Toenail Fungus Treatment

What is Onychomycosis?

Fungal Toenail Infection:
Symptoms and Treatments

  • DNA Culture Testing
  • Thorough Recovery
  • Safe and Effective

Several factors may increase your risk of developing “fungal infections” onychomycosis, including:

  • a family history of the infection
  • a damaged nail or a nail injury
  • extensive use of nail polish or artificial nails
  • nail that’s frequently exposed to water or dampness (e.g., locker rooms, swimming pools, etc.)
  • not wearing shower shoes in public showers
  • existing common infections like athletes’ feet.
  • When a fungus is found between toes and skin on feet, these are called athlete’s foot (“tenapedis”)

How is the diagnosis of the onychomycosis confirmed?

Onychomycosis is usually diagnosed by visually inspecting the area affected and asking the patient to describe their symptoms. Discussion of the family history of the disorder may be warranted, as there is a possibility that the condition is hereditary. Sometimes it is necessary to have a biopsy performed to confirm the diagnosis because it is difficult to know what is wrong with a biopsy in a clinic.

The correct diagnosis must be made because the treatment for each condition is unique. If the diagnosis is not valid, the infection may continue to worsen over time. In addition, it may cause unnecessary medication exposure and an increased risk of side effects.

Sometimes, a laboratory confirmation test is necessary to correctly identify the pathology causing the symptoms. Nail scrapings can be used as a culture to produce a good sample for microscopic examination. Three main types of tests can be done in a laboratory:

  • potassium hydroxide smear
  • DNA culture
  • Standard culture
  • histological study

Types of Onychomycosis

There are four types of onychomycosis:

  • Distal subungual onychomycosis
  • White superficial onychomycosis
  • Proximal subungual onychomycosis
  • Candidal onychomycosis

Treating Stubborn and Unsightly Toenail Fungus

Several treatment options for toenail fungus include oral, topical, and laser treatments. The type of treatment you receive often depends on your infection’s severity.

Topical Toenail Fungus Treatments

Topical toenail fungus treatments are medications applied topically to the nail to kill the infection. They help to stop the nail from becoming more brittle. But topical treatments are not as effective as oral medications; they can be effective if the infection is mild. All fungal topical treatments Footsteps LLC provides are approved for topical use by the Food and Drug Administration (FDA).

Common topical treatments for nail fungus

Amorolfine and ciclopirox are two of the most common topical treatments for nail fungus. You apply them like nail polish every day for a year. But topical medications are less effective than other treatments because they don’t kill the fungus as effectively, especially in moderate or severe cases. In these cases, your healthcare providers or Footsteps LLC may also recommend taking oral medication to help you manage your condition.

Topical treatments keep fungus from growing while you wait for the nail to grow naturally. Some treatments take many months, but others take just a few weeks.

Oral Toenail Fungal Treatments

Some people may need to take oral medications to control the fungus.

Patients diagnosed with toenail fungus often require oral medications because they are the most effective treatment options. Some medications work faster than other medications and treatments, sometimes in just a few months. These medications work by inhibiting the fungus’s growth by slowing the nail’s growth.

A DNA culture would treat the fungal nail infection properly. Footsteps LLC, Dr. Formanek, an American Podiatric Medical Association member, methodically provides the DNA culture before treating the fungal nail infection.

Side Effects

Although these medications are effective, they can cause serious side effects, including liver and heart problems. You can learn more about these medications by reading about the side effects of the medication and checking with your healthcare provider. If your blood pressure and cholesterol levels are normal, you should be prescribed a safe medication.

Nail Removal or Removal of the Infected Nail Enamel

Nail removal is usually necessary if you don’t respond to other treatments or are severely disabled. If you have nail fungus, surgically removing some of your nails or applying a chemical to encourage them to fall off themselves may be necessary.

Laser Treatment for Toenail Fungal Infection

Many different laser devices are on the market, varying in their power and wavelength. It may be that many companies claim to have good results using lasers. There is no standard treatment for treating toenail fungus with laser therapy. Treatment plans differ depending on the company and each doctor. Currently, no clinical trials prove that laser therapy can cure toenail fungus. The FDA explicitly allows for the use of lasers to cause temporary improvement in the appearance of nail beds in patients with toenail fungus.

