© SKI Publishing
About Foot Fungus: Tips for Toenail Treatment
By Christine Dobrowolski,
The medical term for toenail
fungus is "onychomycosis," pronounced
on * EE * ko * my * ko * sis, and represents both the fungal and yeast
elements that can affect the toenail. Six to nine million Americans are
affected with toenail fungus and athletes tend to be affected at a higher
rate. In a recent study of NBA and WNBA players, 89% of players had onychomycosis
at some time during their career. It is of no surprise that athletes
are more susceptible to developing toenail fungus. The combination of
a closed-in shoe and increased warmth and moisture from sweating create
a perfect environment for fungus to grow.
There are a number of treatments for onychomycosis. The most aggressive
and effective treatments are with oral anti-fungal medications. The most
common oral anti-fungal medications are Itraconazole (Sporonox ®)
and Terbinafine (Lamisil ®). Both medications are taken once daily
for 3 months, although they continue working for up to 9 months. The
effectiveness of the medications ranges from 60 to 80%, with a recurrence
rate of 15%. Lamisil® appears to be more effective and has fewer
drug interactions than Sporonox®, but both medications are equally
expensive. With both medications there is a long list of benign side
effects including nausea, vomiting, abdominal pain, diarrhea, rash, headache,
taste disturbances and dizziness. Serious adverse effects are very rare,
less than 0.5%, but do include hepatitis and acute hepatic necrosis.
Luckily, there are many other options besides oral anti-fungal medications.
Unfortunately, they are not very effective. The most effective topical
medication is Ciclopirox (Penlac ®) lacquer. Some studies have shown
cure rates up to 60%, but in my experience the effectiveness is about
10-15%. Side effects occur in less than 2% of patients and include burning
and redness around the nail. This medication is only available by prescription
and is also expensive. Another prescription topical is a urea based medication
called Carmol® 40. This medication helps to decrease thickness of
Home remedies that can be used include bleach, tea tree oil, grapeseed
extract, Vics VapoRub® and others. With any home remedy or non-prescription
topical, you must understand that the effectiveness of the treatment
is fairly low, less than 10%. If you do try one of these therapies make
sure to use it every day. File the top of the nail down to roughen up
the surface and apply the medication with a q-tip. Bleach can cause skin
irritation and some individuals have had skin reactions to the Vics VapoRub®.
In most cases the few side effects that have occurred with these topicals
are minimal and they are considered very safe.
To increase the effectiveness of the treatment, I recommend combination
therapy. If you choose to take an oral medication, make sure you use
a topical anti-fungal agent as well. Nail removal is also an option.
Once the nail is removed, the topicals can reach the nail bed and become
more effective. The nail will grow back in over a period of 8-10 months.
Permanent nail removal is reserved for those with chronic ingrown nails,
ulceration under the nails or pain from the fungal nails.
The best form of treatment is prevention and preventing the fungus from
spreading to other toenails may be the best treatment option. I recommend
choosing a topical that you feel comfortable with and use it once a week.
No matter which treatment option you choose, you should take the following
steps to avoid re-infection.
- Make sure you
rotate your shoes often and keep them in a cool dry place.
your insoles frequently, and make sure they dry out between use.
- Place an anti-fungal
powder or spray in the shoes to help fight off the fungus.
out the shower on a weekly basis and wash your shower mat regularly
in hot water.
- Make sure your
athletic shoes fit well to prevent jamming at the toes. Jamming
at the toes leads to microtrauma at
the nails and increases
chance for fungal infection.
- If you belong
to a gym or health club, wear sandals in the locker room and don't
- Don't keep your
shoes in the gym locker where they cannot dry out.
- If your feet sweat
excessively, try using an antiperspirant spray on your feet before
The bottom line is
that treating onychomycosis is very difficult. If you have fungal toenails
that cause pressure, pain or infection,
talking to your doctor about prescription medications or nail removal.
Make sure you take precautions to prevent re-infection and take multiple
approaches to eradicate the problem. If your fungal toenails are
only unsightly and don't cause any discomfort, try a weekly application
of an over the counter topical along with methods to prevent re-infection.
is a podiatrist, runner, and author of "Those Aching Feet:
Your Guide To Diagnosis and Treatment of Common Foot Problems," available
via her publisher, SKI Publishing, and at Barnes & Noble and Amazon.com.
by Dr. Christine Dobrowolski, DPM