Noah Sinclair
Toenail fungus is a common condition that can be treated in a variety of ways, depending on the severity and duration of the infection. While mild cases can be treated with over-the-counter antifungal creams, gels, sprays, or patches, more severe or persistent infections may require prescription medication or even surgical intervention. In rare cases, surgical nail removal may be recommended, where a doctor will loosen the skin around the nail and remove it from the toe. This procedure is typically a last resort, as it can be painful and the nail may take up to a year or more to grow back. To prevent reoccurrence, it is important to follow your doctor's instructions for wound care and complete any prescribed medication to ensure the fungus is eradicated.
| Characteristics | Values |
|---|---|
| Surgical treatment | Doctors loosen the skin around the nail and remove it. This procedure is rare and a new nail usually grows back within a year. |
| Non-surgical treatment | Doctors trim and file the nail to help products penetrate deeper. Antifungal pills, creams, gels, sprays, and patches are also available with or without a prescription. |
| Nail matrix removal | Doctors can destroy the nail matrix by applying a chemical to the cuticle area to prevent future infection. |
| Laser treatment | Laser heats up the nail layers to destroy the fungus' genetic material. Treatments take about 30 minutes, and at least two treatments are needed. |
| Antifungal medicine | Doctors may prescribe medicine that can be painted onto the nails daily. |
| Natural remedies | Tea tree oil has shown mixed results in studies, with one study showing its effectiveness on par with clotrimazole cream when applied twice daily for six months. |
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What You'll Learn
Surgical toenail removal
Before performing the surgery, a podiatrist will conduct a thorough examination of the affected toe to determine the extent of the problem, including an assessment of the nail, surrounding skin, and any symptoms you may be experiencing. This step is crucial to tailor the treatment plan accordingly.
On the day of the procedure, your podiatrist will administer a local anaesthetic to numb the toe and ensure your comfort during the surgery. The specific technique employed will depend on the underlying condition. For example, partial nail avulsion involves removing one or both sides of the infected nail, while total nail avulsion, or Zadek's procedure, entails complete removal of the nail and, in the case of Zadek's procedure, the underlying tissue from which it grows. In some cases, a chemical may be applied to the nail matrix to prevent regrowth.
After the surgery, your podiatrist will provide you with aftercare instructions to ensure proper healing. Generally, it is recommended to keep the dressing dry, elevate your leg for a few days to reduce swelling, and refrain from strenuous exercise for at least two weeks. You may also be advised to wash around the wound with clean water twice a day and apply petroleum jelly and a non-stick bandage to promote healing.
The recovery time can vary, but it is common to experience some discomfort and swelling for a few days post-surgery. Most people take at least two days off work to rest and recover, and toenails typically take 12 to 18 months to grow back completely.
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Antifungal pills
Oral medications have higher cure rates and shorter treatment times compared to topical alternatives. However, it can still take 9 to 12 months to see full results. Antifungal pills also have the fewest side effects when compared to other treatments.
There are a few different types of antifungal pills that can be prescribed. One type is terbinafine, which is typically taken once a day for 6 to 12 weeks. Common side effects of terbinafine include headaches, skin rash, and vomiting. Itraconazole is another option, which may also be taken once a day for 6 to 12 weeks. Potential side effects of itraconazole include headaches, stomach upset, and respiratory infection.
It is important to consult a doctor or medical professional to receive a prescription for antifungal pills and to ensure that you are following the correct dosage and treatment plan. They will be able to advise on the most suitable medication and provide guidance on managing any potential side effects.
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Laser treatment
Toenail fungus, or onychomycosis, is a fungal infection that thrives in damp, dark places and feeds on keratin—the material that makes up nails, hair, and eyelashes. It causes the nail to thicken and yellow, become distorted, and eventually crumble away. It is incredibly easy to catch and spread and can also spread to other toenails and people.
During treatment, a powerful laser is directed at the toenail and penetrates through to reach the fungal infection underneath. It destroys the fungus responsible for the infection and helps return your nails to their normal colour and thickness. Most patients require at least a year for their nails to fully regrow without blemishes, and you will likely need at least two treatments. Results are not visible until at least two months after treatment.
While laser treatment is promising, it is important to note that results are mixed and a sustained cure has proven elusive. Even with multiple treatments, the fungus often returns. Success also depends on the type of laser being used. If you decide to move forward with laser therapy, make sure it takes place in a medical setting with someone experienced in this particular treatment.
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Natural remedies
While prescription antifungals are traditionally used to treat toenail fungus, natural remedies are also available and may be more effective in treating mild-to-moderate toenail fungus. These remedies typically have fewer side effects, although there is less scientific evidence that they work.
One popular home remedy for toenail fungus is Listerine mouthwash. Listerine contains menthol, thymol, and eucalyptus, which have antibacterial and antifungal properties. To use this treatment, soak the affected foot in a basin of amber-coloured Listerine for 30 minutes daily.
Another potential remedy is garlic, which may have antifungal properties. Place chopped or crushed garlic cloves on the affected area for 30 minutes daily, or treat the infection from the inside out with garlic capsules.
Apple cider vinegar is also believed to be a treatment for toenail fungus due to its antimicrobial properties. Soak the affected foot in one part vinegar to two parts warm water for up to 20 minutes daily.
Tea tree oil, derived from the leaves of the Melaleuca alternifolia tree, is another natural antifungal. A study found that 100% tea tree oil applied twice daily cleared nail fungus in 18% of participants after six months, with noticeable improvement in 56% of cases. Mix a few drops of tea tree oil with a carrier oil, such as coconut or olive oil, and apply it directly to the affected nail using a cotton swab. Repeat this process twice daily for several weeks.
In addition to these treatments, it is important to practice good foot hygiene to prevent toenail fungus. Wash and dry your feet daily, especially between the toes, and choose breathable footwear. Change your socks regularly and use antifungal powder in your shoes to reduce moisture.
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Post-removal care
After the nail has been removed, your doctor will apply ointment to the wound and cover it with gauze and tape. For the first 24 to 48 hours, keep the wound dry. After this initial period, clean the wound with water twice a day. Avoid using hydrogen peroxide or alcohol, as these can slow down the healing process. Instead, a thin layer of petroleum jelly, such as Vaseline, can be applied to the wound and covered with a nonstick bandage. Reapply the jelly and replace the bandage as needed. The wound should heal within a few weeks, but it may take 12 to 18 months for the toenail to grow back.
During the recovery process, it is important to prevent a fungal infection from recurring. Your doctor may prescribe an antifungal cream or other treatment to apply to the nail bed as the new nail grows. Antifungal pills, such as itraconazole (Sporanox) and terbinafine (Lamisil), are also effective, but they require a prescription and can have side effects. Over-the-counter antifungal creams, gels, sprays, and patches are also available, such as clotrimazole (Lotrimin). These treatments may need to be applied for several months.
To prevent future infections, you can take measures such as keeping your feet clean and dry, trimming your toenails straight across, and wearing clean socks and shoes. Avoid sharing nail clippers or files with others, and disinfect your nail tools regularly. If you notice any signs of a fungal infection, such as discoloured or thickened nails, consult your doctor promptly for early treatment.
If you want to prevent the nail from growing back, your doctor can destroy the nail matrix by applying a chemical to the cuticle area. This is a more permanent solution to prevent recurrent fungal infections. However, it is important to carefully consider this option as it will result in the permanent loss of the toenail.
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