The Ineffectiveness of Laser Fungal Nail Treatment

In a study by Jager, Oesterhelt, et al., no patient was cured of fungal infection after 12 months of treatment. Tracey Vlahovic, DPM, a leader in the field of podiatry, mentioned that laser therapy is not a reliable monotherapy for toenail fungus. Little data is available regarding the safety and effectiveness of laser therapy for treating nail fungus. In the May 2013 issue of the journal Fungi, authors Liddell and Rosen wrote that the evidence to date has not indicated superior outcomes in long-term endpoints to the standard of care systemic therapy. These authors state that the postulated antifungal mechanisms remain unverified. Despite a lack of literature on the topic, laser therapy is now considered among the viable treatment options for onychomycosis. Since many offices already have lasers for other indications, it is understandable that physicians are eager to find other innovative applications for these devices. Many factors may influence whether or not the use of lasers becomes widely accepted. Some medical schools are offering incentives to encourage patients to try laser treatments. It is important to conduct well-powered, randomized controlled trials that compare laser therapy to other medical treatments. Many studies are needed to test which laser treatment is optimum for different types of onychomycosis and the different etiologic fungi.

There are many different types of lasers and treatment protocols; there is simply no way to know which ones will produce the best results and which protocols are the best. There are no reliable studies to prove that laser treatment is effective. When you consider the fact that there are many different types of laser devices and the cost of the laser treatment, it is challenging to recommend laser treatment for toenail fungus. Because of the vast amount of data that has been published, conventional treatments for toenail fungus were as good or better than laser therapy alone. Many other treatments can help people with this condition.

We are waiting to see if any studies will be done that prove the use of lasers for treating toenail fungus. We have determined that seeking laser therapy for toenail fungus is not in your best interests. We will continue to provide other traditional treatments.


Karsai S, Jäger M, Oesterhelt A, et al. Treating onychomycosis with the short-pulsed 1064-nm-Nd:YAG laser: results of a prospective randomized controlled trial. J Eur Acad Dermatol Venereol. 2016; epub Aug 13

Lucette Teel Liddelland Ted Rosen Laser Therapy for Onychomycosis: Fact or Fiction?

J Fungi (Basel). 2015 Jun; 1(1): 44–54.


Which toenail fungus treatment is the best?

Although onychomycosis can affect people of any age, it is more common in older adults. If you have onychomycosis, your doctor may prescribe a course of oral antifungal medication. Sometimes, he or she may also recommend using a topical antifungal medication or even removing the affected nail through mechanical or chemical debridement.

Since Not all toenail fungus does not need to be treated. We’ve received DNA testing reports with no fungal elements when it’s a bacterial infection.

Dr. Formanek’s mission is to eliminate toenail infections. By gathering a small sample from the fungal nail infections using precision nail clippers, Dr. Formanek can prevent the spread of the fungi before the fungus grows.

What happens if you don’t treat a fungal nail infection?

Many people who ask this question suffer from severe toenail fungus. Others are not so fortunate and want to know how bad the infection can get. Because fungus can cause severe pain and discomfort, many people are curious about how bad it can be. When people are suffering from toenail fungus, they are unlikely to get any other serious illness.

If you have a mild toenail fungus, it won’t kill you; it may cause you to feel very dejected. Anyone who has toenail fungus should seek treatment as soon as possible. Even a mild toenail fungus can cause the nail bed and the nail’s cuticle to become infected. This can cause the nail to become thick and painful. It will cause the toenails to become inflamed, abnormal discoloration, and also cause the skin around the nails to become very thick and painful.

Toenails that have become infected with nail fungus will eventually start to grow out of the nail bed. Even though it is extremely rare, there is a chance that the fungus may affect other parts of the body. If this happens, it will be embarrassing for you. There is a greater risk that someone diabetic or undergoing chemotherapy will develop nail fungus.


It is common for patients to think that having mycotic nail growths is only a cosmetic problem; it may cause painful ulcers in older adults and cause painful foot ulcers in diabetic patients. Treatment for onychomycosis is problematic because any drugs cannot remediate the infection or because treatment fails to reach the nail. Treatment depends on the degree to which the nail changes, the organism that causes it, and potential drug interactions. Treatments vary in effectiveness, depending on cure parameters that differ among studies. For example, a mycotic cure means that no organisms are found in a nail by microscopy and culture. A “clinical cure” means that nail health is restored to what it should be; it may be as simple as a regular nail in 80% to 100% of the patients who are treated; it may be as simple as a nail that looks normal in 80% to 100% of the patients who are treated. It is challenging to measure cure accurately because it is subjective and differs from study to study.