Sophia Delgado
Toenail fungus is a common condition that causes the nail to become thick, discoloured, and brittle. While it is not a serious infection, it can be challenging to treat and may take a long time to resolve. In rare cases, toenail removal may be recommended as a last resort if other treatments have failed. However, removing the nail does not guarantee that the fungus will be cured, as the fungus can persist in the nail bed. Additionally, nail removal carries a risk of complications, including thickened nail regrowth or re-infection. Before considering nail removal, it is essential to explore non-surgical treatment options, such as topical or oral antifungal medications, which can effectively clear the infection and promote healthy nail growth.
| Characteristics | Values |
|---|---|
| Is nail removal necessary to cure a fungal infection? | No, it is the last resort. |
| Are there other treatment options? | Yes, including laser therapy, light therapy, anti-fungal gels, oral medication, and topical medication. |
| What are the risks of nail removal? | The nail may grow back misshapen, thickened, or with the fungus re-infecting the nail. |
| How long does it take for the nail to grow back? | It can take up to 18 months for the nail to grow back completely. |
| What happens after the surgery? | The doctor applies antibiotic cream and a bandage to the nailbed, and the patient must keep the area elevated to reduce pain and swelling. |
| How effective is nail removal? | Exposing the nailbed allows topical medications to penetrate and treat the fungus more effectively. |
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What You'll Learn
Toenail fungus treatment options
Toenail fungus is characterised by thick, discoloured, and brittle nails that can cause pain and embarrassment. While it is not a serious infection, it can take a long time to treat and often requires a combination of treatments.
Toenail removal is a last resort for treating toenail fungus, as there is no guarantee that the new nail will grow back properly. The nail may grow back thickened, misshapen, or with the fungus re-infecting the nail. However, in rare cases, permanent nail removal may be an option. Toenail removal exposes the nail bed, allowing topical medications to penetrate the nail bed as the nail grows back, potentially increasing the efficacy of these treatments.
There are several non-surgical treatment options for toenail fungus. Laser therapy is a new method that uses light energy at specific wavelengths to pass through the nail tissue and attack the fungus without causing any pain or damage to the nails or skin. Oral antifungal medications are another option, but they may have negative side effects, so it is important to consult a doctor and get a blood test before starting treatment. Topical antifungal gels and creams can also be applied directly to the nail, although their success rate varies depending on the severity of the infection. In addition, it may be necessary to file down the nails to allow the medication to penetrate deeper.
To prevent toenail fungus, it is important to be cautious in warm, dark, and moist places like communal showers and gyms, as the fungus that causes athlete's foot can spread to others and infect the toenails. Catching a fungal infection early can save time and increase the chances of treatment success.
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Laser treatment for toenail fungus
Toenail fungus, also known as onychomycosis, is a fungal infection that causes tissue damage to the nail matrix or plate bed. It is typically caused by yeasts, non-dermatophyte molds, and dermatophytes. The infection causes the nail to thicken and yellow, become distorted, and eventually crumble away.
The success of laser treatment depends on the type of laser used. Multiple treatments are often required, and even then, the fungus may return. Laser therapy is generally considered a safe option with few adverse effects. It is particularly suitable for patients experiencing adverse events with systemic antifungals, as well as individuals with diabetes, older individuals with drug intolerance, and patients with liver and kidney problems.
While laser treatment offers a promising approach to combating toenail fungus, it is not a cure. The data show mixed results, and a sustained cure has proven elusive. Therefore, it is essential to consult with a board-certified podiatrist to determine the best course of treatment for toenail fungus.
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Oral medication for toenail fungus
Toenail fungus is a common condition that can damage the nail's structure and appearance. While non-surgical treatments are usually preferred, in some cases, surgery may be recommended to remove the nail. However, this is considered a last resort as it does not guarantee that the new nail will grow back properly, and the fungus may re-infect the nail.
Oral antifungal medications are an effective alternative to treat toenail fungus without resorting to nail removal. These medications work by delivering the treatment through the bloodstream, attacking the fungus from the inside out. There are three main groups of oral antifungal medications commonly used: griseofulvin, azoles (including itraconazole, fluconazole, albaconazole, posaconazole, and ravuconazole), and terbinafine.
Terbinafine is a widely studied oral antifungal medication for toenail fungus. It is available by prescription only and comes in tablet or granule form. The typical dosage for adults is 250 milligrams once daily for 12 weeks. It is important to continue taking terbinafine for the full duration of treatment, even if symptoms improve, as fungal infections can be slow to clear up. Additionally, maintaining a constant amount of the medication in the blood by taking doses at the same time every day is recommended for optimal results.
