What Causes Toenail Fungus & How to Recognize It

Understanding Fungal Toenail Infections

Toenail fungus, medically known as onychomycosis, is a fungal infection that affects the nail and the tissue beneath it. It's the most common cause of nail thickening and discoloration and accounts for a large portion of all nail disorders seen in podiatric practice.

Causes & Risk Factors

Onychomycosis is caused by dermatophyte fungi, the same organisms responsible for athlete's foot. The infection typically begins at the tip of the nail and works its way back toward the nail root over time. Fungus thrives in warm, moist, dark environments, which is why the feet are particularly susceptible. Risk factors include:

• A history of athlete's foot or skin fungal infections
• Sweaty feet or consistently wearing damp footwear
• Walking barefoot in communal areas like pools, locker rooms, or gym showers
• Wearing tight shoes that restrict airflow around the toes
• Older age, as nails become more vulnerable to infection over time
• Reduced circulation or a weakened immune system
• Diabetes, which increases susceptibility to foot and nail infections

Types of Toenail Fungus

While dermatophytes are the most common culprit, toenail infections can also be caused by non-dermatophyte molds or yeasts such as Candida. The type of organism involved can influence which treatment is most effective, which is one reason a professional evaluation is valuable rather than guessing at home remedies.

Symptoms

Toenail fungus often goes unnoticed in its early stages because it rarely causes pain. As the infection progresses, common symptoms include:

• Yellow, white, or brown discoloration of the nail
• Thickening or distortion of the nail shape
• Brittle, crumbly, or ragged nail edges
• A buildup of debris under the nail
• A foul odor coming from the affected nail
• In more advanced cases, separation of the nail from the nail bed

The big toenail is most commonly affected, though the infection can spread to other nails if left untreated. It can also spread to the surrounding skin, contributing to or worsening athlete's foot.

Toenail Fungus Treatment Options Available in Council Bluffs

How Dr. Barnes Treats Toenail Fungus

Treatment for onychomycosis depends on the severity of the infection, the number of nails affected, and the patient's overall health. Dr. Barnes will review your nail health and recommend the most appropriate approach, which may involve one or more of the following options.

Topical Antifungal Medications

For mild to moderate cases, topical antifungal treatments applied directly to the nail can be effective. Dr. Barnes carries physician-dispensed topical medications in the office, as well as prescription options such as Jublia and Kerydin, which are formulated to penetrate the nail and target the fungal infection beneath it. Topical treatments are a good fit for patients who prefer to avoid oral medication or have health considerations that make systemic treatment less appropriate.

Oral Antifungal Medication

For more established infections, oral antifungal medication is often the most effective treatment option. Dr. Barnes may prescribe Lamisil (terbinafine), which treats the infection at the nail bed where the fungus is most active. Lamisil is typically taken for three months, allowing a healthier nail to grow in as the infection clears. Because oral antifungals are processed by the liver, lab work is usually performed before starting the medication to ensure it's appropriate for you.

Nail Debridement

Regardless of which treatment approach is used, Dr. Barnes may trim and thin the affected nail during your visit. Reducing the thickness of an infected nail improves the penetration of topical medications and can relieve any discomfort caused by the nail pressing against footwear.

Nail Removal

In cases where the nail has become severely thickened, deformed, or unresponsive to topical or oral treatment, permanent nail removal may be the most practical solution. Dr. Barnes performs this procedure in the office under local anesthesia. Removing the nail eliminates the infected tissue entirely and, in most cases, resolves the problem more definitively than medication alone.

Prevention Tips

Treating the infection is only part of the picture. Dr. Barnes may also recommend steps to reduce the risk of reinfection, including:

• Treating any concurrent athlete's foot or skin fungal infection
• Using antifungal shoe spray to eliminate fungus from footwear
• Wearing breathable, moisture-wicking socks
• Avoiding nail polish on affected nails, which can trap moisture and worsen the condition
• Keeping nails trimmed short and clean