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How to Treat Toenail Fungus

Toenail fungus is one of those potentially embarrassing medical conditions that no one seems to want to discuss. But it's also one of the more common foot ailments. Learn how it's contracted, how to prevent it, and how to get rid of it.

By
Sanaz Majd, MD,
Episode #151

How to Treat Toenail Fungus

Unfortunately, fungus is not always as easy to eradicate as bacteria is with antibiotics.  Antibiotics don’t work for fungi (or for viruses, for that matter); they only work on bacteria, which is a completely different organism.  To get rid of toenail fungus, we need to use anti-fungals.  These drugs tend to be metabolized heavily through the liver and therefore have a very small risk of liver damage.  So when discussing toenail fungus with your doctor, make sure you realize that you are taking this risk (albeit very small) in exchange for a cosmetic issue (albeit unattractive). 

The first-line of defense for toenail fungus is a drug called terbinafine – it’s now generic and quite inexpensive.  It’s taken once daily for 3 months.  Unfortunately, it’s effective only for about 75% of those with toenail fungus.  And after the 3 month treatment is over, you may not see the full effects of the drug until the nail is grown out – which can take up to one year.  You will also need your liver checked prior to starting treatment and one month into it.

If you decide not to treat your toenail fungus with an oral medication, that’s OK, too.  I would suggest over-the-counter terbinafine cream instead – the toenail is thick and hard to penetrate, and you would need to use it twice a day every day for months to even a year to see a difference. But for those with mild toenail fungus, this may be sufficient.  Also, a 10-minute foot soak using a mixture of 1 tablespoon of bleach in half a gallon of water every night can aid the process. (Be careful not to overdo the bleach - anymore than 1 tablespoon per half gallon can burn the skin).

Prevention of Toenail Fungus

The best way to manage toenail fungus is to prevent from getting it in the first place.  If you have fungus, you are much more likely to get it again if you’re not careful.  How do you do that? Here are 5 tips:

  1. Don’t walk barefoot:  That’s right – not even in the house.  And don’t forget the flip flops when you use public showers, pools, hotel rooms, etc.

  2. Don't sweat it:  Apply powder to the foot after you shower to keep the moisture in check, and/or spray an aluminum-based antipersperant to your feet every day. Change your socks (once or even twice) throughout the day if you are on your feet all day and tend to sweat.

  3. Bleach it:  Spray bleach once a week to your shower floors to disinfect the fungus and bleach your socks when you wash them.

  4. Maintain proper foot hygiene:  Don’t forget to take care of your feet – you bathe your entire body every day in the shower (hopefully), so don’t neglect your feet.  Clean and scrub them with a foot brush.  Learn more about how to properly take care of your feet in my episode How to Care for Your Feet.

  5. Apply anti-fungal creams:  If you’ve already been treated for toenail fungus, it may be a wise idea to apply over-the-counter terbinafine cream once a day to prevent future fungal infections.  Think of it like brushing your teeth, but instead of preventing cavities you're preventing an infestation.

So start thinking on your feet and take good care of them!

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