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How do you know if toenail fungus is severe?

Toenail fungus, also known as onychomycosis, is a common condition that can range from mild to severe. While any case of toenail fungus requires treatment, knowing when it has advanced to a severe state is important. Severe toenail fungus can lead to permanent nail damage, pain, and potentially serious infections if left untreated.

What are the symptoms of severe toenail fungus?

Some of the key symptoms that indicate a severe case of toenail fungus include:

  • Thickened, brittle, distorted nails
  • Detached or lifted nail from nail bed
  • Crumbly nail debris under the nail
  • Discolored nail – yellow, brown, black
  • Foul odor coming from the nail
  • Complete destruction of the nail
  • Pain or discomfort around the toenail
  • Secondary bacterial or yeast infection around nail

The more advanced the fungus infection, the more the nail will become thickened, distorted, discolored and detached from the nail bed. Mild cases may only involve white or yellow spots on the nails without much debris or detachment from the nail bed.

What causes severe toenail fungus?

All cases of toenail fungus are caused by microscopic fungi called dermatophytes. Severe infections occur when the fungus is allowed to penetrate deep into the nail bed and cuticle over time. Factors that can lead to severe toenail fungus include:

  • Untreated mild or moderate fungal infection
  • Weakened immune system
  • Diabetes
  • Peripheral vascular disease
  • Injuries to the nail that allow fungus entry
  • Very thick nails
  • Poor foot hygiene
  • Excessive sweating or damp socks/shoes
  • Walking barefoot in public areas

If the fungal infection is allowed to progress, the fungi will burrow deeper into the nail over time. People with diabetes, circulatory issues, or weakened immunity are also more prone to severe infections.

How is severe toenail fungus diagnosed?

To diagnose a severe case of toenail fungus, the podiatrist will:

  • Ask about your symptoms and examine your toenails
  • Look for typical signs of fungal infection
  • Send nail clippings for a laboratory test to confirm fungus
  • Rule out other potential causes like psoriasis

The podiatrist will be able to determine if the toenail fungus is severe based on the extent of thickening, detachment, debris and distortion seen on examination. A positive fungus test will confirm the diagnosis.

Can severe toenail fungus spread to others?

Yes, severe toenail fungus is highly contagious and can spread to other people. The fungal spores thrive in warm, moist areas like public showers, swimming pools and locker rooms. The infection spreads when bare feet come in contact with the fungus. The risk is even higher if you have an open sore or skin injury on your feet or toenail. Some ways it can spread include:

  • Using public showers or walking barefoot in locker rooms
  • Sharing towels, socks or shoes with an infected person
  • Getting a pedicure with unsterilized instruments
  • Wearing infected person’s shoes or socks

To protect others, ensure to sterilize nail files, clippers and other instruments after use. Also avoid direct skin contact and avoid sharing personal items like towels or footwear.

What problems can severe toenail fungus cause?

If left untreated, severe toenail fungus can lead to additional problems like:

  • Permanent nail damage – Long-standing infection causes permanent thickening and distortion of the nail.
  • Chronic pain – As the infection grows under the nail, there may be swelling, pain and discomfort which affects walking.
  • Bacterial infection – The damaged nail is prone to secondary bacterial infection which can be painful.
  • Spread to other nails – Other toenails and fingernails also become infected if personal hygiene is poor.
  • Cellulitis – The skin around the toenail can become red, swollen and tender.

The longer fungus remains in the nail, the higher the likelihood of experiencing these complications. Diabetics face additional risks like foot ulcers and gangrene from severe toenail fungus.

When should you see a doctor for severe toenail fungus?

You should make an appointment with your doctor or podiatrist right away if you notice any of the following:

  • Thick, distorted toenails
  • Discolored nails
  • Detached or lifted nails
  • Debris accumulating under nails
  • Foul smell from nails
  • Redness, swelling or oozing around nail
  • Increased pain in toe or nail

Early treatment is key to clearing up severe toenail fungus before permanent damage sets in. Seeking timely medical care also prevents the infection from spreading further or causing secondary infections. Your doctor can prescribe oral or topical anti-fungal treatment tailored to the severity of your condition.

What over-the-counter treatments can I try?

In mild cases, over-the-counter antifungal treatments may help. However, these are generally not effective at treating severe or chronic toenail fungus. Some OTC options include:

  • Clotrimazole (Lotrimin, Desenex)
  • Miconazole (Micatin, Tinactin)
  • Terbinafine (Lamisil AT)
  • Tolnaftate (Tinactin)

These come as creams, solutions, powders and sprays applied directly to the affected nail once or twice daily. They work best on milder cases with white streaks or surface discoloration. See your doctor if you don’t see improvement in 2-3 months.

What prescription medications are used?

For treating severe toenail fungus, oral antifungal medications are often prescribed by the doctor. Some common prescription medications include:

  • Terbinafine – Taken daily for 6 weeks to completely treat fungal infection.
  • Itraconazole – Taken in pulses for 1 week per month over 2-3 months.
  • Fluconazole – Taken weekly for several months to clear fungal infection.

