Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. The elderly and those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.
* Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.
* Clean and dry feet resist disease.
* Washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection.
* Shower shoes should be worn when possible in public areas.
* Shoes, socks, or hosiery should be changed more than once daily.
* Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
* Wear shoes that fit well and are made of materials that breathe.
* Avoid wearing excessively tight hosiery, which promote moisture.
* Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks.
* Disinfect instruments used to cut nails.
* Disinfect home pedicure tools.
* Don't apply polish to nails suspected of infection—those that are red, discolored, or swollen, for example.
Treatment of Fungal Nails
Treatments may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.
A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail.
Newer oral antifungals, may be the most effective treatment. They offer a shorter treatment regimen of approximately three months and improved effectiveness. Podiatrists may also prescribe a topical treatment for onychomycosis, which can be an effective treatment modality for fungal nails.
In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.