Fungi love dark, damp places, so your feet are especially vulnerable to fungal infection, says Rebecca Sundling, DPM, a podiatrist at Foot and Ankle Specialists in western Michigan.
Both toenail fungus and foot fungus are very common, and both can be caused by the same organism. However, they aren’t the same condition, and they are treated differently, she says. Read on to learn how to identify toenail and foot fungus, and how to prevent and treat both.
Toenail Fungus: Causes and Risk Factors
Toenail fungus is a fungal infection in the toenail. It happens when a fungus — anything from mold to yeast to other types of fungus — gets in the nail bed from a cut or break in the nail or repetitive trauma to the nail, and penetrates the nail itself, says Dr. Sundling. The nail then continues to grow with the fungus. Once a nail plate is infected with fungus, it will stay infected, and you must wait to see how it grows out and whether the new nail growing behind it is healthy. The new nail rarely grows in healthy without treatment, says Sundling.
Toenail fungus is very common — 14 percent of people have it in North America, according to research — and it’s more common the older you get, adds Sundling. Wearing shoes that are too small can damage the nail and make it more vulnerable to fungus, as can having a fungal infection on the skin of the foot (known as foot fungus or athlete’s foot) and not treating it, which could expose the nail to fungus. You may be more at risk to toenail fungus if you have diabetes, or a weaker immune system.
Signs and Symptoms of Toenail Fungus
When you have a toenail fungus, the nail tends to be thickened, discolored — yellow, brown, or dark white — and crumbly; it’s a little bit more brittle and breaks easily, says Sundling. It’s not always painful, but it may get painful as the nail gets thick and is pushed down into the skin, she adds.
Your Options for Treating Toenail Fungus
If you think you may have toenail fungus, you should see a podiatrist or dermatologist, who will send a specimen or a piece of your nail to a lab. Different types of fungus are treated slightly differently, so it’s important to know which type you have, says Sundling.
Also, sometimes the root of the problem is not a fungus at all, but rather another condition, or some kind of trauma to the nail bed — for instance, if you dropped something on your toe. There is no treatment for toenail trauma, but removing the nail may be an option if the nail is painful.
If you do have a toenail fungus, your doctor will likely recommend one or more of the following treatment options:
- Trimming the Toenail Trimming the toenail is usually combined with medication, but having a podiatrist periodically trim the nail down is helpful and allows the medication to work better, says Sundling. (Most of the time, the nail gets so thick that you can’t trim it yourself, she adds.)
- Prescription Topical Medications These are used the same way you would use nail polish. One such medication, efinaconazole (Jublia), has about a 50 percent success rate, says Sundling, and you must use it every day for 48 weeks. Another similar medication, ciclopirox (Loprox), has a 20 percent success rate, and you must use it for 11 to 12 months, she adds. One caveat: If you like painting your toenails with regular nail polish, you won’t be able to do so for the whole time you’re using these medicines.
- Oral Medications Terbinafine is an oral medication that most experts now recommend be taken for one week a month over three months, according to research — an approach known as pulsed dosing. Previously, the dosage was daily for three months, but that raised the risks of serious liver side effects, and the pulsed dosing approach appears to be at least as effective with reduced risks. Itraconazole (Sporanox) is another oral medication for toenail fungus. It’s 50 percent effective, and you take it for three months, says Sundling.
- Nail Removal Sometimes completely removing the toenail is seen as a treatment option for toenail fungus, says Sundling. There are two ways to do it: Permanently, so it never grows back (and then you won’t have a toenail anymore), or you can let it grow back in. Sometimes it grows back in as a healthy nail, and sometimes it grows back with the fungus.
- Home Remedies There are people who swear by applying Vicks VapoRub, oregano oil, or tea tree oil to the toenail daily, says Sunding. However, these home remedies have never been proven by research to be successful at removing a fungal infection, she adds.
- Lasers There are laser treatments for toenail fungus, but they can be very expensive and insurance doesn’t cover them, says Sundling. More research is needed to know whether lasers can provide safe and effective treatment for most people, according to the American Academy of Dermatology, but the U.S. Food and Drug Administration has approved several laser devices for the treatment of toenail fungus, as one review detailed.
- Ignoring It You don’t have to treat toenail fungus, as it’s mostly a cosmetic issue, says Sundling (though in some cases it can be painful). Some people put toenail polish on the affected nail and forget about it, she notes.
Foot Fungus: Causes and Risk Factors
A foot fungus is a fungal infection of the skin, better known as athlete’s foot, says Sundling. The fungus enters through cracks in the skin. It’s known as athlete’s foot because athletes and people who are more active and sweat a lot are more at risk. Kids are also more at risk, because they don’t tend to wear different shoes, and changing your shoes is one way to avoid foot fungus.
Foot fungus is very common. It does not mean that someone is dirty or didn’t bathe, and if you have a compromised immune system, you may be more susceptible, says Sundling.
Signs and Symptoms of Foot Fungus
Itchy skin is an early sign of foot fungus, or scaly, peeling skin, or tiny blisters on the skin that will pop at times, says Sundling. The skin tends to break out in the shape of a moccasin, or the area of the foot that a moccasin would cover. You don’t see foot fungus on the top of the foot very often. It’s common to get a fungal infection between the toes as well, she adds.
How to Prevent Both Foot and Toenail Fungus
While toenail fungus and foot fungus aren’t the same condition, the following tips can help you prevent both, says Sundling:
- Practice good hygiene, such as keeping your feet clean.
- Alternate your shoes during the week. Your feet sweat all day long. Alternating your shoes allows them to dry out, so the fungus can’t survive.
- Wear moisture-wicking socks that help dry out shoes and kill fungus. You can find these at running stores and athletic stores. If your socks are exceptionally sweaty, changing them more than once per day can help.
- Wear shoes in public places like locker rooms, pools, and gyms to limit exposure to fungus.
- Stay healthy to maintain a good immune system to fight off fungal infections.
- Wear shoes that fit well — most people wear shoes that are too tight and they don’t realize it.
- Use over-the-counter sprays or powders that help dry out shoes and kill fungus.
- Keep your skin dry, and don’t forget to dry between the toes after bathing, exercising, or sweating. A lot of people don’t dry between the toes, so the skin stays wet, which can lead to infection.
Your Options for Treating Foot Fungus
To treat foot fungus, you have the following over-the-counter and prescription options:
- Use an over-the-counter or prescription antifungal cream. For most people, the fungus should go away easily, and you might be able to self-treat, says Sundling. “I tell patients to buy the over-the-counter cream because it’s cheaper and it works just as well,” she says. If you have a very severe case, you can get antifungal creams with steroids mixed in — these are prescription only, she adds. See a podiatrist if you have a foot fungus that’s not going away, as it can spread to other parts of your body.
- Take oral medication. You can also take terbinafine (the same medication used for toenail fungus) for two weeks (as opposed to the once-a-week for three months it takes to treat a toenail infection with this medication). Doctors don’t often prescribe oral medication for a fungal infection of the skin unless it’s a really severe case, Sundling says.
Toenail vs. Foot Fungus: A Summary
While foot fungus is fairly easy to treat, toenail fungus is incredibly difficult to eliminate, and in some cases, it never goes away, says Sundling, noting that even the best oral medication is only up to 70 percent effective. However, if you’re patient and undergo the right course of treatment, you can have positive results. Moreover, keeping your feet dry and alternating your shoes will help you avoid getting a toenail or foot fungus to begin with.
Additional reporting by Jennifer D’Angelo Friedman.