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Varicose Veins During Pregnancy: Causes, Risks and When to See a Vascular Surgeon
Close to 40 percent of pregnant women develop varicose veins at some point during pregnancy. For most, the swollen, twisted veins that show up
Medically Reviewed by
Dr. Peter Hanna, DPM
Board Certified Podiatrist
Toenail fungus is one of those conditions everyone seems to have an opinion about, usually involving vinegar soaks, tea tree oil, or a home remedy someone swears cleared it up in a week. The reality is less convenient. Toenail fungus lives beneath a hard, protective nail plate that most home treatments simply cannot penetrate, which is part of why it lingers for months or years when left alone. Here is an honest look at what actually clears toenail fungus, what the evidence says about newer options like laser therapy, and when it makes sense to bring in a podiatrist.
Toenail fungus, known medically as onychomycosis, is a fungal infection that gets into the nail plate, the nail bed beneath it, or both. It is extremely common, affecting a meaningful share of adults, and becomes more likely with age.
Most cases are caused by dermatophytes, the same broad family of fungi responsible for athlete’s foot, though molds and yeasts cause a smaller share of infections. Because the fungus is living inside dense nail tissue rather than on the surface of the skin, it is naturally protected from a lot of what would otherwise kill it.
This is also a genuinely contagious condition. It spreads through direct contact or through contact with surfaces such as locker room floors, shared nail tools, or shoes, which is part of why it is so widespread and why it tends to come back if the source of exposure is not addressed.
Tea tree oil, menthol vapor rub, vinegar soaks, and similar home remedies show up constantly in searches for toenail fungus. Small studies have looked at some of these options, and a few show mild benefit, but the research is limited and the results are inconsistent.
The core problem is penetration. The nail plate is dense, protective tissue by design, and most substances applied to its surface simply cannot reach the fungus living underneath or within it in a concentration high enough to clear the infection.
That does not mean these remedies are entirely useless as a supportive habit alongside real treatment, but relying on them alone, especially for months at a time, usually means the infection keeps progressing while symptoms are only partially masked.
The earliest sign is usually a small area of discoloration, often white, yellow, or brownish, near the tip or side of the nail. Over time, this can spread across more of the nail and deepen in color.
As the infection progresses, nails commonly become thicker, more brittle, and prone to crumbling at the edges. Our guide on what causes thick toenails covers this particular symptom in more depth, since thickening has a few possible causes beyond fungus alone.
Pain is not typically an early symptom, which is one reason toenail fungus often goes unaddressed for a long time. By the time nails become uncomfortable in shoes or noticeably distorted in shape, the infection has usually been present for a while.
Toenail fungus thrives in warm, moist, enclosed environments, which describes the inside of a typical closed shoe reasonably well. Sweaty feet, tight or non-breathable footwear, and prolonged moisture all create conditions where fungi can take hold and multiply.
A prior or current case of athlete’s foot is a significant contributor, since the same fungi involved can spread from the skin to the nail. Our post on athlete’s foot spreading to the face illustrates just how easily these infections can travel to other areas when left untreated.
Nail trauma, whether from an injury, tight shoes, or repetitive stress from activities like running, can also make a nail more vulnerable, since a damaged nail plate offers fungi an easier point of entry than a healthy, intact one.
Age is one of the strongest risk factors. Older adults develop toenail fungus considerably more often than younger people, partly because nail growth slows and circulation changes with age.
People with diabetes face a substantially higher risk, both because of circulation changes and because a weakened immune response can make it harder for the body to clear the infection on its own. Our diabetic foot care services address this connection directly, and our post on early diabetic toenail changes is worth reading if you have diabetes and are noticing nail changes.
Other risk factors include a weakened immune system from any cause, frequent exposure to communal showers or pools, excessive sweating, and having a family member with the condition, since genetics appear to play some role in susceptibility.