While oral terbinafine has shown effectiveness in curing toenail fungus and achieving a normal-looking nail, it is not without potential side effects. Before prescribing terbinafine, a doctor will consider the patient's medical history and may request a liver enzyme blood panel to determine the safety profile of the medication for that individual. Studies have not been conducted to establish the safety and efficacy of terbinafine in children and the geriatric population. Therefore, caution is advised for elderly patients due to an increased risk of liver, kidney, or heart problems.
Oral azoles, such as itraconazole, fluconazole, albaconazole, posaconazole, and ravuconazole, are another group of antifungal medications that have demonstrated effectiveness in treating toenail fungus. Compared to placebo, azoles have shown better outcomes in achieving a normal-looking nail and curing the infection at a microscopic level. However, as with any medication, it is important to consider the potential benefits against the risks when deciding on a treatment option. Consulting with a doctor is essential to determine the most suitable treatment for toenail fungus, considering the individual's medical history and the potential side effects of the medication.
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Toenail removal surgery
On the day of the surgery, you can typically shower, eat, and take your usual medications unless advised otherwise. The surgery itself is performed under local anaesthesia to numb the toe and reduce pain. Depending on the specific condition, the podiatrist may perform a partial nail avulsion, which involves removing one or both sides of the infected nail, or a total nail avulsion, which involves complete removal of the nail. The surgery usually takes less than an hour, and you will be able to walk out of the clinic afterward.
After the surgery, your doctor will apply an antibiotic cream and a bandage to the nail bed to prevent bacterial infection. You will need to keep your leg elevated above the level of your heart for the first 48 hours to manage pain and swelling. During this time, you may experience pain, throbbing, swelling, bleeding, or fluid coming from the wound. Your doctor will provide detailed instructions for post-operative care, including how to change your bandages regularly. It typically takes about 2-3 weeks for the nail bed to heal, and nail regrowth can take up to 18 months.
While toenail removal surgery can be effective, it is important to consider the risks. There is a chance that the new nail may grow back misshapen, thickened, or with a fungal infection. As such, non-surgical treatments are usually preferred, and surgery is often a last resort when other treatments have failed.
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Toenail fungus prevention
Toenail fungus is usually treated with medication, but in rare cases, surgery may be required to remove the nail. However, nail removal does not guarantee that the new nail will grow back properly, and the fungus may re-infect the nail. To avoid this, here are some tips for toenail fungus prevention:
Keep your feet clean and dry: Wash your feet daily with soap and water, especially between your toes, and dry them thoroughly. Fungi thrive in warm, damp environments, so keeping your feet clean and dry can help prevent toenail fungus.
Choose the right footwear: Avoid tight, snug-fitting shoes that cause your feet to sweat. Opt for breathable shoes made of materials like leather, canvas, or mesh that allow for airflow.
Wear moisture-wicking socks: Choose socks made from synthetic fibres that pull moisture away from your feet. Change your socks daily and put on a fresh pair if they become sweaty.
Trim your toenails: Keep your toenails short and trim them straight across. This helps prevent fungi and other germs from collecting under your nails.
Disinfect your nail tools: Sanitize your nail clippers, files, and scissors after each use. Wash them with warm water and soap, then disinfect with rubbing alcohol.
Treat athlete's foot: Fungi that cause athlete's foot can spread to your toenails. If you develop symptoms such as cracked, scaly, or peeling skin on your feet, or itching, burning, or stinging between your toes, treat it immediately.
Avoid going barefoot in public: Wear shower shoes or flip-flops in public pools, locker rooms, and showers. Fungi spread easily, so protect your feet from coming into contact with infected surfaces.
By following these prevention tips, you can lower your risk of developing toenail fungus and maintain healthy, clear nails.
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Frequently asked questions
Removing the nail is the absolute last resort option for treating nail fungus and is only performed in rare cases. Non-surgical forms of treatment are preferred, such as topical or oral antifungal medications.
Alternatives to nail removal include laser therapy, light therapy, and other surgical procedures that kill the fungus. Topical antifungal gels or nail medicines can also be used, as well as oral antifungal tablets.
After nail removal surgery, the doctor typically applies an antibiotic cream and a bandage to the nailbed to prevent bacterial infection. The patient is advised to keep their arm or leg elevated above the level of their heart for 48 hours to help with pain and swelling. The nailbed usually heals within 2-3 weeks, and a new nail may take up to 18 months to grow back.
