Medical Issue

Toenail Fungus (Onychomycosis)

Toenail Fungus (Onychomycosis)

Toenail fungus (onychomycosis) is an infection related to the fungus that causes athlete's foot (tinea pedis). Onychomycosis grows inside and under the nail in the nail bed. It can cause the nail to thicken, yellow or darken, and the edge of the nail may grow ragged and crumble. The condition is a very common condition in adults, and is one of the most common patient issues in a podiatry office.


Symptoms include thickened and/or distorted nails that are dull and discolored, nail edges that are ragged or crumbling, and build-up under the nail surface. The disease typically affects more than one nail.

Risk Factors

Athlete’s foot sufferers are more likely to contract toenail fungus. Men are more likely to get toenail fungus than women, although women who get pedicures are more likely to contract the fungus. Living with someone who has toenail fungus increases the risk of acquiring it. People who perspire heavily, have skin conditions, diabetes or circulation problems face an increased risk for contracting toenail fungus. Environmental factors including a humid environment, walking barefoot in a public bath or pool area, or wearing shoes or socks that reduce ventilation can all lead to an increased possibility of contracting the fungus. Without prevention, athlete’s foot sufferers and anyone who had a previous toenail fungus infection is likely to be re-infected.


Toenail fungus thrives in moist, damp places, such as showers or shoes where humidity build-up and warmth help ensure transmission and growth of the organism. Walking barefoot in pools, showers, or locker rooms increases the likelihood of the spread of the fungus. Although the fungus can affect fingernails as well as toenails, toes are exposed more easily, are confined more frequently, and have less blood supply. Although not common, some patients with toenail infections will also have a fungal infection in a fingernail.


There are three general options for treating onychomycosis:

  1. Topical solutions including ointments and medicated nail lacquers
  2. Prescription oral medications
  3. Laser therapy

Temporary or permanent nail removal is an option if other treatments are unsuccessful.

Topical solutions

Topical solutions include over the counter remedies and prescription medicines such as Formula 3, Penlac, Ciclopirox, and Jublia.  They usually require application once or twice a day often for periods of one year or longer. Topical solutions can reduce fungus, but offer an overall efficacy (success) rate of 10-20% for partial nail clearance of toenail fungus.

Oral medications

Oral options include products such as Lamisil.  Treatment cycles are typically three to four months.  Efficacy rates are around 35%. Reinfection is very common after a course of treatment. Oral medications also have potential side effects including possible liver damage.


Laser treatments typically require a few treatments and may have higher efficacy rates.

The Concierge Podiatry Advantage

Dr. Roth's proprietary treatment is based on the realization that individual treatment options are insufficient to resolve most toenail fungus cases. He discovered that the only way to solve toenail fungus problems is to combine several different types of treatment. The Concierge toenail fungus treatment protocol starts with special nail shaping that removes most of the diseased nail, followed by laser therapy to eliminate fungus from beneath the remaining nail surface. Patients are given low dose oral medication along with various patient-specific topical solutions to further reduce the fungus incidence rate, and special nail vitamins to speed nail growth.

Because toenail fungus treatments are unlikely to be successful in one visit, Dr. Roth provides each patient with a comprehensive treatment plan including a schedule for visits leading to a successful result including bundled treatment plans. And because of Dr. Roth's special vitamin regimen, significant results are often seen in two to four months, much more quickly than with other treatment programs, with a full solution in as little as six months.

  • Contact Concierge Podiatry for an appointment
  • Learn more about treatment options often used to treat this issue