advised). It works by killing the fungus directly, rather than just halting its growth. Terbinafine can interact with other drugs and can’t be used by certain people, including women who are or may become pregnant and anyone with liver disease. Some health care providers now use “pulse dosing”—where the drug is taken daily for only one week a month for several months.

Prescription topical medications. Applied for 6 to 12 months, these clear nail lacquers have few side effects. Ciclopirox (Penlac) has a far lower cure rate than oral drugs, especially for thick nails, and is best used for milder cases. Two new topical treatments were recently approved for treating nail fungus: tavaborole (Kerydin) and efinaconazole (Jublia), which appear to be as effective as oral drugs. You might also talk to your doctor about amorolfine (Loceryl Curanail), which can be ordered online from Canada or the U.K. as a do-it-yourself kit, with disposable nail files, cleaning pads, applicators, and instructions. Sometimes oral and topical drugs are combined for better results.

High-tech toenail fungus treatment

Laser treatment. Several laser devices have received FDA clearance for the “temporary increase of clear nail in onychomycosis,” with an emphasis (ours) on temporary. Preliminary research suggests they may be promising, but overall the evidence is still limited and studies have been of poor quality. You can try this—if you can afford the high cost (typically $1,000, not covered by insurance). Another emerging (but also understudied) technology is photodynamic therapy, which involves applying a topical agent that is then activated by light.

Bottom line: If you have toenail fungus that is causing pain or other problems, see your primary care provider, dermatologist, or podiatrist. Anyone with diabetes, circulation problems, or an immune disorder who develops any type of foot infection should get immediate medical attention. Whatever treatment you choose, be patient, since the nail has to grow out before you can see if it is working, and that takes months.

Alternative Remedies for Toenail Fungus

Countless remedies have been tried to combat toenail fungus, including tea tree oil, olive oil, vitamin E, Campho-Phenique, oil of bitter orange, and Listerine. You may be surprised to learn that one popular OTC product may actually work.

Originally published September 2013. Updated July 2016.

Here’s What to Do If Your Toenail Is Falling Off

Photo: Vladeep /

If your toenail is about to fall off, you’re probably thinking “Help!” in sheer panic and making the same face as the “scream” emoji. But when it comes to losing one of these little guys, it pays to take a chill pill and wait.

Here’s everything you need to know about the super-common issue of losing a toenail.

Reasons Why You’re Losing a Toenail

An infection: “A fungal infection occurs when there’s an overgrowth of fungi under or on the nail. Fungi love warm, moist environments, which is why they are so common on toenails,” explains Sonia Batra, M.D., a dermatologist and cohost on the show The Doctors. Symptoms of an infection include yellowing and streaking on the nail, a flaky nail surface, and crumbling nails. Left untreated, the nail can detach from the nail bed entirely, she explains.

Trauma or injury: No infection? Any sort of trauma to the toe-such as a heavy object landing on it or a hard stub-can also cause the nail to fall off. “The nail will likely turn dark or black as blood builds up underneath it and puts pressure on it. It will likely fall off in a few weeks,” she says.

And, for all you avid runners: It’s not uncommon to lose a toenail from logging lots of training miles. “The repetitious action of your toe hitting the front of the shoe can cause injury to the nail, and cause it to eventually fall off,” says Dr. Batra. “Distance runners training for marathons often experience this, as well as those who are running in ill-fitting shoes or whose toenails are too long.” (P.S. You should also be stretching your feet post-workout.)

How to Deal with a Toenail That’s Falling Off

If it looks like your nail is headed for danger, resist the urge to tear it off. “Don’t rip off a broken toenail if it’s not ready,” says Dr. Batra. “If it’s barely attached and just hanging on, it should be fine to gently remove it with clippers.”

If you have doubts, though, it is best to leave it alone. Just file down any rough edges to keep them from catching on anything, treat any bleeding from the tear, clean the area, and make sure to monitor it for any signs of infection.

Your Nail’s Gone-Now What?

“If your toenail falls off and it’s bleeding, the first thing to do is apply pressure to the area until it stops bleeding. Then clean the skin underneath with soap and water and apply an antibiotic ointment to prevent infection before covering the open wound with a bandage,” says Dr. Batra. Keep the area clean and covered until the wound closes and heals.

If there are open cuts or tears in the underlying skin from the nail coming off, you should keep the skin cleaned and covered to prevent bacteria from entering and causing infection, she says. Once all open wounds have healed, it’s fine to leave the area uncovered-just make sure to keep it clean and dry.

It’s worth giving your toe a little extra TLC because you definitely don’t want an infection to spread to the new nail growing in.

“Redness/drainage/excessive pain could be signs of infection but not always,” says Said Atway, M.D., a podiatrist at The Ohio State University Wexner Medical Center. “The consequences of a bacterial infection in the toe are the same as the consequences of any other skin/soft tissue infection in that the infection could spread and lead to further detriment of the surrounding tissue,” he says. Obviously, not great-so if you think it could be infected, go get it looked at by a doc.

