Toenail fungus is termed medically “onychomycosis” and is a microscopic infection of the surface of the toenail by fungal organisms. Most commonly this is from the fungal group called dermatophytes.
The toenails fall victim to this infection as they are vulnerable around damp areas such as in showers, pools, locker rooms and in shoe gear. Once these dermatophytes grab hold of the toenail the nail often becomes discolored, darker yellow/brown, and may develop a foul odor.
Debris forms under the nail plate and lifts it from the underlying bed. The fungus may then spread to the adjacent toes or even to the fingers. These thick nails make self-trimming difficult and the pressure on them can be painful with shoe wear.
Patients who have chronic athlete’s feet and who are immune suppressed, such as is seen with diabetes and peripheral arterial disease, are particularly susceptible.
Toenail fungus usually goes ignored for many years. It is often the change in cosmetic appearance of the toenail which brings a patient in for evaluation. Diagnosis is made from the characteristics seen on clinical exam of the affected nail plates. These nails may present with:
• White powdery appearance on the nail surface
• Thickened yellow and brown debris under the nail
• Pain may or may not be present
Nail plate biopsy and samples for fungal culture can confirm the diagnosis, however, such tests are usually not required.
An appropriate treatment plan for fungal toenails is individualized depending upon the patient and their general health status. Determining the risk of treatment versus the benefit is an important consideration when choosing the best treatment plan.
• Debridement of the nails
• Topical medications applied on the nail surfaces
• Oral antifungal medications
• Laser therapy
• Surgical nail removal
Non-surgical Options for Treatment of Toenail Fungus
Debridement involves the routine removal of portions of the thickened diseased nail to de-bulk the nail and provide maintenance for the condition.
Topical antifungal agents may be applied directly to the affected nails but usually require up to 10-12 months of daily application. This treatment can be expensive and may have only marginal success.
Oral antifungal agents offer the best chance for resolution of the toenail fungus, but proper patient selection due to medication risks must be considered.
Laser treatments are rarely covered by insurance plans and their results are still not as promising as would be hoped for.
Surgical Options for Treatment of Toenail Fungus
Surgical options would involve either temporary or permanent nail removal. Temporary removal of the nail however does not treat the underlying fungus and subsequent regrowth will often lead to recurrence. Permanent nail removal is reserved as a treatment of last resort.