Beautiful, healthy nails are about more than just appearance
Anyone who enjoys wearing open-toed sandals or flip-flops in summer knows how nice it feels when well-groomed, healthy-looking nails are on display. However, good nail appearance is only one of the reasons why proper nail care is important. Fungal toenail infections, also known as onychomycosis, do not resolve on their own. If left untreated, the fungus gradually spreads, affects an increasing portion of the nail, and can eventually destroy the nail structure completely.
People with circulation problems should pay particular attention to nail care. According to Dr. Ami Sheth, a doctor of podiatric medicine practicing in Los Gatos, California, and a spokesperson for the American Podiatric Medical Association, impaired circulation makes wound healing more difficult.
“When the skin is damaged or cracked, it creates an entry point for fungal skin infections, which can later develop into bacterial infections,” the doctor emphasizes.
Because toenail fungus is usually painless in its early stages, many people are unaware they have a problem for a long time—especially if they do not regularly examine their feet.
Completely avoiding contact with microscopic fungi is practically impossible—they are found wherever there is warmth, moisture, and poor ventilation. However, proper daily foot care can significantly reduce the risk of infection.
Clean, dry feet and properly trimmed nails help prevent fungal colonization. For fungi to grow, there is usually a disruption of the natural connection between the nail and the skin or the presence of micro-injuries, explains Dr. Sheth.
“Such injuries can be caused by improper pedicures, tight footwear, or repetitive physical stress such as running or hiking, when nails are constantly compressed or lifted from the nail bed,” she notes.
She also points out that individual susceptibility varies greatly: some people become infected easily, while others remain unaffected even when living with someone who has a fungal infection.
If a fungal infection does occur, the following measures may help prevent its spread:
Wash your feet thoroughly before putting on socks and shoes, and dry them carefully, especially between the toes.
Trim nails straight across and not too short, so the nail edge does not extend beyond the tip of the toe and injure the tissue beneath the nail.
Wear comfortable, breathable shoes. If your feet become sweaty, change your socks as soon as possible.
Regularly spray the inside of shoes with over-the-counter antifungal products (e.g., Cutasept F), as shoes provide an ideal environment for fungal growth.
Always wear flip-flops or sandals in public areas where people commonly walk barefoot, such as locker rooms, swimming pools, and shared showers.
Thoroughly clean and disinfect nail clippers, files, and other pedicure tools after each use.
Getting rid of an established toenail fungal infection is often challenging. Successful treatment depends heavily on consistency and strict adherence to the prescribed treatment plan.
“Over time, the fungus penetrates deeper into the nail tissue—progressing from a small discoloration to a thickened, deformed nail and eventually to a nail that is completely overgrown and damaged by fungus,” explains Dr. Marlene Reid, a doctor of podiatric medicine from Naperville, Illinois.
Treatment strategies depend on the severity and depth of the infection. In milder cases, such as superficial white onychomycosis, the white fungal patches on the nail surface can sometimes be gently filed down, and the remaining nail treated with over-the-counter topical antifungal medications.
When the fungus affects deeper layers of the nail, topical treatments alone are often insufficient, as they do not penetrate deeply enough to eradicate the infection completely. In such cases, longer treatment courses or prescription medications may be required.
Signs of more advanced infection include thickened, discolored nails that may eventually become painful. In these situations, consulting a podiatrist is recommended. A comprehensive treatment plan may include:
Removal of affected nail portions to relieve pressure and improve the penetration of topical medications.
Topical treatments (such as medicated nail lacquers or creams), which require long-term and consistent use.
Oral antifungal medications, such as terbinafine or itraconazole, which are typically taken for at least three months and have good success rates when used correctly, but require medical supervision and monitoring of liver function.
In very advanced cases, the nail may be removed surgically or chemically. Sometimes only part of the nail is removed to allow the remaining portion to grow back healthy. If the entire nail is removed, temporary artificial coverings or light-cured protective materials may be used to shield the nail bed while a new nail grows.
Home remedies, such as tea tree oil, are not sufficiently supported by scientific evidence and are not recommended as primary treatments.
The FDA has also approved certain laser devices that can temporarily improve the appearance of nails affected by onychomycosis. However, clinical results have been inconsistent, and laser treatments are often not covered by insurance. Before choosing laser therapy, it is important to consult a healthcare provider to understand realistic expectations and check insurance coverage.
