Toenail fungus, known medically as onychomycosis, causes nails to thicken, discolor, and become brittle or crumbly over time. It doesn't go away on its own, and left untreated it can spread to other nails or the surrounding skin. The good news is there are several proven treatment paths, and the right one for you depends on how severe the infection is and how quickly you want results.
Below, we break down the main removal and treatment options — topical, oral, laser, and surgical — along with what to expect from each, and how to keep the fungus from coming back once it's gone.
What is toenail fungus?
Onychomycosis is a fungal infection of the nail plate or the nail bed underneath it. It thrives in warm, moist environments, which is why it's so common in people who wear closed shoes for long periods, spend time in locker rooms or pools, or have had an injured or previously infected nail. Signs include a nail that looks yellow, white, or brown; is thicker than normal; becomes brittle or crumbly at the edge; or separates from the nail bed.
Topical treatments
Topical antifungal creams and medicated nail lacquers — containing ingredients like ciclopirox or efinaconazole — are applied directly to the nail, usually once a day. They tend to work best for mild to moderate infections that haven't spread deep into the nail bed. Because the medication has to reach the infection as the nail grows out, topical treatment typically takes several months of consistent, daily use before you see a clear nail.
Oral antifungal medications
For moderate to severe infections, oral antifungals such as terbinafine or itraconazole treat the fungus systemically, through the bloodstream, which generally makes them more effective than topical treatment alone. A typical course runs anywhere from a few weeks to a few months. Because oral antifungals are processed by the liver, your podiatrist may recommend monitoring, especially if you take other medications or have liver concerns.
Laser treatment
Laser therapy targets the fungus with focused light energy and is a popular option for people who want an in-office procedure with no downtime — a typical session takes about 10 to 20 minutes. Most patients need multiple sessions spaced a few weeks apart for the best results, and because it's often considered cosmetic, insurance coverage for laser treatment is inconsistent, so it's worth checking with your provider beforehand.
Surgical nail removal
For nails that are severely infected, thickened, or painful, partial or complete surgical removal of the nail may be recommended, often combined with topical or oral antifungal treatment to clear the infection at the nail bed. This is a well-tolerated, in-office procedure performed under local anesthetic. New nail growth is a gradual process and can take roughly 9 to 12 months to fully grow back.
What about home remedies?
Home remedies such as vinegar soaks, tea tree oil, or over-the-counter creams are popular online, but they generally aren't strong enough to fully clear an established fungal infection. They may temporarily improve the nail's appearance without addressing the fungus underneath, which can allow the infection to persist or worsen. If you've tried home care without success, it's a good sign it's time to see a podiatrist.
Choosing the right treatment for you
The best option depends on how severe the infection is, how many nails are affected, your overall health, and your tolerance for the time commitment each treatment requires. A podiatrist can examine the nail — and in some cases send a sample for testing to confirm it's truly a fungal infection — before recommending a plan. Combining treatments, such as oral medication with a topical, is common for more stubborn infections.
Preventing toenail fungus from coming back
Because fungus thrives in warm, damp environments, prevention is largely about keeping your feet dry and your shoes rotated. Helpful habits include:
- Keeping feet clean and thoroughly dried, especially between the toes
- Wearing moisture-wicking socks and rotating shoes so they can fully dry between wears
- Wearing sandals in public showers, locker rooms, and pool areas
- Not sharing nail clippers or files with others
- Monitoring treated nails for signs of recurrence, since fungal infections can return
If you're dealing with a discolored, thickened, or painful toenail, our team can help you find the treatment that fits your situation. You can request an appointment at either of our Northern Utah offices.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation.