Podiatrists are the specialists for treating toenail fungus, medically known as onychomycosis. As Doctors of Podiatric Medicine (DPMs), they specialize in the foot, ankle, and lower leg, including complex nail disorders and infections. Toenail fungus is a persistent infection that rarely resolves on its own. A podiatrist’s expertise is necessary to diagnose the specific pathogen and prescribe targeted, prescription-strength treatment, as over-the-counter products are often ineffective.
How Podiatrists Diagnose Toenail Fungus
Diagnosis begins with a visual examination of the affected nail, checking for discoloration, thickening, or brittleness. Since conditions like nail trauma, psoriasis, or bacterial infections can mimic fungus, laboratory confirmation is necessary for accurate treatment planning. The podiatrist collects a small sample, usually by scraping or clipping infected nail tissue or debris from beneath the nail plate.
The sample is sent to a lab for testing, often involving microscopy or a culture test to identify the specific yeast or fungus. Identifying the exact pathogen, such as dermatophytes like Trichophyton rubrum, allows the podiatrist to select the most appropriate antifungal agent. Molecular testing, which analyzes the DNA or RNA, is also available for rapid and accurate diagnosis, ensuring the treatment is precisely targeted.
Professional Treatment Methods
Podiatrists offer treatment options significantly more potent than non-prescription alternatives. For mild to moderate infections, prescription-strength topical medications, such as a lacquer or solution, are used. Products like efinaconazole or tavaborole are formulated to penetrate the hard nail plate more effectively than over-the-counter creams, reaching the infection in the nail bed.
For severe or widespread infections, oral antifungal medications like terbinafine or itraconazole are prescribed, working from the bloodstream to attack the fungus at the nail matrix. These medications are effective but require careful medical monitoring, sometimes including liver function tests, due to potential side effects. The podiatrist also performs professional debridement, trimming and thinning the infected, thickened nail tissue. Debridement improves the nail’s appearance and allows topical medications to better reach the infection site.
Advanced Therapies
Advanced therapies are available for stubborn cases that do not respond to medication alone. Laser treatment uses focused light energy to pass through the nail plate, heating and destroying fungal cells without damaging surrounding healthy tissue. For painful, persistent, or severely deformed nails, the podiatrist may recommend a partial or complete surgical removal of the nail plate, known as a matrixectomy. A combination of these methods is often utilized to achieve a permanent cure.
Preventing Recurrence and Maintaining Foot Health
Successfully treating toenail fungus is only half the battle, as re-infection is frequent because fungal spores are common in the environment. A major preventative measure involves managing the environment inside shoes, which is often damp and dark—ideal conditions for fungi. Patients should use an antifungal spray or powder inside all footwear daily and rotate shoes, allowing each pair 24 hours to air out and dry completely between wears.
Wearing breathable footwear and moisture-wicking socks helps keep the feet dry, reducing humidity that encourages fungal growth. After bathing or exercise, thoroughly dry the feet, paying particular attention to the spaces between the toes. Avoid walking barefoot in warm, public, moist areas, such as gym showers, locker rooms, and public pool decks. Consistent adherence to this foot hygiene routine, even after the nail appears clear, prevents the fungus from returning.