Why Is Toenail Fungus So Difficult to Treat

Fungal toenails not only look unsightly but can be painful and may lead to more serious bacterial infections, especially if you have circulation issues or injuries that are not healing right. Treatment and cure can be challenging as fungal toenail conditions are often persistent, and the fungus lives on the layer directly beneath the toenail, a hard-to-reach place. Call Premier Podiatry to learn more about the causes of toenail fungal infection from experts, how it can be eliminated, and what steps you can take to prevent it from occurring. They offer the highest quality care with optimum treatment options to ensure you are back to normal activities and movement as soon as possible.

Toenail fungus is a widespread fungal infection that affects toenails. It happens when fungi get between your toenail and toenail bed, the tissue right underneath the toenail, through a crack or cut in your toe. The warm and damp environment in the shoes provides the ideal breeding ground for fungal growth where they thrive.

Toenail fungus not only affects the appearance of your nails and foot, but can also cause pain and prevent you from wearing your favorite shoes.

What Is Toenail Fungus?

Toenail fungus is a common condition that begins as a white or yellow spot under the tip of the toenail. It is caused by a microscopic organism called dermatophyte fungus. Fungal infections are more likely to happen in toenails than in the fingernails as toenails are confined in shoes where they get a dark, warm, moist environment where they grow well.

As the infection goes deeper, nail fungus may cause your nails to discolor, thicken, and crumble at the edge. If left untreated, this infection could spread to other toenails, skin, or even your fingernails.

Read more about: Types Stages of Toenail Fungus

Why Is It Difficult to Treat Toenail Fungus?

Toenails are made up of multiple layers stacked on top of each other. Although the fungus affects the appearance of the nails, it lives on the layer directly beneath the toenail. The fungus can get into and between those layers. It may also sit on top of the nail or grow underneath it. As the nails are not porous, it is difficult for the medication to reach the infection in concentrations great enough to kill the fungus.

In some cases, fungus can get into the cells that make the nail, called the nail matrix. When the cells manufacturing the toenail are infected, it can become really hard to treat it.

Also, toes have less blood flow than fingers, making it harder for the body’s immune system to detect and stop the infection. Such infections can be contagious and are often difficult to get rid of completely, but the good thing is that they do not pose any serious health risks.

How Does Nail Fungus Start?

Damaged, injured, or loosened toenails are the perfect entry point for fungi. These microscopic organisms are present everywhere. They live on surfaces, both indoors and outdoors, and search for places to live and reproduce. According to expert podiatrists, feet are warm, moist, and enclosed body parts, and for this reason, fungi thrive here.

Toenail damage can result from repetitive friction caused by sports such as running or from some foot injury. The damage provides fungi a chance to enter and take hold under and between the layers of the nail. With time, the fungi can also invade the nail matrix, special cells that help in the growth of new fingernails and toenails.

Factors that can increase your risk of developing nail fungus include:

• Wearing tight shoes
• Walking barefoot in moist areas like swimming pools, saunas, and public showers
• Poor blood circulation in the legs
• Weakened immune system
• Skin conditions such as psoriasis
• Medical conditions such as diabetes and cancer
• Athlete’s foot
• Symptoms of nail fungus

Initial symptoms of toenail fungus include a small, white, yellow, or brown spot under the tip of the nail. As the infection progresses and the fungi grow and burrow deeper, the nail becomes thickened, crumbly, and discolored. It may also look malformed or misshapen as the fungus grows on the layer directly beneath the toenail. If it is not treated timely, the infection can spread to adjacent nails too.

When fungus builds up under the nail, it can loosen and even separate the nail from the bed. The fungus can also spread to the skin around your nails. The nail may crack or break in one or more spots.

While these symptoms can indicate a fungal infection, they may not be sufficient for accurate diagnosis. Toenail fungus can look like any other condition, including psoriasis. Thus, it is essential to have your toenail checked by a doctor.

You should consult a podiatrist if you suffer from the following or develop them along with nail symptoms:

• Diabetes, an immune disorder, or poor circulation issues in your legs
• There is bleeding, swelling, or pain around the affected nail
• You are having difficulty walking

Your doctor will take a sample of the affected nail and examine it under a microscope to confirm the presence of fungi and its type. Knowing the causes of infection can help to determine the best treatment for destroying fungi and their spores to prevent re-infection in the future.

Treating Nail Fungus

Treatment for toenail fungus depends on which fungus you have and how bad the infection is. Your podiatrist can explain treatment options and suggest steps to keep the fungus from growing back. The earlier treatment begins, the more likely it is to be successful.

If your infection is not causing pain or you do not have any underlying medication condition, it indicates a mild infection that may be easy to treat.