How to Keep the New Nail Safe

You’ll start to see a new nail coming in after about six weeks (yay!), but it’ll grow at your normal nail growth rate, says Dr. Batra. It usually takes about a year for a toenail to grow back out (from cuticle to tip). Here’s how to monitor the progress:

  • If you’re not sure why your toenail fell off in the first place, be sure to identify and fix the issue before the new one comes in, or else it could be susceptible to the same thing.
  • If you lost the old toenail to a fungal infection, treat the new nail with antifungal medication too.
  • Keep the new nail smooth and filed to keep ragged edges from catching on socks and breaking further.
  • Keep your feet dry, change your socks often, and avoid going barefoot in public locker rooms to prevent infections.
  • Wash your feet every day with soap and water and choose breathable socks.
  • If the new nail grows back crooked or damaged, see a doctor.
  • If there’s thickening or discoloration, keep the area clean and dry and use over-the-counter antifungal medications. If it doesn’t clear, see a doctor for stronger antifungal cream.

What about nail polish?

Even though it’s tempting to swipe on some red polish and pretend everything is ~fine~, you should avoid painting the new nail if possible. “If you have a big event coming up, you can paint the new toenail,” says Dr. Batra. “However, nail polish prevents maximum airflow to the nail, so the best way to ensure healthy regrowth is to keep the nail free of polish until it’s fully grown in.

If the toenail is falling off from injury, painting the new one isn’t too risky. But if it’s falling off from a fungal infection, you’ll likely make the infection harder to treat, she warns. Not to mention, “acetone-containing nail polish remover can also weaken the new nail plate as it grows in and make it more susceptible to infection,” she says.

You’re probably fine painting the skin while you’re waiting for the new nail to grow in. “Nail polish won’t damage the skin as long as it is healthy and there are no open cuts, blisters, or infections,” says Dr. Batra. (Related: These Nail Polishes Are Good for Your Nails)

How about an acrylic nail?

“If you lost your nail due to fungus, don’t get an acrylic toenail applied-it’ll make the problem worse as it provides a moist and warm safe haven for fungal infections,” says Dr. Batra.

If you lost it due to injury, however, an acrylic toenail is an option for a short-term fix (like a wedding), says Dr. Batra, but acrylic nails can interfere with optimal regrowth of the real nail. So consider stepping away from the nail glue and letting your body do its thing instead.

You can take some steps to heal from the inside-out too. “You can also take a biotin supplement, which helps strengthen nails and hair,” says Dr. Batra. “A healthy diet rich in protein may also help-the building blocks of keratin are found in foods like quinoa, lean meats, eggs, and yogurt,” she says. (Not to mention, those foods are great for your body, too.)

Otherwise, you just have to wait; there are no other effective quick fixes to get nails to grow faster, says Dr. Batra. You may hate having a naked toe for a few months, but it’s #worthit for the nail to grow in healthy, straight, and strong.

  • By By Isadora Baum

What To Do When Your Toenail Is Falling Off

But it’s true, we don’t do much with our toenails. Our fingernails are still essential. Itches demand scratching. Our fingernails enable us to pick up small objects, and folks with a creative bent can paint them up like 10 tiny blank canvases on which to display their personality.

But our toenails? In the remote past, having claws on our back feet helped us dig, served as climbing pitons, and provided defensive weaponry. But now? Not so much. Toenails have evolved to protect the tips of our toes and often become troublesome.

A lot of the trouble with toenails occurs when they get detached from their nail bed

Toenail detachment can happen because of fungal conditions or psoriasis. Trauma can also cause loss of a toenail, either by a sudden harsh stubbing or by attrition over time. Here we’ll describe the causes of a toenail falling off and what to do when the loss of a toenail has already occurred or has become inevitable.

Why and how your toenail falls off

Fungal infections under the toenail

  • Fungi thrive in environments that are warm and moist, and that’s often the climate inside your socks.
  • Athlete’s foot can morph into a fungal infection under the nail.
  • Diabetes can increase the risk of a fungal infection by restricting circulation in your feet.

Whatever its source, a fungus growing between your toe and its nail can erode the connective tissue between the two, eventually resulting in a complete detachment.

Symptoms of a fungal infection

  • A flaky surface
  • White or yellow streaking on a toenail
  • Crumbling on the edge of the nail
  • An unpleasant smell

How to prevent fungal toenails

You can increase your chances of avoiding fungal infections by keeping your feet dry, changing your socks frequently, wearing shoes with ventilation, keeping your toenails trimmed, disinfecting your nail clippers, and wearing protective footwear in damp communal areas, like spas or locker rooms.

Treatment of fungal toenails can include toenail removal

A fungal infection under a toenail can be stubbornly resistant, so a permanent cure can be a lengthy process. Most courses of treatment include oral medication and/or topical ointments.

Laser therapy is also an effective treatment for fungal toenails. In rare cases, the fungus may be so pervasive and resistant that a permanent resolution may require surgical toenail removal. See your podiatrist for the treatment appropriate for your particular condition.

Psoriasis

Psoriasis is a skin condition caused by the immune system mistakenly attacking healthy skin cells, leaving scaly red patches. It usually appears on surface skin, but it can also affect the area under your toenails. Psoriasis can cause a scaly accumulation of skin cells under the toenail. Eventually, the pressure can separate the nail from its bed.

