While we see our share of patients with serious health problems, one of the most frequent reasons for visits to the clinic is for something that is at first perceived as an annoying cosmetic issue—those ugly, split, discolored toenails.

Fungal nail infections occur when a fungus takes root either on the nail or in the nail bed. For most healthy people, fungal nail infections don’t cause problems more serious than embarrassment while they’re wearing sandals.

But if left untreated in patients with diabetes or a weakened immune system, the condition could turn . . . really ugly. An infection can cause nails to become brittle and broken, and may contribute to foot odor. If left untreated, the infection can spread to other areas. Fungal infections don’t go away without treatment.

The old method of treatment was to paint the nail with an anti-fungal polish. But because of the thickness of the toenail and its slow growth pattern, it can take a year or more to achieve results— if ever— with a topical solution. There are oral medications that are more effective, but they are associated with some side effects such as possible liver damage.

A third option is laser nail fungus treatment. This procedure uses a laser light to gently heat the skin under the nail until the fungus is killed. Results are usually seen in six to 12 months. There are no known side effects. The treatment can be repeated if desired.


Nail infections are caused by yeasts, molds and certain types of fungus. Toenail fungi (the plural of fungus) are everywhere— in the gym, public pools, your carpets, schools and nail salons. Technically known as onchymycosis, this opportunistic condition thrives in warm, moist environments. Most infections are caused by the same critter that brings us athlete’s foot.

Nail infections tend to run in families. Some people are prone at a fairly young age, but for most of us the first sign of infection is seen after age 60. Men are more apt to develop infections, possibly because men are more frequent visitors to public showers and gyms whereas women prefer to shower at home. Our diabetic patients are especially vulnerable.

Here are some ways to prevent toenail infections:

  • Wash and dry your feet carefully each night before bed
  • Wear socks and change into clean ones if your feet get sweaty (while exercising, for instance)
  • Choose roomy shoes or sandals that allow moisture to escape
  • If your shoes get wet with perspiration, let them dry for 24 hours
  • Don’t share your personal grooming tools, such as nail files, clippers, towels or socks, with other people
  • Wear flip-flops or sandals in public areas such as showers, pools or locker rooms.


Nail infections are notoriously slow to respond to treatment. As with many conditions, the earlier you begin treatment, the better your chances of a cure. The first sign of a nail infection is usually a toenail that starts to thicken and become discolored. The area around the nail may itch. This is the time to call the clinic; don’t wait until the situation is dire.

After you rid yourself of the pest, it can come back if you’re not careful. And toenail infections are contagious; other members of the family can contract the infection from a shared towel or bath mat.

Aside from the above precautions, don’t buy shoes that are too narrow or tight. Be careful to protect your toes from trauma (like dropping something on your foot). A torn nail gives the fungus an opening. Once the fungus is established, the nail itself acts like a shield to protect the fungus from medication.

If you have been coping with this problem and you are tired of wearing clunky shoes— to the beach, even in summer— contact our office and ask about laser treatment for nail infections. Fungal infections may be stubborn, but they’re not irreversible.