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What to do about toenail fungus under your nails

Are you embarrassed about your unsightly toenails?

If your toenails look discolored, thickened, or are becoming more brittle or painful, you may have toenail fungus under your nails.

Don’t worry, you’re not alone! Millions of Americans have toenail fungus infections, called onychomycosis. It’s estimated to affect 10 percent of the general population, 20 percent of people over 60 years, and 50 percent of those older than 70 years.(1)

The good news is there are a number of strategies that can help turn your discolored and unsightly nails into clearer, healthier-looking nails.


What causes toenail fungus under the nails?

Toenail infections, like other infections, are caused by tiny microscopic organisms living where they’re not supposed to be. In the case of toenails, these organisms are often fungi, like yeasts and molds. These invaders can live in the layer of dead skin cells around and underneath your toenails.

Toenail fungus is contagious and you can get it from being exposed to others’ infections. These yeasts and molds are present everywhere in the environment, but tend to grow and flourish in warm, moist places like community pools, gyms, and change rooms.

Your risk of getting the toenail infection increases if you:

  • spend time in a warm, moist climate or wear sweaty shoes,
  • wear shoes that are too tight or have metal toe-caps that may cause tiny injuries to the toenails,
  • have health issues (like diabetes, poor circulation, lowered immunity, psoriasis, or hyperhidrosis–excessive sweating), or even from
  • increasing age.

If you think you have toenail fungus under your nails, reach out to me or your health care provider to get an accurate diagnosis. Before treating it, you want to be sure if the reason for your unsightly toenails is, in fact, fungus under your nails (or whether it’s something else). You don’t want to let a fungal infection go too far, as not treating it can lead to further complications.(2)

How to help toenail fungus

Once you have been diagnosed with toenail fungus under your nails, there are several strategies that can help. They can be used independently or together, depending on your circumstances.

One treatment is with anti-fungal medications. These are pills taken by mouth, sometimes for weeks or months. Some people have medical conditions or are taking other medications that make these antifungal pills risky. Others who take them sometimes experience unwanted side effects.(3) In these cases, I recommend other strategies.

Another common treatment for toenail fungus is medicated nail polish. These aren’t always very effective and must be used for many months. This is because nails are naturally a tough protective barrier. Because the infection is located underneath the nail, this makes it hard for the medication to penetrate through the nail to reach the underlying infection.(4,5) This is especially true in cases where at least half of the nail is infected.(3)

Both medications and medicated polish are long-term strategies that may be risky for many people, and may not work at all. Plus, treatment with these often takes several months.

This is why I prefer using laser technology. It’s safe, quick, and pain-free.

Laser procedure for toenail fungus under the nails

Using a laser (a focused beam of light) directly on the toenails helps to reach those areas underneath and inside the nail. This is because the type of light used can penetrate through the tough layers of the nails. Laser procedures are very convenient because they can be completed in under 10 minutes per foot.

The PinPointe foot laser is FDA-approved for the temporary increase of clear nail in patients with onychomycosis.(2)

This machine can be used on almost all patients because it has virtually no side effects. In one study, over 83% of people who received three sessions with a laser and improved their foot hygiene (details on that are below) had no fungi after 18-months.(3)

Some people start to see visible improvement after just one visit, although you may need to return a small number of times for follow-up.

The laser works by targeting the fungi without hurting your skin and nails. It’s designed to be at the right level to penetrate your nail and damage the infecting fungi, while not being too high to cause burning or pain for your feet.(5) Most people don’t feel anything, or they just feel a warming sensation.

At the time of the procedure, the toenail will usually not become instantly clear–it takes time to grow out. As long as your infection is treated and you don’t get re-infected, you should see new healthy, clear nail as it grows out within 12-18 months.


Foot hygiene for lasting results

Using medications or procedures can vastly improve the appearance of your toenails if you have a fungal infection. However, for lasting results, you need to step up your foot hygiene habits. Remember, there is always a chance of reinfection because the fungus is present everywhere in the environment.

Here are some suggestions:

  • Be nicer to your feet by wearing comfortable well-fitting shoes. Dispose of your oldest footwear and use an antifungal power in other footwear.
  • Keep your feet clean and dry with daily washing with soap and thorough drying with a clean towel. Wear cotton socks, or none at all if you’re in a warm, humid climate.
  • Keep your toenails trimmed and regularly disinfect all tools you use to cut, file, or otherwise attend to your feet.(3)
  • Never share your footwear with others and wear something on your feet whenever you go to a swimming pool, gym, or another warm place where people walk around barefoot.(3)

If you have toenail fungus under your nails, remember…

Once your diagnosis is confirmed, you have several options available to deal with it. You and your podiatrist can decide on the best course for you: anti-fungal pills, medicated nail polish, and/or laser therapy. The reason I prefer laser procedures is that they’re very safe and effective at improving the look of unsightly nails due to fungal infections.

Regardless of which method you use, for lasting results, it’s important that you follow-through with proper foot hygiene to reduce the risk of getting it again.

I’m Dr. Kelly Geoghan, DPM, Board Certified Surgeon and Aesthetic Podiatry Specialist. If you’re in the Baltimore area, contact me for an appointment for your personalized plan for flawless feet at:

  • Lutherville: (410) 753-4422
  • Dundalk: (410) 753-4422


1 – Westerberb, D. P. & Voyack, M. J. (2013). Onychomycosis: Current trends in diagnosis and treatment. Am Fam Physician, 88(11), 762-70.


2 – “Indications for Use Statement for PinPointe Foot Laser.” Food and Drug Administration, Department of Health and Human Services. May 13, 2013.


3 – Zalacain, A., Merlos, A., Planell, E., Cantadori, E. G., Vinuesa, T., & Viñas, M. (2018). Clinical laser treatment of toenail onychomycoses. Lasers Med Sci. 33(4):927-933. doi: 10.1007/s10103-017-2198-6.


4 – Ortiz, A. E., Avram, M. M., & Wanner, M. A. (2013). A review of lasers and light for the treatment of onychomycosis. Lasers Surg Med, 46(2):117-24. doi: 10.1002/lsm.22211.



5 – Angelo, T., Borgheti-Cardoso, L. N., Gelfuso, G. M., Fleury, S., & Gratieri, T. T. (2016). Chemical and physical strategies in onychomycosis topical treatment: A review. Medical Mycology, 55 (5), 461–475.[LINK:]

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