Toenail fungus may be an embarrassing condition, but it’s very common and highly treatable. For milder cases, treatment may not be necessary. However, toenail fungus rarely goes away on its own, and there’s always the likely chance of recurrence despite successful initial treatment. If left untreated, toenail fungus can worsen and may become uncomfortable and painful. It’s also good to note there are other nail conditions – such as harmless lines and ridges, or innocuous discoloration – that mimic some symptoms of fungal nail infection and can be easily mistaken for toenail fungus.

So, what exactly is toenail fungus, and how do I know if I have it?

What is toenail fungus?

Medically known as onychomycosis or tinea unguium, toenail fungus is an infection that gets in through the cracks in your nails or cuts in your skin. It occurs due to the overgrowth of fungi in, under, or on the nail. Because fungi thrive in warm, moist environments, this type of environment can cause them to naturally overpopulate. The same fungi that cause jock itch, athlete’s foot, and ringworm can also cause fungal nail infections.

Toenail fungus typically starts out as a white or yellow spot under the nail that grows over time. It can cause the affected nail to thicken, crumble, and discolor (yellow, off-white, red-brown, green, black). The discoloration is caused by debris build-up under the nail and can cause the nail to loosen or completely separate from the nail bed.

Toenail fungus develops over time, so any immediate difference in the appearance of your nails may be too subtle to notice in the beginning. A toenail can affect a single toenail, or multiple toenails at a time, spreading to neighboring nails and even your fingernails if left untreated. The condition can also worsen due to multiple factors including toenail injuries, wearing the wrong type of footwear, and improper trimming of the toenails.

What are the symptoms of toenail fungus?

Scaling under the nail (subungual hyperkeratosis)
White or yellow streaks on the nail (lateral onychomycosis)
A crumbling corner or tip of the nail (distal onychomycosis)
Yellow spots on the bottom of the nail (proximal onychomycosis)
Flaking white areas on the nail’s surface
Distorted or oddly-shaped nail
Foul-smelling odor coming from the nail
A brittle or thickened nail
Nail lifting from the nail bed
Loosening or complete loss of the nail

How common is toenail fungus?

Toenail fungus is much more common than fingernail fungus. It accounts to 50% of all nail diseases, affecting between 35 to 36 million Americans at any given time. Only 6.3 million of those have actually been diagnosed by a podiatrist or medical practitioner, and only 2.5 million received treatment. An estimated 2 to 18% is affected by toenail fungus worldwide, with the number translating to around 35 million people worldwide. The number increases every year, with millions of dollars being spent annually for oral and topical antifungal prescriptions.

The chances of getting toenail fungus increases as you age, with a reported 18.2% of patients between the ages of 60 to 79 experiencing some sort of toenail fungus, a relatively high number in comparison to the 0.7% of patients younger than 19 years old. People suffering from age-related conditions such as diabetes, weaker immune system, and lower/impaired blood flow are prone to toenail fungus as well. People with a genetic predisposition to toenail fungus, meaning those with family members who have it, are also prone to toenail fungus recurrence.

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