Medical Issue

Toenail Fungus (Onychomycosis)

Toenail Fungus (Onychomycosis)

Toenail fungus (onychomycosis) is an infection related to the fungus that causes athlete's foot (tinea pedis). Onychomycosis grows inside and under the nail in the nail bed. It can cause the nail to thicken, yellow or darken, and the edge of the nail may grow ragged and crumble. The condition is a very common condition in adults, and is one of the most common patient issues in a podiatry office.


Symptoms include thickened and/or distorted nails that are dull and discolored, nail edges that are ragged or crumbling, and build-up under the nail surface. The disease typically affects more than one nail.

Risk Factors

Athlete’s foot sufferers are more likely to contract toenail fungus. Men are more likely to get toenail fungus than women, although women who get pedicures are more likely to contract the fungus. Living with someone who has toenail fungus increases the risk of acquiring it. People who perspire heavily, have skin conditions, diabetes or circulation problems face an increased risk for contracting toenail fungus. Environmental factors including a humid environment, walking barefoot in a public bath or pool area, or wearing shoes or socks that reduce ventilation can all lead to an increased possibility of contracting the fungus. Without prevention, athlete’s foot sufferers and anyone who had a previous toenail fungus infection is likely to be re-infected.


Toenail fungus thrives in moist, damp places, such as showers or shoes where humidity build-up and warmth help ensure transmission and growth of the organism. Walking barefoot in pools, showers, or locker rooms increases the likelihood of the spread of the fungus. Although the fungus can affect fingernails as well as toenails, toes are exposed more easily, are confined more frequently, and have less blood supply. Although not common, some patients with toenail infections will also have a fungal infection in a fingernail.


There are three general options for treating onychomycosis:

  1. Topical ointments and medicines including prescription drugs, and nail polishes
  2. Oral medications including prescription drugs, vitamins and supplements
  3. Laser therapy

Nail removal is also an option if other therapy is unsuccessful.

Topical solutions

Topical solutions include drugs such as Formula 3, Penlac, Ciclopirox, and Jublia.  They usually require application once or twice a day for periods which may be longer than one year, can have some side effects, and offer an overall efficacy (success) rate of 10-20% in solving toenail fungus issues.

Oral medications

Oral options include products such as Lamisil.  Treatment cycles are typically six months to over a year.  Efficacy rates are around 35%, but do not target all the types of fungus. Reinfection is very common after taking a prescription. Oral medications also have potential side effects including possible liver damage.


A laser solution can be more effective, requires typically 3-4 treatments, and no have efficacy rates of as much as 90%.  Older lasers were less effective; the result of using a different technology.

The Concierge Podiatry Advantage

Over 25 years, Dr. Roth has refined a treatment protocol that has proven more successful than other approaches.

  • Contact Concierge Podiatry for an appointment
  • Learn more about treatment options often used to treat this issue