Treatment options may include:

Oral Medications

Oral medications are the most successful treatment for fungal nail infections. You will have to take the prescribed tablets for three months or 90 days to ensure the infected nail grows out and returns to normal. These medications are generally safe if you do not have any medical condition, but they are not suitable for everyone and lead to harmful effects. Long-term use of oral anti-fungal medications can put stress on the liver or interact with other medications, which often makes it difficult to continue with them. Your doctor will keep an eye on your condition and recommend the most effective medication to ease your symptoms. Some patients require two courses of treatment or pulse dosing – periodic top-ups of the medication for desired results.

Topical Treatment

Topical treatment includes prescription-strength antifungal creams or topical nail paints to get rid of the fungus. These medications can be applied right onto the nail to treat fungus over time or until the nail grows out. Rub the cream into the infected nails after soaking them. These creams work better if you first thin the nail. The medication gets through the hard nail surface to the underlying fungus and helps to grow a new nail free of infection, slowly replacing the infected part.  Topical medications are most effective when they are used in combination with oral medications.

Medicated Nail Polish

Your doctor may prescribe an antifungal nail polish to help with infection. These nail paints usually require application on the infected nails and surrounding skin once a day. After seven days, you have to wipe the piled-on layers of nail polish with alcohol and begin fresh applications. This process continues till the nail grows out. You may have to use this type of nail polish for almost a year to get rid of toenail fungus.

Toenail Removal

It is usually the last resort when no other treatment works. The affected nail is surgically removed under a local anesthetic. Surgical removal of the toenail must be followed up with antifungal therapy to prevent the fungus from coming back as the nail regrows. Permanent removal of the nail and its roots is risky too, and not usually recommended by podiatrists.

Your healthcare provider will recommend a treatment based on your symptoms and situation. He will customize a treatment plan to prevent the infection from spreading and coming back again.

Laser Treatment

Laser treatment for toenail fungus can be used for treating serious cases of fungal infections. It requires multiple sessions as a part of the treatment plan. Laser therapy has delivered good results, but due to a lack of reliable data regarding the long-term efficiency of laser treatment, it is still not a very popular option and can be expensive.

At-Home Remedies for Toenail Fungus

Home remedies can help manage your toenail fungus and prevent it from recurring. They include:

• Soak your feet in apple cider vinegar solution. One-part vinegar to one-part water is a good ratio for a foot soak.
• Tea tree oil is another option for toenail fungus due to its antiseptic and fungicidal properties. Apply tea tree oil after removing as much dead nail as possible. Let it sit for about ten minutes before washing or wiping it away. Continue this process for two to three times a day.
• Sodium borate and baking soda are both alkaline and help to lower acidity, preventing the fungus from growing. Create a paste by mixing equal parts of sodium borate and baking soda with a small amount of water. Apply this mixture onto the infected toenail three or four times a week. Keep using it even after the fungus has cleared for about four weeks to keep it from coming back.
• Coconut oil contains caprylic acid that can penetrate the cell walls of the fungi and destroy them. Soak your toenail in coconut oil for about 15 minutes a day. You can repeat this process without worrying about side effects as coconut oil does not harm the skin.
• Lavender oil is an ideal at-home remedy for mild cases of toe fungus. Rub a few drops on the infected area before going to bed, and cover your feet with wool socks. Do not wear socks with synthetic fibers as they retain moisture, which can aggravate the infection. Take off your socks in the morning and continue with your routine. Repeat this process for a few weeks for complete healing and to prevent infection from coming back.

Home remedies are good, but they may not work for everyone the same way. There is no potential harm in trying them as they do not cause any side effects. Filing down the top surface of the nail before trying any topical cream or treatment can help the product penetrate the nail and get rid of the infection.

How to Prevent Toenail Fungus?

Prevention is the best medicine, and it is better to keep the infection from occurring than treating it. Following some simple foot hygiene practices can reduce your chances of contracting a toenail fungal infection:

• Don’t share your nail trimmers, files, or tools with anyone else. If you go for a pedicure, ask the technician how they sterilize and disinfect their tools between customers.
• Choose footwear made of natural fabric or leather. Mesh shoes or shoes with mesh panels are the best as they help with air circulation, preventing fungus growth.
• Rotate shoes and change socks frequently during the day.
• Spray your shoes with disinfectant and give them time to dry completely before you wear them again.
• Wash your feet at least once a day and make sure they are dry, especially between the toes.
• Always wear flip-flops or shower shoes when using public showers, swimming pools, or saunas.

Check your nail beds and the skin around your toenail regularly, at least once a month. Watch for changes in color and texture, as well as for cuts or damages. If you find anything unusual or your symptoms do not improve, call your doctor for expert guidance.

Toenail fungus is not too painful or causes complications, but it can make you feel conscious about how your feet look. If you are noticing discoloration or thickening of your toenail, do not wait to see what is happening. Schedule an appointment with an experienced podiatrist for an accurate diagnosis and timely treatment. With non-invasive and painless treatment solutions, Dr. Velimir Petkov and his team focus on getting rid of fungal infections and restoring your nail health. The expert podiatrists at Premier Podiatry determine the fungi causing your problem and help to eliminate pain, restore mobility, and improve your quality of life and overall health.