How To Treat a Toenail Infection

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It’s estimated that over 10% of the adult population has, or will suffer from, onychomycosis, at some point in their lifetimes.

Onychomycosis is the medical term for a fungal infection of the nail.

It can apply to both fingernails and toenails, but it is most often found in toenails.

This can be an embarrassing issue for many sufferers. The discolored yellow toenails are not often painful (unless they lead to further infection), but they can be unattractive and can sometimes produce an unpleasant odour.

Toenail Fungus example
Source: Example of a Toenail Fungus infection prior to treatment with Terbafine

The first step to curing a toenail infection is to diagnose whether the problem is onychomycosis, or another nail condition.

Do I Have a Toenail Infection?

There are several treatments available to those suffering from onychomycosis, but it is important that you first confirm that you do indeed have a fungal infection.

The frail yellow nails associated to toenail fungus could have a different root cause.

For example, nail dystrophies look very similar, but will not respond to traditional antifungal treatments.

Nail dystrophy is where the nail thickens as a result of trauma or pressure applied to it, sometimes gradually over a number of years. It could be triggered by poorly fitting shoes applying too much pressure, or by poor circulation, or through a number of diseases.

There are various nail deformities that look like a fungus infection, but aren’t.

For this reason, we recommend you see a doctor to confirm the exact infection (if there is one).

Prescription Medication for Toenail Infections

The FDA has recently approved two new prescription medications to treat toenail infections: these are Jublia (efinaconazole) and Kerydin (tavaborole).

As we documented recently, Jublia had a complete cure rate of 15-18 percent in clinical trials that were concluded in 2014. This was after daily usage of the topical treatment for 48 weeks.

Kerydin resulted in a 6.5-9 percent complete cure rate.

These cure rates are modest at best considering the lengthy usage (almost a year) and the potential side effects.

Note: ‘Complete cure’ takes in to account complete removal of fungus and lack of any resulting side-effects. The total percentage of Jublia users who had no traces of fungus after the 48 week course was over 50%.

What are the side-effects?

Some users reported redness, itching, swelling or irritation of the toes. In the Jublia test, 2.3% of users suffered ingrown toenails, which may be a possible complication.

One issue of prescription medication for toenail infections is the cost.

It is expensive.

With a bottle of Jublia containing 80 drops costing around $550, somebody suffering from a toenail infection in all ten toes is likely to get through a bottle per week. Multiply that by 48 weeks and only those with good insurance coverage will be able to afford the full treatment.

Home Remedies for Toenail Infections

Predictably, there is a raft of home remedy treatments for toenail infections, many of which you can find highlighted (with their pros and cons) on this site.

The home remedies generally consist of:

  • Laser treatments
  • Antifungal creams
  • Footsoaks
  • Various miscellaneous ingredients that some users have found to be effective.

You can read our complete guide to treating infected toenails for a full breakdown of each treatment.

Whilst the non-prescription treatments have not undergone the same rigorous testing of Jublia or Kerydin, laser treatment shows some promising signs that should become clearer over the next couple of years.

Laser treatment for infected toenails works by heating the nail bed to disrupt fungal growth. Research suggests that fungi are sensitive to heat, around 40–60 °C (104–140 °F), and applying heat could destroy or prevent further growth of the fungi.

There are many laser treatment home kits that can be purchased for a relatively low price ($150-$250), and used in the privacy of the user’s own home. In addition, many local clinics now offer a laser treatment package for infected toenails.

While the evidence is still unclear, this is a promising option that may avoid some of the known side effects associated to antifungal pills and topical solutions.

How to Stop a Toenail Infection Coming Back

As with most medical issues, the best defence is prevention.

You should aim to maintain healthy feet and nails before fungus becomes a problem.

We have listed out several best practices for avoiding toenail infections, and stopping them from coming back in future.

These include:

Tips for Preventing Toenail Infections

  • Washing your feet regularly with an anti fungal soap
  • Keeping your nails trimmed short
  • Always drying your feet and toes thoroughly after getting them wet
  • Investing in sweat-absorbent socks. These will keep your toes dry even on a hot day or if you’re exercising
  • Only wearing shoes that fit well – ill-fitting ones will put pressure on your toes and allow the introduction of fungus
  • Avoiding going barefoot in public places – take flip flops with you to the gym and swimming pool
  • Starting treatment as soon as you spot the first signs of toenail fungus. This should stop the fungus spreading to the rest of your nails
  • Sprinkling anti-fungal powder in your shoes after use

Taking a proactive view of good nailcare should help you avoid any further toenail fungus infections.

If you find that a toenail infection returns after following all of the above, consult your doctor for further tests.