Video Transcription – Why Treatments for Fungal Toenails Fail

We all know that treatments for fungal toenails are not 100% effective.  Not oral medication; certainly not topical medication; not even laser, although laser is the most effective treatment.  But do you know what the number one reason anti-fungal treatments fail?


The number one reason that anti-fungal treatments fail is because it wasn’t fungus to begin with.  Not every thickened, discolored nail has fungus.  Lots of things can cause the toenails to become thickened, discolored, brittle, and loose from the skin beneath it.  If there was ever trauma to the nail; if you ever dropped something on the toe, or stubbed your toe; damage to the nail can cause it to look like fungus when there isn’t any.


Lots of other things can cause nail changes that may mimic a fungal infection including certain types of arthritis, diseases of the liver and thyroid, medications including certain antibiotics and chemotherapy, as well as skin conditions like psoriasis.


Constant pressure on the nails is a subtle type of trauma that can cause nail changes that look like fungus.  For example, if you have hammertoes, where your toes curl down and you’re walking on the tips of the toes, you may be putting excessive pressure on the ends of the nails, and they can become thickened, discolored and even loose and painful.  It may look like fungus, when it’s not.


But here’s the kicker; when the nail is deformed for whatever reason, it can be an invitation for fungus to invade the nail.  What was once an abnormal nail for another reason has now become a fungal infection.  So how do you know if you have fungus in the nail?  Sometimes I can eyeball it.  As a foot specialist, and seeing lots of fungal nails over the years, I can often say without a doubt, that you have fungus in the nails.  But not always.  When in doubt, I let the pathologist make the call.  I’ll take a clipping the deformed nail and send it to the lab.  They’ll look at it under a microscope and see the fungus, or not, if it isn’t there.  And they’ll culture the nail and see which, if any, fungus grows.  That way, we can be sure that we know what we’re treating and how to treat it.


If you have a toenail fungus, you don’t want to let it go, as it can get worse, spread and lead to pain and even chronic athlete’s foot; it’s the same fungus.  But before you self-diagnose, come to Kansas City Foot and Ankle, and we’ll make sure to diagnose your condition appropriately and treat you for what you have; which may not necessarily be what you THINK you have.