The symptoms of psoriasis under a toenail are quite similar to the symptoms of a fungal infection, so an accurate diagnosis requires the attention of a podiatrist. Medicated creams can be prescribed to alleviate the symptoms, and phototherapy, involving intense spectrums of light, is sometimes helpful.

Blows to the toes

If you bang your toenail hard enough or often enough, that trauma can cause a toenail falling off, either suddenly and violently, or by the attrition of repetitive micro-impacts over time.

A toe can be the subject of trauma in a variety of contexts, such as contact sports, the fall of a heavy object, or a particularly harsh stubbing. Any application of sudden force to a toe (and it’s usually the big toe) can cause ruptures of blood vessels in the nail bed. The accumulation of blood (called a subungual hematoma) between the toenail and its nail bed will cause a dark blue or black toenail. As the blood continues to collect under the nail, the increasing pressure will gradually detach the toenail. This process can take several weeks.

Dedicated runners are at increased risk of a toenail falling off from running

The constantly repeated impact of a toe hitting the front of a running shoe can accomplish over an extended period of time the same result as a single sudden traumatic blow. The most effective way to prevent toenails falling off from running is by making sure that your running shoes fit perfectly, neither too short nor too long.

Triage treatment for toenails

If your toe and its nail have somehow become a bloody mangled mess, get to your podiatrist immediately.

If your toenail is partially detached, here’s what to do (heroics not necessary)

Your toenail is not going to reattach itself, so don’t bother trying to tape it down. Next, resist the urge to just get it over with. Even if it appears inevitable that the nail will eventually be lost, do not stoically rip it off. Clip off all of the detached portion and file down any rough edges. Clean the affected area, apply some antibiotic ointment to prevent infection, and then cover the toe with a bandage. Repeat the process as healing and regrowth progress. If any complications arise, see your podiatrist.

How long does it take for a toenail to regrow?

It can take about a year to a year and a half for a toenail to completely regenerate itself. During this process, keep your feet dry, change your socks frequently, and keep the new nail smooth, to prevent ragged edges from catching on your socks.

If you’re suffering with troublesome toenails, don’t hesitate to make an appointment with UFAI. The doctors at University Foot and Ankle Institute are here to help.

Our nationally recognized podiatrists offer the most advanced foot and ankle care, together with the highest success rates in the nation. We are leaders in research and treatment of all foot and ankle conditions.

For more information or to schedule a consultation, please call (877) 736-6001 or visit us at www.footankleinstitute.com.

  • About
  • Latest Posts

Dr. Avanti Redkar, DPM

Dr. Avanti Redkar is board certified in podiatric medicine and joined University Foot and Ankle Institute under a fellowship in sports medicine and ankle reconstruction. She attended podiatry school at the New York College of Podiatric Medicine and went on to complete her surgical residency at Good Samaritan Hospital in West Islip, New York, where she was trained in foot and rearfoot surgery, wound care, and hyperbaric medicine.
Dr. Redkar specializes in foot and ankle pathology and is available for consult at our Mid-Wilshire Los Angeles and Beverly Hills locations.

Latest posts by Dr. Avanti Redkar, DPM

  • How to Avoid Winter Foot Woes, Tips From our Doctors – December 5, 2019
  • Little Toe Hurts? Four Things to Know About Pinky Toe Pain – October 28, 2019
  • Worried About Your Wide Feet? Don’t Be! – September 24, 2019

The Dangers of Ignoring Toenail Fungal Infections

With all the serious health dangers out there, like cancer and diabetes, having a yellowed nail from toenail fungus can seem pretty insignificant. Since toenail fungus (onychomycosis) usually isn’t painful, many people put off seeking treatment, says Peter Joseph, DPM, a podiatrist with Allegheny Health Network in Pittsburgh. While many people are otherwise healthy and may just think of it as a cosmetic problem, ignoring a toenail infected with fungus could have health consequences beyond appearances. Potential complications of a toenail fungal infection:

Foot pain. Over time, a nail infected with fungus can become thick and misshapen, causing pain, Dr. Joseph says. It can even make it difficult to walk when wearing shoes, according to the American Podiatric Medical Association.

Spread of the fungus. Sometimes untreated toenail fungus can spread to the surrounding skin on the foot. This may result in athlete’s foot, a condition marked by itchy, red, cracked skin. “If you wear shoes and socks all day and one of your toenails is infected, it can spread quite easily because fungus thrives in a warm, dark, moist environment,” Joseph says. The fungus can also spread to the genitals, where it becomes jock itch, a condition that can affect both men and women, according to the American Osteopathic College of Dermatology.

Widespread infection. This complication of toenail fungal infection is of particular concern for people with diabetes and other chronic conditions that weaken the immune system. If a toenail fungus spreads to the skin and causes it to crack, bacteria can get in. This may cause cellulitis, a condition that produces swollen, red, tender skin and must be treated with antibiotics, according to the U.S. National Library of Medicine. In severe cases of cellulitis, the infection can enter the bloodstream and be deadly. “And it can all start from a simple fungal infection,” Joseph says.

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