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Toenail Fungus

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Introduction

Not only is toenail fungus unsightly, but it is difficult to treat.  You should consult a podiatrist at the first sign of toenail fungus, such as white or yellow spots on the nails.  Your doctor will provide treatments to help stop the fungus and promote healthy nail regrowth.
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Anatomy

Your toenails are hard surfaces that protect the ends of your toes. Toenails grow very slowly.  New cells form at the base (nail root) of the nail underneath the cuticle.  The new cells push the old cells out, covering the nail bed.  The toenail is formed from old cells that harden and flatten with the help of a hard protein substance (keratin).  This is the same type of protein in hair.
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Causes

A toenail fungus infection results when fungi (dermatophytes) enter the nail through a small opening.  The fungi grow best in a warm moist environment, such as damp socks or shoes.  Because the toenails do not have a good blood supply, it is hard for the immune system to rid the body of the infection on its own.

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Symptoms

A white or yellow spot under the tip of the nail is usually the first sign of toenail fungus.  The toenail will thicken and become discolored (brown, yellow, white).  The toenail may be brittle and ragged.  An infected toenail can hurt and smell bad.
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Diagnosis

You should see a podiatrist at the first sign of toenail fungus.  Your doctor will review your medical history and examine your toenails.  A sample from underneath the edge of your toenail will be examined to confirm the diagnosis.
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Treatment

Your podiatrist will trim your toenail.  Medicated nail polish or oral antifungal medication is used to treat the fungus.  Over-the-counter products are usually not very helpful because toenail fungus is hard to treat.  It will take about 4 months or longer for an infection to heal and a new toenail to grow.
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Prevention

You can help prevent toenail fungus by:

• Trimming your nails straight across.
• Keeping your nails clean and dry.
• Using an antifungal spray or powder daily.
• Wearing shoes in public showers, locker rooms, and pool surrounds.
• Discontinuing the use of nail polish.  Nail polish can trap fungus and promote an infection.
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Am I at Risk

The fungus that causes toenail infections thrives in warm damp areas, including public areas, such as locker rooms, showers, gyms, and pool surrounds.  Walking barefoot increases the likelihood of contact with the fungus.  Toenail fungus infections occur most frequently in older adults and men. 

Risk factors for toenail fungus infections include:

• If your family members have toenail fungus, you are at risk for having it too.
• Certain medical conditions, such as diabetes or a compromised immune system.

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Complications

An infected toenail can detach from the nail bed. In extremely severe cases, the toenail may need to be surgically removed.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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