A podiatrist can often recognize toenail fungus on sight, but confirming the diagnosis usually involves taking a small clipping or scraping from the affected nail. That sample is examined under a microscope or sent for culture testing to confirm fungus is actually present and, in some cases, to identify which type.
This step matters more than it might seem. Other conditions, including nail psoriasis and simple nail injury, can look remarkably similar to a fungal infection, and treating the wrong condition wastes time and can delay real relief.
Confirming the diagnosis also helps guide which treatment is most appropriate, since the severity, location, and type of fungus involved can all influence which option is likely to work best for a given case.
For mild to moderate infections, prescription topical antifungal solutions are often the first approach. Options such as efinaconazole and tavaborole are applied directly to the nail once a day, typically for around 48 weeks, since nails grow slowly and the medication needs sustained contact to work.
These topical treatments tend to have fewer side effects than oral medication, which makes them a reasonable first choice for many patients, including older adults or those who cannot take systemic antifungal drugs for other health reasons.
The tradeoff is a real one, though. Because topical products only partially penetrate the nail, cure rates are generally lower than with oral medication, and consistent, daily, long-term use matters enormously to how well they work.
When a topical approach is not a good fit, or the infection is more severe, oral antifungal medication is often the next step. Terbinafine is the most commonly prescribed option, typically taken daily for about twelve weeks to treat toenail infections.
Oral antifungals reach the infection through the bloodstream rather than relying on penetrating the nail from the outside, which generally makes them more effective than topical treatment alone. Because they work systemically, your provider will usually check liver function before and during treatment, since liver-related side effects, while uncommon, are a real consideration.
Even after the medication course ends and the fungus itself is cleared, it typically takes a year or longer for a toenail to fully grow out and look normal again, since the visible nail simply needs time to be replaced by healthy new growth.
Beyond medication, a podiatrist has several in-office tools that can meaningfully improve outcomes. Nail debridement, which reduces nail thickness, can make walking more comfortable and helps topical medication reach the infection more effectively.
Nail abrasion, filing down the surface layer of an affected nail, can be useful for a specific type of fungal infection that sits close to the nail’s surface. In more severe or resistant cases, partial or full nail removal, sometimes called nail avulsion, allows a healthier nail to grow in over time.
These procedures are generally used alongside medication rather than as a stand-alone cure, and a podiatrist can help determine whether any of them are likely to meaningfully help your specific case.
Laser therapy for toenail fungus gets a lot of attention, and the honest answer is that the evidence is genuinely mixed. Some clinical studies, including a 2024 systematic review and meta-analysis, found that laser treatment produced comparable or somewhat higher clinical cure rates than oral terbinafine in the studies reviewed, with fewer reported drug-related side effects.
At the same time, it is worth knowing that laser devices are not currently FDA approved specifically to treat the fungal infection itself. Current FDA clearance for nail lasers covers improving the appearance of a nail after the fungus has already cleared, not curing the infection outright, and several independent reviews have noted that results can fade over time even after an initial improvement.
What this means practically is that laser therapy is a reasonable option to discuss with a podiatrist, particularly for people who cannot tolerate oral medication, but it should not be viewed as a guaranteed quick fix. When it is used, it tends to work best as part of a broader treatment plan rather than as a stand-alone solution, and results vary meaningfully between patients and between laser types.
For many patients, the most effective approach is not any single treatment but a combination. Pairing oral or topical antifungal medication with in-office nail debridement, for instance, can improve how well the medication penetrates and how quickly visible improvement shows up.
Some research on combining laser treatment with topical antifungal cream has shown better outcomes than either approach used alone, likely because the laser changes the nail surface in ways that let topical medication absorb more effectively.
A podiatrist who is familiar with your specific infection, its severity, and your overall health can put together a combination that reflects the best current evidence rather than a one-size-fits-all approach.
Patience matters more with toenail fungus than with almost any other common foot condition. Even when treatment successfully kills the fungus, the nail itself does not instantly look normal, since the visibly affected nail has to grow out and be replaced by new, healthy tissue.
