Fungal Toenails - Indianapolis Podiatrist - Jeffrie C. Leibovitz, DPM

More Than You Ever Wanted to Know About Fungal Nails

There are a few things you can count on: taxes, death, and mycotic (fungal) nails. You might be lucky and avoid 2 of these. 

More than half of people over 50 years old have mycotic nails. It goes up every decade with 60 percent of 60-year-olds and 70 percent of 70-year-olds having these thick and ugly nails. Just throw in the towel if you make it to 100.

Don’t be fooled, though. This is not a problem only reserved only for the aged. It does not discriminate, and the longer you have it, the harder it is to attack. Early intervention can make a profound difference when it comes to treatment.

On average, people wait 3-5 years after they notice changes in their nail before they see a doctor. After months…






the fungus will own the nail.

A thick nail can be painful, but it can also be an embarrassment. If you want to wear sandals, go to the beach, or spend time with at your friend’s pool, it can also be a quality of life issue. It only contributes to the problem if you hide the unsightly nails under socks, shoes, and nail polish.

Recognizing a Fungal Nail Infection (Onychomycosis)

There are three stages of fungal nail infection. Let’s work backwards. 

Stage 3

The thickness of the nail can be profound, 4-20 times thicker that a normal nail. The entire nail will be so dark that you cannot see the pink nail bed. Loose debris will build up under the nail. The nail will loosen from the nail bed and can periodically fall off. 

Sorry for being a Debbie Downer, but the nail will grow back in the same way or even thicker. 

The change in the shape of the nail can be dramatic. The term “gryphotic“ nail means “rams horn” and the nail will grow in an upward twisting pattern to resemble its name. The nail can also take a 90-degree turn from the toe. 

stage 3 mycosis (1)


Stage 2  

Affected nails will have 30-100 percent of their surface area discolored and will be 2-4 times thicker than a fingernail. An extra strong nail clipper will be required to cut these nails. Separation of the nail and bed can be up to 25 percent. If a single nail has noticeable changes, you will probably see slight changes in other nails.

Stage 1

Less than 20 percent of the nail will show discoloration. It will be somewhat yellow, brown, or gray (the color of smoker’s nails). If a yeast infection is in the nail, there will be white patches or streaks. This may also show up at the end or sides of the nail. The nail will have normal thickness.

stage 1 mycosis

Can a Normal Nail Return?

The key is recognizing early nail changes. The changes associated with stage 3 can take 5-10 years to appear, 1-5 years for stage 2, and 1 year or less for stage 1. Unfortunately, we rarely pay attention to our nails so early changes are overlooked and ignored until stage 3. 

Nail fungus is like a slow, smoldering fire. It is so much easier to put out when it starts. Once it becomes a raging house fire, it can sometimes be hopeless. So early detection is the most important factor in the success rate.

I Frequently Hear…

“The nail started changing 6 months ago.“ (What actually happened is the nail started hurting 6 months ago, but has been changing color and thickening for the last 5-10 years.) 

“I dropped something on my nail 5 years ago and it fell off. It came back thick and ugly. I thought it would go away.” 

“I keep getting infections from an ingrown nail and now it is thick and dark.”

“I have tried EVERYTHING. Tree tea oil, Vick’s Vaporub, vinegar… and nothing happened. I used this stuff for 6 months.” Medicines that have actual antifungal properties will take 1 year to clear the nail.


The treatment method with the greatest success is a combination of oral and topical medications, nail nutrition, and debridement. 

Each individual treatment by itself is marginally helpful. Oral meds have a 50 percent cure rate in the toenails, topical meds are at 5-10 percent, and nail nutrition falls below 2 percent. Nail debridement reduces the size and bulk of the nails so there is less fungus to combat, but does not eliminate it. 

When you combine all these therapies, we can see a 75 percent cure rate. The definition of “cure” is worth discussing. 

The nail may look “better” after a year of treatment and even show 80 percent improvement, but if the nail bed is not pink and thin, the fungus is still there. Success is when the toenail appears as clear and thin as the fingernail.

Oral Medication

Oral meds are used for 90 days (1 tab/day). Consistency is critical. This type of medication can cause liver irritation, so monitoring blood work should be done before treatment has started, and repeated at 45 days. (I want the results to be in the low normal range to consider this option.) This type of liver problem can also occur with cholesterol and oral diabetic medications. Adding several medications that effect the liver may not be a good idea. We don’t want you to have pretty nails and a bad liver. 

Warning: Do not consume grapefruit juice while taking anti-fungal oral meds. It is metabolized at the same area of the liver as anti-fungal, cholesterol, and oral diabetic meds. 

Topical Medication

The topical meds are considered fungal static, which means they do not kill the fungus but slow it from advancing or getting worse. The goal is to have the oral meds kill the fungus and the topical meds keep it from advancing. A new nail will eventually replace the old discolored nail.

The newest research indicates that just attacking the fungus may not be enough. Improving the health of the nail is also very important. The new generation of topical meds include a selection of products that restore the nail. 

Laser Therapy

Additionally, there is a new treatment option available! Laser therapy helps all of the above with fighting off a fungal nail infection. This is a very easy therapy – it just takes a 3 sessions over the course of 3 months.

Getting a normal nail is hard but letting the fungus win is easy.

Fungus is Everywhere

Fungi are saprophytes, which means they thrive off of dead are decaying tissue. A culture of the carpet in your house, car, or the last restaurant you dined at would find fungus. So you can blame the community shower, the kid’s nasty bedroom, nail salon, or fitness center, but fungus is everywhere.

What you should especially be concerned about is: your shoes.  

A closed shoe collects perspiration, never gets cleaned, and accumulates dead cells. (When is the last time you cleaned the inside of your shoes, if ever?) There is an endless food source for fungi as well as bacteria in a shoe.

Don’t Shoot the Messenger

Denying that the nail has fungus will lead to delay in treatment, and delayed treatment is a nail in the coffin for good results. 

Remember, nail discoloration may not be from polish. The typical first response to seeing some, however, is to hide the changes with more polish. There is always a surprise that after covering nail discoloration for a few more years, the nail has only become worse. 

This is a delicate issue with a pedicurist. They do not want to bring attention to a fungus among us because they will be blamed for of causing the problem. If you are not caring for your nails you may be in ignorant bliss for years.

Also remember, the best route to recovery is giving me a fighting chance to help you. Showing me a stage 3 nail and expecting to hear great news about how it will be normal in a few weeks is as frustrating for me as it is for the patient. You may have heard this before but get this treated early

There’s No Better Time to Get help for Fungal Nails than Today

The take home point is awareness. People get to stage 2 and 3 fungal nails because they have no idea what is happening to their feet, and that is just a shame.

Spread the word! If you, a friend, loved one, or someone that uses the same nail polish bottle at your foot spa has what might be the beginning of a nail problem contact my office. If it’s nail fungus, we can hit it hard and early. If it’s not, it was something worth looking at anyway – it might be something else in need of treatment.

Call our office at (317) 545-0505 to schedule an appointment. We’ll be happy to see you!

doctor checking a patients toes