Fungal Toenails: What Causes Them and When to Seek Treatment

A thick, discolored toenail can be easy to ignore at first. Maybe it looks yellow. Maybe it feels harder to trim. Maybe it has started to lift, crumble, or look different than the nails around it.

While some nail changes come from trauma or shoe pressure, others may be caused by a fungal nail infection.

Fungal toenails, also known as onychomycosis, happen when fungus enters the nail bed and begins changing the color, thickness, and texture of the nail. These infections can affect fingernails, but they are much more common in toenails because feet spend so much time inside warm, enclosed shoes.

At Neighborhood Foot and Ankle in Dallas, Texas, Dr. Jonathan Pajouh and Dr. Veena Devaraju help patients understand what may be causing nail changes and what treatment options may be appropriate.

What Does a Fungal Toenail Look Like?

Fungal toenails do not always look the same from person to person. In the early stages, the changes may be subtle. A small white or yellow spot may appear near the edge of the nail. Over time, the nail may become thicker, darker, more brittle, or harder to trim.

Common signs may include:

• Yellow, white, or brown discoloration
• Thickened or brittle nails
• Crumbling or splitting edges
• Unpleasant odor
• Nail lifting from the nail bed

As the infection progresses, the nail may become uncomfortable in shoes or painful with pressure. Some people also notice that the nail becomes difficult to cut at home.

Not every thick or discolored nail is fungal. Nail trauma, psoriasis, circulation issues, and other conditions can sometimes cause similar changes. That is one reason professional evaluation is important before starting treatment.

Why Do Fungal Nail Infections Happen?

Fungus can enter the nail through small cracks in the nail or surrounding skin. Once it gets under the nail, it can be difficult to reach with basic over-the-counter products.

Toenails are especially vulnerable because shoes and socks can trap moisture and warmth. This creates an environment where fungus can grow more easily.

Risk factors may include:

• Sweaty feet
• A history of athlete’s foot
• Walking barefoot in public showers or locker rooms
• Nail injury or repeated shoe pressure
• Diabetes or circulation concerns

People who spend long hours in closed-toe shoes, athletes, older adults, and patients with certain medical conditions may be more likely to develop fungal toenails.

Can Fungal Toenails Go Away Without Treatment?

Fungal toenails usually do not clear on their own. In many cases, the infection slowly worsens as the nail continues to grow.

Some people try home remedies, nail polishes, or drugstore creams for months without much improvement. This can happen because the fungus is often beneath the nail, where topical products may not penetrate well.

Treatment can also take time because toenails grow slowly. Even when the infection improves, the damaged part of the nail has to grow out before the nail looks healthier. A licensed podiatrist can help set realistic expectations and explain which options may make the most sense.

“I know fungal nails can feel embarrassing, but we see this all the time. The important thing is figuring out what is actually causing the nail change so we can choose the right treatment instead of guessing,” says Dr. Jonathan Pajouh.

Treatment may include prescription topical medication, oral antifungal medication, professional nail trimming or debridement, or monitoring when the case is mild. The right option depends on the severity of the infection, the patient’s health history, and whether one nail or multiple nails are involved.

When Should You See a Podiatrist?

You should consider having a toenail evaluated if the nail keeps changing in color, shape, thickness, or texture. It is also important to seek care if the nail becomes painful, starts lifting, or becomes difficult to trim safely.

Patients with diabetes, circulation problems, neuropathy, or a weakened immune system should be especially cautious. Nail issues that seem minor can become more serious when sensation, blood flow, or healing are affected.

A podiatrist can examine the nail, discuss possible causes, and recommend the most appropriate next step. In some cases, testing may be recommended to confirm whether fungus is present.

At Neighborhood Foot and Ankle, Dr. Pajouh and Dr. Devaraju provide evaluation and treatment for fungal toenails, damaged nails, nail pain, and other foot and ankle concerns.

If you are dealing with thick, discolored, brittle, or lifting toenails, schedule an appointment to get answers and review your treatment options.

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Published by Neighborhood Foot and Ankle | Dr. Pajouh and Dr. Devaraju | Serving Dallas and surrounding DFW | 972-726-6464

Educational purposes only. Not medical advice.