For toenails specifically, that regrowth process commonly takes a year or longer, since toenails grow considerably slower than fingernails. Seeing gradual improvement over months, rather than a dramatic change in a few weeks, is the normal and expected pattern with legitimate treatment.
It also helps to know upfront that nails may not return to exactly how they looked before the infection, particularly if the nail bed or nail matrix sustained lasting changes. A podiatrist can give you a more specific idea of what to expect based on how advanced your particular case is.
Toenail fungus has a real tendency to return after treatment, which makes prevention habits worth keeping up even after your nails look clear again. Wearing shoes in locker rooms, pools, and other shared spaces meaningfully reduces exposure to the fungi that cause infection.
Keeping feet dry, choosing breathable socks and shoes, and avoiding sharing nail clippers or files with anyone else, including household members, all lower your risk. Sanitizing your own nail tools between uses is a simple habit that is easy to overlook.
For people who have already cleared an infection once, some podiatrists recommend an ongoing maintenance regimen, such as periodically applying a topical antifungal product, particularly if you have diabetes or another condition that raises your risk of recurrence.
If you notice nail discoloration, thickening, or crumbling that has lasted more than a few weeks, it is worth having it evaluated rather than waiting to see if it resolves on its own, since toenail fungus does not typically go away without treatment and tends to get harder to clear the longer it is left alone.
This is especially true if you have diabetes, poor circulation, or a weakened immune system, since a fungal nail infection in these situations carries a higher risk of complications. Our general podiatry team can also address any related discomfort alongside the fungal infection itself.
We offer both nail fungus treatment and laser nail fungus treatment as part of our podiatry services, along with care for related conditions like athlete’s foot. Getting an accurate diagnosis and a treatment plan suited to your specific infection is the most reliable way to actually get rid of toenail fungus, rather than cycling through remedies that were never going to reach it in the first place.
There is no truly fast cure, since nails grow slowly and fungus lives deep within the nail. Oral antifungal medication tends to work fastest at clearing the underlying infection, typically over about twelve weeks, but the nail itself still needs a year or longer to fully grow out and look normal.
The evidence is mixed. Some studies show promising cure rates, and laser therapy has fewer medication-related side effects than oral treatment, but laser devices are not currently FDA approved specifically to cure the underlying infection, and results vary between patients. It is worth discussing as an option with a podiatrist rather than assuming it guarantees a cure.
It is uncommon for toenail fungus to resolve completely on its own, and it often gets worse or spreads to other nails if left untreated. Seeing a podiatrist for an accurate diagnosis and treatment plan gives you a meaningfully better chance of clearing it.
Some small studies suggest mild benefit from certain home remedies, but the nail plate blocks most topical substances from reaching the infection in a strong enough concentration to clear it. These remedies are not a reliable substitute for medical treatment.
Treating the underlying infection can take anywhere from twelve weeks to several months depending on the method used, but the nail’s appearance takes considerably longer to normalize, often a year or more, since it depends on new, healthy nail growing out to replace the affected portion.
Yes. It spreads through direct contact and through shared surfaces such as locker room floors, pool decks, nail tools, and shoes. Wearing shoes in communal spaces and avoiding shared nail tools both help reduce the risk of spreading or catching it.
Toenail/Nail Fungus, Cleveland Clinic
Nail fungus: Diagnosis and treatment, American Academy of Dermatology
Laser treatment for toenail fungus may not provide cure, UCLA Health
Efficacy of Laser Therapy in Comparison With Other Methods for the Treatment of Onychomycosis: A Systematic Review and Meta-Analysis, PMC
Dr. Peter Hanna is a board-certified podiatrist and reconstructive foot & ankle surgeon with over 15 years of experience. He serves as Director of Podiatry at South Florida Multispecialty Medical Group, specializing in complex reconstruction, minimally invasive surgery, and diabetic foot care.
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