Toenail disorders are rarely
disabling or even painful. But they are a nuisance. One of the most
common problems is toenail fungus (medical name onychomysosis)about
15% of people have it, including nearly half of those over 70. The
toenail, particularly on the big toe, thickens and discolors; the
end may separate from the nail bed. You notice debris when you cut
the nail, which is often so thick you can't cut it. In severe cases,
the nail may detach and fall off. Diabetes increases your risk for
toenail fungus (and other foot disorders); so does smoking and being
over 60. Thickened, discolored toenails, whether they hurt or not,
are an unwelcome development, especially in an age where sandals are
popular and people want to look young.
There's plenty of
hearsay about remedies. Some popular measures, such as dipping the
toes in bleach, can be harmful. Others, such as a daily application
of Vicks VapoRub, are merely ineffective or unproven. Some people
swear by Campho-Phenique, tea tree oil, toothpaste applied with a
toothbrush, or soaking the toe in rum or sea water. Drugstores and
health-food stores sell salves and potions. Such remedies may seem
to work, since toe-nail fungus eventually gets better (and worse) on
its own. None of them can actually penetrate to where the fungus
If you try to treat your toenail yourself, avoid anything
abrasive, flammable, or highly toxic, or any substance likely to
irritate the skin. Damaging your skin will only help the fungus to
flourish. Applications of vitamin E are useless and can cause
There's a choice of
prescription pills to treat toenail fungus: fluconazole (Diflucan),
itraconazole (Sporanox), terbinafine (Lamisil), and others. They do
have drawbacks: you need to take them over several months, and a
full course of treatment can cost up to $1,500. Sporanox costs more
than $100 a week. Side effects may include liver and kidney
problems, nausea, and headache. You'll need blood tests to monitor
liver function. The drugs can interact with many medications,
notably cholesterol-lowering drugs. They don't work for everybody,
and even if they do work, the fungus may come back. There's also a
toenail lacquer, ciclopirox (Penlac), requiring up to 48 weeks of
treatment. It helps, but may not cure. It's somewhat less expensive
than the pills.
When to see a doctor
If you have
diabetes or circulation problems and are therefore more vulnerable
to foot infections, or if your toenail is really painful, get
medical advice. A doctor can accurately diagnose the condition. It
may look like a fungus, but could actually be eczema or something
else. You may decide to take a prescription drug. In extreme cases,
surgical removal of the nail may be necessary.
The best steps
Avoid getting athlete's foot, since the
fungus may spread to the toenail: wear rubber shoes in public
showers, and practice good foot hygiene. The truth is, though, that
anybody can get toenail fungus, with or without athlete's
Here's how to care for your feet:
daily and dry thoroughly between the toes.
shoes. Make sure they fit. Avoid pointy styles and other
Wear socks made of synthetics that draw moisture
away from your skin. Cotton is not as good.
If your feet sweat a
lot, try an antiperspirant on them.
Cut toenails short and
straight across. It's okay to apply nail polish to cover up the
If you do have toenail fungus, gently remove
debris from under the nail with an orange stick (used for manicures)
once a week.
Go barefoot and/or wear sandals when you can. Fungi
thrive in dark wet places.
If you share pedicure tools with your
family, wash and disinfect the tools (dip them in alcohol) after
use. If you go to a nail salon, make sure the tools are disinfected,
or bring your own.