Toenail infection

Toenail infections are usually highly unsightly, often uncomfortable, and in some cases can lead to further infection and problems with your feet. Most toenail infections are fungal. Sometimes it affects the skin as well.

If your toenails have a fungal infection it will usually disfigure the nails, but can also cause physical pain and impair the ability to work.

Something interesting to note is that nail fungi affect toenails four times more often than fingernails. It can also spread from nail to nail, or from foot to foot. However, if you get a fingernail infection it is usually limited to one nail, or one hand.

Most commonly, toenail infection is caused by the nail being exposed to a warm moist environment. This is the most ideal environment for a fungus to develop. It usually start on the nail or under its outer edge. This is called onychomycosis. The type of fungus is what determines how severe it is and what the symptoms may be.

In some cases the fungus may turn the nail yellow, gray, brown, or black. Other times the nail may become brittle and crack. In more severe cases it may separate from the nail bed. If the fungus gets under the nail, or on the skin, then the surrounding skin may be red, itchy or swollen. Of course, how bad the symptoms are really depends on how early you catch nail fungus, and how you treat it.

Another toenail infection can cause thickened toenails.

Thickened toenails: Sometimes if your toenail undergoes physical damage it may cause it to be thick until the damaged area grows out. Many young men who play contact sports, such as football will have thickening of their big toes. Elderly people often have thick, hard toenails as well because of years of damage adding up. They may also have thicker toes because they stub them more often, or because the nails grow more slowly as you age, which means the damage takes longer to repair.

Sometimes fungal infection can make your nails thick as well. The most common infection that causes thickening of the toenails is Trichophyton rubrum, the same fungus that causes athlete's foot. Occasionally, other types of fungus, such as yeasts, are responsible, and people who have been abroad may have some quite exotic fungi that can cause thickening as well. Another cause of thickening could be psoriasis, a skin condition, that will make nails thick, with tiny pits on their surface.

Of course, thickened toenails is not the most common toenail infection, fungal infections are. Let's take a closer look at fungal infections:

How a fungal infection occurs:

Typically fungal infections are caused by moisture and heat, which was noted previously. However, it is important to understand that it is easy to pick up fungi, especially if you are using communal showers, or changing rooms frequently, such as at a gym, or a pool. The other thing that most people do not realize is that they may already carry the fungus on their skin, and it is just waiting for the right environment where it will thrive, which is somewhere warm and moist.

Because we wear enclosed shoes, sweat often gets trapped in the heat, and this makes for the ideal place for fungus to grow and spread. Research has shown that areas where no shoes, or open shoes are worn, have far fewer toenail infections than places where closed toed shoes are common. If you wear closed toes for long periods of time, especially in wet or moist environments, you need to take extra precautions in order to avoid fungal infections.

When a fungus affects the toenail it typically will shelter under the tip of the nail and start to get a hold. The likelihood of a fungal infection increases significantly under the following circumstances, so to avoid this embarrassing, and gross problem, try to avoid the following situations:

• Infections are more likely if the end of the nail has been damaged, or is already slightly separated from the end of the toe. This happens when you stub your toe, or if you wear shoes that do not fit right. So, get the sizes, and watch where you walk.
• Infection is more likely if you are taking long-term tetracycline medication and then expose your toenails to sunlight - this is called photo-onycholysis, and is hard to avoid. However, if you are on this medication, consider wearing closed toed shoes out of doors.
•  If you have a condition such as diabetes or an immune deficiency. Staying healthy in all aspects is going to help you to keep your toenails healthier.
• If you are elderly. Nails take longer to grow and longer to heal, making it easier for fungus to take room.
• If you already have fungus multiplying between the toes, such as in the case when you have athlete's foot.

If you do not do something to take care of a toenail infection, the fungus will very gradually spread towards the base of the nail and down the sides, loosening the nail from the underlying toe and filling the separated area with crumbly, yellowish-white gunk. The nail itself becomes thicker and yellowish brown in color, while this happens over years and months, it is very gross, and not good for your foot health, so do what you can to identify when you have an infection, and take the steps to treat it.

The first step in treating a toenail infection is recognizing it. There are a number of types of fungal infections, so let's take a look at what they are, and what the nail will look like if it has this particular infection type.


Distal subungual onychomycosis, or DSO: This is a toenail infection with the fungus dermatophyte. This fungus type will invade the space between the tip of the toe and the nail tip. The nail turns yellow, and starts to separate from the nail bed.

White superficial onychomycosis, or WSO: This is a fungus that affects only the surface of the nail, it turns it white and crumbly in spots. This is one of the most easily treated infections because you can scrape it off, and use a topical antifungal medication to stop it from returning.

Proximal subungual onychomycosis, or PSO: This is the least common of nail fungi. It starts our white or yellowish near the cuticle, and as it gets worse a plaque collects under the nail, eventually the nail lifts and falls off the bed.  It is treated with a systemic drug.

Candida Albicans (yeast infection): This is typically a fingernail problem, not a toenail, but it can infect toes, turning them yellow or green or the nail may look opaque. This infection is best treated topically.

Okay, so now that you understand the basics of the different infections, let's look at how to treat them:

Topical ointments and antifungal powders help contain a fungus infection, but not cure it. Usually it requires more serious treatment.

One standard treatment is an oral drug called griseofulvin. This prevents the fungus from spreading until the infected nail grows out.

Another commonly used medication is ketoconazole. However, this can take months to work, and has serious side effects.

A topical cream called Lamisil, has been shown to be effective.

Terbinafine is an oral medication that has achieved an 80 percent cure rate if you take it for three months.

There are also many home remedies you can try to treat toenail infections. If you notice a symptom of infection, start a home remedy right away to help you eliminate fungus faster:
 
Vinegar:  To use this treatment option, fill a basin with warm water and vinegar in equal proportion. Then soak your toenails for 20 minutes. Then wipe them dry, and do not cover them until they are all the way dry. Do this twice daily till symptoms disappear.

Tea Tree Oil: Tea tree oil is a natural and powerful fungicide and antiseptic, and is a great home remedy, simply rub the affected toenails with a cotton ball dipped in tea tree oil twice a day until the fungus is gone.

Listerine: While this is a mouthwash, it also makes a great fungal treatment. Soak your infected toenails in Listerine for 20 minutes twice daily.


Rubbing Alcohol: Rubbing alcohol is an inexpensive way to treat toenail infection. Soak affected toes, for about 20 minutes twice daily. Then be sure to dry them thoroughly.

Hydrogen Peroxide (3%): Hydrogen Peroxide (3%) treatments of soaking twice a day for 20 minutes is another way to treat infection. Sometimes straight hydrogen peroxide is a bit harsh, so dilute it with some water.

Of course, while it is treatable, the best thing you can do is simply prevent it. In recap the best way to prevent fungal growth is to do the following:

• Keep the nails dry and clean
• Change socks often, even several times a day if your feet get wet, or sweat much
• Use an antifungal foot spray or powder if you are worried
• Avoid cutting or tearing the skin around the toenails since this may be an entry point for infection