Get foothold on toenail treatments

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DEAR MAYO CLINIC: Why do your toenails get so thick and discolored as you get older? Is it a fungus and, if so, what can a person do to clear it up? Does soaking your feet in hot water with ginger in it help?

Toenails can thicken and discolor for a variety of reasons.

This problem is not limited to the elderly. The most common causes for thickened and discolored toenails include fungal infection (onychomycosis) and trauma.

A fungal infection of the nails can be difficult to treat effectively.


Multiple home remedies exist for treating these infections, such as the one you mention.

To my knowledge, none of them have been scientifically tested, and none are known to give consistent, positive results. Fortunately, other treatment options are available.

Trimming and thinning the affected toenail plates regularly may help.

Before you trim your toenails, soak them in water for 10 minutes to soften them. Dry them thoroughly after soaking. Then, gently stroke the surface with an emery board to thin the nail.

After you’re done thinning, use a nail trimmer to cut the nail straight across.

Don’t round your toenails at the corners when you trim them as it increases your risk of an ingrown toenail.

Antifungal ointments and creams are available as over-the-counter medications.

There is also a prescription-strength antifungal medication that comes in a lacquer you paint on your nails once a day.


These topical medications do not have very high cure rates. Generally, you need to use them for at least six to 12 months as the affected nail grows out.

Another option is removal (avulsion) of the toenail in hopes that a normal nail will grow back. There is no guarantee the nail will grow back healthy, though. The nail may grow back thickened, fungal or ingrown.

For particularly painful, thickened toenails, whether or not they are infected, the nail can be removed permanently. But, this treatment usually is used only after other options have failed.

In most cases, oral antifungal medications are the most effective treatment.

You typically take these medications for six to 12 weeks. Then, as the toenail grows out, a healthy nail develops at the base.

The fungal toenail simply grows out over a period of about six to 12 months. Oral antifungal medications have a higher cure rate than other treatment options, particularly if the specific type of fungus can be determined.

It is, therefore, recommended that samples of the affected toenail be tested with a fungal culture to identify the presence and type of fungus.

The test results can show if an oral antifungal medication would be effective against the identified fungus.


As these medications have potential side effects, including liver damage, your doctor will likely have you undergo blood tests prior to prescribing the medication and while you are taking it, to monitor your health.

Even if treatment with oral antifungal medication is successful, there is potential for recurrence, particularly if you regularly expose your nails to warm, moist conditions — an environment in which fungus can thrive.

To help prevent nail fungus and reduce recurrent infections, keep your nails short, dry and clean.

Wearing synthetic socks that wick moisture away from your feet and changing your socks often can help.

Also, wash your hands after touching an infected nail to keep the fungus from spreading to other nails. — Martin Ellman, D.P.M., Orthopedic Surgery, Mayo Clinic, Rochester.

E-mail a question to or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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