Dear Alice,

I think I might have a toenail fungus infection (onychomycosis). Should I purchase over-the-counter medication and try to remedy the situation on my own, or should I go directly to a podiatrist to evaluate this problem? I do have an excellent insurance and prescription policy!

Dear Reader,

You don't say what makes you so sure that what you have is a bona fide toenail fungus infection (onychomycosis). Perhaps you have noticed some of these symptoms or signs:

  • Thickening of the nail
  • Brownish or yellowish discoloration of the nail
  • "Toe jam" accumulating under the nail and along its edges (sometimes that toe jam can smell pretty rank)
  • Brittle crumbling or breakage of the nail

If you're saying yes to some or all of these points, you indeed may have described or identified a fungal toenail infection. And yes, check in with a health care provider to find out what kind of treatment is best for you. You don't want to wait till you lose your toenail, or until the infection spreads to other nails on your foot. You could go to a podiatrist, a dermatologist, or your general or family health care provider, all of whom can help diagnose and treat this fungus. After examining your feet and nails, your health care provider may carefully trim away as much of the nail as possible. To accurately diagnose a fungal toenail infection, a sample of toenail will be sent to a laboratory for testing.

Fungal toenail infections are relatively common. Like other fungal foot infections, toenail fungus can be picked up while walking barefoot in locker rooms or public shower facilities. Fungi love warm, moist places, so imagine how happy the lil' critters are if you don't dry your feet well! Once you've got a fungus growing on one toenail, it can easily spread to other nails on that foot, to nails on your other foot, and even to your fingernails (although, granted, this last possibility is pretty rare).

If the lab confirms the diagnosis of a fungal toenail infection, a number of treatments are available. If the infection seems predominantly superficial, you might be given a prescription for a medicated toenail polish that contains an anti-fungal agent. You paint this onto the affected nail(s) daily. Deeper infections or infections that involve more than one nail will require oral medications. These medications need to be taken exactly as prescribed by your health care provider. As with antibiotics, you need to take all of the medication, even if your nails start to look better. Also, before you begin taking a new medicine, be sure to tell your health care provider if you have other medical conditions or if you're already taking other legal or illegal drugs. And, avoid all alcoholic beverages while you're taking one of these anti-fungal medicines, because the combination can be hard on your liver.

Here are some tips to help prevent getting fungal toenail infections:

  • Wear protective footwear (such as flip-flops or aqua shoes) when you use communal bathrooms, showers, or locker rooms because fungal foot and toenail infections are very contagious.
  • Be sure to wash and dry your feet thoroughly every day, and use foot powder to help absorb moisture. Cornstarch is an inexpensive option, although you can purchase medicated foot powder if you'd like (which will help protect you against fungal foot infections, such as athlete's foot).
  • Wear clean socks each day.
  • Keep your toenails carefully trimmed.
  • Don't share your pedicure tools with others.
  • Make sure your shoes and socks aren't so tight that your poor feet have no breathing room.

Kudos to you for keeping on your toes regarding foot health!


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