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Footnotes / Blog

Fungal Toenails (Onychomycosis)

Sunday, August 13th, 2017 Elizabeth Anthony


Onychomycosis, also known as Tinea Unguium, is a fungal infection of the nail. It is more common in toenails than fingernails.


The most common symptom of a fungal nail infection is the nail becoming thickened and discoloured: white, black, yellow or green. The nails can become brittle as the infection progresses, causing piece of the nails to flake off and fall away from the rest of the nail.



Onychomycosis is usually caused by a Dermatophyte Fungus. Certain environments allow these fungi to thrive. Moist environments caused by excessive sweating, non-breathable socks or shoes, or going barefoot in a wet place such as a swimming pool or shower all increase the risk of obtaining this infection. Poor blood circulation to feet, as experienced in peripheral vascular disease and patients with diabetes, also can put a patient at risk.



(note: Complete cure rates much lower than a clinical or mycological cure rate)

  • Topical
    • Penlaq(Ciclopirox): 6-9 months of daily application to each affected toenail. Works best when applied to nails that have been filed. Reported complete cure rates around 10%. Best for mild cases of fungal toenails.
    • Jublia(efinaconazole): Apply to affected toenails once daily for 48 weeks. Reported complete cure rates of 20%. More expensive, often not covered by insurance unless other treatments attempted first.
  • Oral
    • Lamisil (Terbinafine): 1 pill(250 mg) taken daily for 12 weeks. Reported complete cure rates of 35%. Usually well tolerated, minimal interactions with other medications. Possible liver side effects, blood tests will determine if patient a candidate for treatment. Seen as most effective treatment for fungal toenails.
    • Sporonox (itraconazole): 200 mg pill taken orally once daily. Reported complete cure rates of 14%. Many medication interactions.
    • Diflucan (Fluconazole): 200 mg pill once weekly. Off-label use for nail fungus, however gaining popularity. Studies showing a 50% complete cure rate, however further studies would need to be performed for exact evidence. Since it is pulse dosing, lower chance of medication interactions.
  • Laser
    • Laser treatment for fungal toenails is a non-invasive option. There are studies underway to determine the effectiveness of this treatment modality in treating onychomycosis. This option requires multiple office visits to the podiatrist, and can be used in conjunction with other oral or topical treatments.

It can take 1 year to see complete changes in a fungal toenail, due to the slower growth of toenails compared to fingernails.


The Podiatrists at Innovative Foot and Ankle are well versed in all current treatment options for fungal toenails. If you are concerned you may have this infection, visit one of our offices in the NJ areas of Kenilworth, Little Ferry, Bayonne, or Montclair.