Toenail Fungus: Treatments That Work and How to Prevent It

Thick, yellow, crumbly toenails aren't fun to look at, and plenty of people hide their feet all summer because of them. Toenail fungus is common, especially as we get older. It's treatable. It just takes patience.

What causes it

Toenail fungus (the medical name is onychomycosis) is usually caused by the same kind of fungi behind athlete's foot. They love warm, damp places: sweaty shoes, locker rooms, pool decks and shared showers.

You're more likely to get it if you:

• are older (nails grow more slowly and circulation can be weaker)
• have diabetes or circulation problems
• have athlete's foot
• sweat a lot or wear closed shoes all day
• have injured the nail before

Signs to look for

• a nail that's thickened, yellow, brown or white
• crumbling or ragged edges
• a nail that's lifting away from the skin underneath
• sometimes a mild unpleasant smell

Other conditions, such as psoriasis or a past injury, can look a lot like fungus. That's why it's worth getting a diagnosis before spending months on treatment.

Treatments with the best evidence

Prescription pills

Oral antifungal medicines, especially terbinafine, have the highest cure rates for toenail fungus. They're usually taken for about three months. Your doctor may order blood tests, because these medicines can affect the liver in rare cases, and they can interact with other drugs.

Prescription nail solutions

Topical treatments such as efinaconazole and ciclopirox are painted onto the nail. They're often used for milder cases or for people who can't take the pills. They have lower cure rates than oral medicine and need to be used daily for many months.

Other options

Your doctor or podiatrist may trim and thin the nail so treatment soaks in better. Laser treatments exist, but the evidence for them is more limited, and they're usually not covered by insurance.

What about home remedies?

You'll find plenty of online advice about tea tree oil, vinegar soaks and even chest rub. Here's the honest picture: some of these have shown mild effects in small studies, but none come close to the cure rates of prescription treatment. They're unlikely to hurt a healthy adult with a mild case, but they're not a reliable fix, and they can delay treatment that works.

If you have diabetes, skip the home experiments and see your doctor or a podiatrist. Foot problems can become serious quickly when you have diabetes.

How long it takes

This is the part that tests everyone's patience. Toenails grow slowly, and a whole new big toenail can take 12 to 18 months to grow in. Even when treatment kills the fungus, the damaged part of the nail has to grow out before your toe looks normal again. Clear nail growing in from the base is the sign it's working.

How to prevent it (or stop it coming back)

• Keep your feet clean and dry, especially between the toes.
• Wear moisture-wicking socks and change them if they get damp.
• Rotate your shoes so each pair dries out.
• Wear sandals or shower shoes in locker rooms, gyms and pool areas.
• Treat athlete's foot quickly.
• Don't share nail clippers or files.
• Cut toenails straight across and keep them short.

When to see a doctor

See a doctor or podiatrist if your nails are painful, if the skin around them is red, swollen or draining, if you have diabetes or poor circulation, or if you'd like to try prescription treatment.