Posts for category: Toenail Fungus

Many people watched the “Big Game” because they are diehard football fans—some even say it should be a national holiday—while others watch it for a much different reason; the commercials! It is no surprise that commercials during the “Big Game” are always the “funniest” but there is always that one commercial that you think to yourself “Why?”. According to AOL.com, that commercial was the one about toenail fungus…yes, toenail fungus. AOL claims the “Toenail fungus commercial was the least sexy ad…ever” and I think that statement may have some truth to it. Although, I’m sure many of us out there (who probably have had our bouts with toenail fungus) are now curious about what Jublia has to offer.

Jublia (efinaconazole) is a new topical medication that is used to treat Distal Lateral Subungual Onychomycosis or fungal toenails. There are many medications on the market ranging from topical applications to oral medications. Many of the medications, however, are dependent on a lot of factors with the main being the severity of the fungus. If the entire nail is thick and covered in fungus not many medications can get rid of it and more invasive measures need to be taken with the most likely being removal of the nail. But, like Jublia is indicated for, if the fungus is just at the tips of the toenails I’d like to think that it would work just fine. The main thing behind treating toenail fungus is trying to prevent it from the beginning and there are numerous ways this can be done. To start, try and keep your feet as dry as possible. Since fungi like warm, moist places, sweaty feet are a prime target. This can be avoided by sprinkling some Gold Bond powder in your shoes or wearing thinner socks. Next, if you’re a person that likes to work out you may find yourself showering in public bathrooms. If so, try and make it a habit to wear your own shower shoes in the shower. This is probably the most common place to pick up fungus. Lastly, UV light is a fungi’s worst enemy so if you have some extra money in the savings, investing in a UV tree might not be a bad idea, especially if toenail fungus is common in your household.

As always, if none of these efforts seem to work please don’t hesitate to call your local podiatrists at Affiliated Foot and Ankle Care located in Monroe and Edison, NJ. Toenail fungus is an extremely common condition and we are very knowledgeable about treating and getting rid of it. It would be nice to give it a one-two punch and knock it out and it be gone forever, but keep in mind it does take quite a long time to completely remove the fungus so it’s safe to say the patience is a virtue.

By Varun Gujral

Fungal nails are a plague that you can't get rid of.  They can cause your nails to become yellow, brown, and/or black and have you thinking twice before you hit the beach with sandals when it finally warms up.  I would like to tell you about my approach to a fungal nail infection.

When a patient walks into the podiatry office with a high suspicion of fungal infection, the first thing to do is take a biopsy.  This generally involves cutting away some nail pieces to send to the pathologist.  The pathologist will inspect the nail tissue for signs of infection and use a special stain to visualize the fungal organisms.  After the biopsy I will trim the nail and clean it up and send the patient home to return in about a week.

If, and when the pathology report comes back positive for fungus, it’s time to consider treatment options. Let's assume we have a relatively healthy patient that wants to be able to wear sandals.  There are basically two options that I present the patient with.  If only one nail is infected (most commonly the big toe) then I present the patient with the option to remove the nail completely.  This is a simple 5-10 minute procedure that requires anesthesia of the toe and some sterile instrumentation to remove the entire nail.  The patient will be put on an oral antifungal agent to ensure no fungus survives and the nail will grow back clean and normal.  This treatment is aggressive but offers the greatest chance of full nail recovery.

The second option is to leave the infected nail intact and try to treat the infection with lasers, creams, or oral antifungal agents.  Lasers and topical creams can work to kill the organism within the nail but should be stacked with an oral antifungal agent that works to kill the fungal organisms on a systemic level.  This option can also result in a clean and normal looking nail in some cases.  If the fungal infection has been present for years or even decades then a full recovery is very difficult or impossible to achieve. 

Oral antifungal agents such as terbinafine have been the gold standard treatment for fungal nails and every treatment regimen should include this medication.  Even with this medication, there are some nails that will never return to normal.  If you have nails that have recently started to change color or become brittle and oddly shaped then you may have a fungal infection and you have the best chance for recovery if you treat it immediately.  Remember, your local podiatrist sees patients with fungal infections on a daily basis. 

If you have any questions about your shoe gear, feet, or nails, make an appointment with your local podiatrist at Affiliated Foot and Ankle Care located in Edison and Monroe NJ today.

By Varun Gujral


Yellow, possibly fungal, nails are one of the most common complaints that show up at a podiatry office.  There are many misconceptions about fungal nails and I'd like to take you on a quick tour of my approach to ugly, yellow, and often dystrophic nails. 

First of all, many patients come in complaining of a fungal infection because their toenails look yellow, chunky, or like they're about to fall off.  The misnomer is that all yellow nails are infected which is often not the case.  The most common cause of yellow dystrophic nails is actually what we call micro trauma.

Micro Trauma to the nail unit is repetitive banging or force on the nail.  This repetitive trauma to the nail will over time cause a callus to form under the nail.  Normally when your skin forms a callus the excess skin will eventually be sloughed off.  When the callus is under the nail the skin is stuck and pushes up on the nail.  This excess skin tissue is what causes the nail to appear yellow and often raises the nail unit up eventually causing the nail to fall off. 

So, when a young patient comes in that has recently started training for a marathon, my mind is thinking micro trauma, not infection.  The micro trauma generally occurs in athletes, especially runners with tight shoes that don't allow enough space for the toes to slide forward upon impact.  Instead the toes are slamming into the forward aspect of the shoe, causing damage.  So, I tell my runners to bring in their shoes so I can take a look and see if they are fitting correctly.  If they have micro trauma then nine times out of ten their shoes are too small. 

The second half of the story is unfortunately, fungus.

Remember that callus which formed under the nail?  Well that callus is mostly keratin, the main component of skin.  Anyone want to guess what fungal organisms like T. Rubrum like to feed on? That's right, keratin.  The micro trauma will cause your nails to become yellow and ugly and can also provide a nice cozy home for fungal organisms to thrive in.  Once that fungus gets in there, it can be very difficult to get rid of.

If you have any questions about your shoe gear, feet, or nails, make an appointment with your local podiatrist at Affiliated Foot and Ankle Care in Edison and Monroe NJ today.

By Nrupa Shah