Toenail Fungus

Toenail fungus—medically known as onychomycosis—is a common infection that occurs when fungi invade the nail or the skin beneath the nail. Early signs often appear as small white or yellow spots near the tip of the toenail. Without treatment, the infection can progress deeper into the nail, causing thickening, discoloration, brittleness, and even nail loss. At Ankle & Foot Specialists of Puget Sound, we offer effective, evidence-based treatments to restore healthy nails and prevent the infection from spreading.

What Causes Toenail Fungus?

Toenail fungus thrives in warm, moist environments and is typically spread through direct or indirect contact. Common sources include:

  • Walking barefoot in locker rooms or public showers

  • Sharing nail tools or footwear

  • Excess moisture trapped in shoes

  • Pre-existing athlete’s foot

  • Nail trauma

  • Weakened immune system or poor circulation

Anyone can develop fungal nail infections, but they are especially common among athletes, older adults, and individuals with diabetes.

Types of Toenail Fungal Infections

Several different fungi can infect the toenails. Understanding the type of infection helps determine the best treatment plan.

1. Distal Subungual Onychomycosis (DSO)

The most common type—often linked to athlete’s foot.
It spreads from the tip of the nail toward the nail bed, causing discoloration, thickening, and crumbling.

2. White Superficial Onychomycosis (WSO)

Appears as white, chalky spots on the surface of the nail.
Progresses slowly and may affect the entire nail if untreated.

3. Candida Onychomycosis

Often caused by trauma or chronic moisture.
Leads to swelling of the skin around the nail, thickening, and deformed nail growth.

4. Proximal Subungual Onychomycosis (PSO)

Begins at the base of the nail near the cuticle.
More common in individuals with weakened immune systems.

Symptoms of Toenail Fungus

Symptoms vary by infection type and severity, but common signs include:

  • Thickened, brittle, or discolored nails

  • White or yellow streaks beneath the nail

  • Crumbling edges or tips

  • Scaling under the nail

  • Distorted nail shape

  • Foul odor

  • Separation of nail from the nail bed

  • Complete nail loss in severe cases

If you’re experiencing any of these symptoms, a podiatric evaluation is recommended to confirm the diagnosis and prevent spreading the infection.

How Toenail Fungus Is Diagnosed

Your podiatrist will:

  1. Examine the nail for color, texture, and thickness changes

  2. Review your foot hygiene and medical history

  3. Possibly obtain a nail sample to identify the type of fungus

  4. Use imaging if trauma or other conditions are suspected

Proper diagnosis helps determine the most effective treatment pathway.

Treatment Options for Toenail Fungus

Not all cases of toenail fungus require aggressive treatment, but addressing the infection early helps prevent it from spreading to other nails or people.

Conservative Treatments

Topical Antifungal Medications

Prescription topical solutions help kill fungus on and beneath the nail surface.

Oral Antifungal Medications

Useful for moderate to severe infections, oral medications treat fungus from within the bloodstream.

Debridement (Nail Thinning)

Trimming and reducing thickness of the nail improves comfort and increases medication effectiveness.

Advanced & Surgical Treatments

Nail Avulsion (Partial or Complete Removal)

For stubborn or severe cases, removing part or all of the nail allows direct treatment of the infected nail bed.

Chemical Treatment of Nail Matrix

Used to prevent the infected portion of the nail from regrowing in chronic or recurring cases.

We determine the safest and most effective option based on the type of fungus, nail condition, and overall health.

When to Seek Treatment

Schedule a visit if you experience:

  • Pain, swelling, or redness around the nail

  • Severe discoloration or deformity

  • Foul odor or drainage

  • Spread of infection to other nails

  • Toenail fungus that does not improve with home care

  • A history of diabetes or circulation problems (seek care immediately)

Early treatment leads to better results and helps prevent complications.

Restore Healthy Nails With Expert Care

Toenail fungus can be stubborn, but professional treatment makes a significant difference. At Ankle & Foot Specialists of Puget Sound, our podiatrists offer advanced, effective solutions to eliminate the infection and promote healthy nail regrowth.

Contact us today to schedule a consultation and take the first step toward clear, healthy nails.

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