Oral antifungal drugs work from within the body to eliminate fungal infection. These medications can have side effects like nausea or liver dysfunction so regular monitoring is required. Topical or nail lacquer medications may also be combined in severe cases.

What natural remedies can help?

Natural antifungals may help in milder cases of toenail fungus. However, severe infections often require prescription medication. Some home remedies that can aid treatment include:

  • Applying tea tree oil 2-3 times daily
  • Using oregano oil on nails
  • Soaking feet in a mixture of vinegar and hydrogen peroxide
  • Applying Vicks VapoRub to nails daily
  • Drinking parsley tea or sage tea
  • Taking oregano or olive leaf extract supplements

Take care if applying essential oils directly to the nails as they can cause irritation. It’s best to mix them with a carrier oil first. Check with your doctor before taking any supplements.

What home care tips can help treat severe toenail fungus?

Along with medical treatment, good foot hygiene and nail care habits at home can help treat severe fungal infection:

  • Trim your toenails straight across to avoid ingrown nails
  • Disinfect nail files, clippers and pedicure tools after each use
  • Wear clean socks daily and rotate shoes
  • Apply antifungal foot powder inside shoes and socks
  • Wear shower shoes or flip flops in public showers
  • Keep feet clean and dry, especially between the toes
  • Apply topical tea tree oil to nails and cuticles daily
  • File down thickened nails after soaking in vinegar

Avoid wearing tight hosiery, sharing personal items, or walking barefoot to prevent reinfection and spread. Keeping feet clean and dry at all times inhibits fungal growth.

Can severe toenail fungus be cured permanently?

With prompt and proper treatment, severe toenail fungus can be cured fully over time in most cases. However, a chronic severe infection may damage the nail permanently even after successful treatment. Some key points:

  • Oral antifungal meds can cure fungal infection in 6-12 weeks
  • Topical medicines may take 6-12 months to eliminate fungus
  • Nails may take 9-12 months to fully regrow normally
  • Permanent thickening or distortion still possible
  • Recurrence common if preventive steps not taken

The outlook is best when treatment begins early before excessive nail damage. Avoiding reinfection is crucial to prevent recurrence of severe toenail fungus.

When should the toenail be removed surgically?

If other treatments fail and the toenail fungus continues to worsen, surgical removal of part or all of the toenail may be recommended. Reasons for nail removal include:

  • Chronic or recurrent severe infection
  • Nail causing persistent pain and discomfort
  • Complete nail destruction
  • Presence of cellulitis or ulcers around nail
  • Fungal infection unresponsive to medications
  • Impaired blood circulation due to thick nail

The toenail can be removed permanently or temporarily to provide relief and allow for normal nail regrowth. Special shoes are needed for 1-2 weeks post surgery to allow healing.

Can I still get a pedicure if I have severe toenail fungus?

Getting regular pedicures is not recommended if you have severe or contagious toenail fungus. The risk of infection spreading to equipment and to others is very high. However, you can still get a pedicure if you take some precautions:

  • Inform staff you have a contagious nail infection
  • Bring your own pedicure equipment
  • Skip cuticle cutting and callus removal
  • Use liquid polish only
  • Don’t allow soaking of your feet in the basin
  • Wear shower shoes in public areas
  • Double check sterilization methods used

Going to a reputable salon and being upfront about your condition allows staff to take steps to minimize the spread of infection. It’s best to wait until the fungus clears before regular pedicures.

How can I prevent severe toenail fungus from recurring?

After successful treatment, taking preventive steps is key to avoiding another bout of severe toenail fungus. Some tips to prevent recurrence include:

  • Practice good foot hygiene and nail care habits daily
  • Apply antifungal spray or powder in shoes regularly
  • Disinfect pedicure tools between uses
  • Avoid injury to toes and nails
  • Wear clean, well-fitting shoes and socks
  • Don’t share shoes, towels or nail files with others
  • Get any nail abnormalities checked quickly
  • Take oral antifungals if fungus reoccurs

Catching reinfection early is crucial. Seeking prompt treatment keeps the fungus from worsening again. Being vigilant with foot hygiene and protective footwear can prevent recurrence of severe toenail fungus.

Table summarizing key points on severe toenail fungus:

Signs of Severe Toenail Fungus Treatment Options Prevention Tips
  • Thick, brittle, distorted nails
  • Discolored or black nails
  • Detached nails
  • Nail debris
  • Foul odor
  • Pain or discomfort
  • Oral antifungal medication
  • Topical ointments
  • Nail removal surgery
  • Good foot hygiene
  • Clean, dry feet
  • Disinfect tools
  • Don’t share shoes/socks
  • See doctor promptly


Severe toenail fungus can have detrimental effects on the nail if left untreated. Being able to identify signs of severe infection allows prompt medical care. While oral and topical medications are effective, preventing recurrence is also vital. Taking preventive steps and maintaining good foot hygiene helps avoid repeat severe infections.