Thick, yellow, crumbling nails aren’t what you want to see when you look at your feet.

At best, toenail fungus is embarrassing. At worst, it can create entry points for worse infections leading to hospitalization or sores that heal poorly in diabetic skin. Many people who experience fungal nail infection want to know if it’s harmful and what can be done to prevent and treat it.

Fungus is all around us

“The fungi and environmental molds that infect nails are literally everywhere we walk,” said Dr. Erik Stratman, a Marshfield Clinic dermatologist. “They are in floors, carpets, showers, pools, soils and our footwear. It is impossible to avoid.”

Because fungus rarely causes symptoms and doesn’t kill the host, it can survive and even thrive under the nails.

Big toenails are the most commonly affected nails. You’ll notice yellowish-white thickening of the nail plate with crumbly, chalky-to-pasty debris under the end of the nail. The nail often is lifted off the skin underneath.

The older a person gets, the more likely he or she is to have toenail fungus. By age 80, there is an 80 percent chance that patient has nail fungus.

Toenail fungus usually starts with athlete’s foot

“Most patients begin with athlete’s foot, which is often an asymptomatic scaling on the bottoms of the feet and between the toes,” Stratman said. “If left untreated, the athlete’s foot infection can spread to affect under the nails.”

Treating athlete’s foot with antifungal powders, creams and sprays can hinder the fungus from affecting toenails. Once nails are infected, treating the athlete’s foot infection later can be temporary. The much more stubborn nail infection will reinfect the skin of the feet, especially between the toes.

Avoiding small, repetitive traumas to the toenails can prevent the nail plate from lifting and allowing fungus to move under the nails.

Prescription medication is the best treatment

Some people swear by the curing ability of Vicks VapoRub or hope that home remedies like vinegar soaks or applying essential oils or cooking oils to the nails will rid their feet of fungus. Unfortunately, scientific evidence doesn’t show that home remedies reliably work.

Medicated over-the-counter powders, creams and sprays don’t work much better. They do a lousy job of penetrating the nail plate and killing fungus, Stratman said. Even new topical prescriptions like medicated nail polish can be expensive and only cure nail fungus 50 percent of the time or less.

If you desire treatment for your toenail fungus, a 12-week course of oral terbinafine often is effective. It remains the mainstay of therapy for fungal infections.

“Previous concerns about risks of serious liver injury from terbinafine have been debunked,” Stratman said. “The true risk is minuscule. Terbinafine has very low rates of dangerous side effects, to the point that blood work monitoring isn’t needed for asymptomatic, otherwise healthy individuals.”

You may be able to regrow a healthy nail if fungal infection is caught and treated early. You must prepare to be patient, though. Even if the medicine works to kill your fungus, it will take the average toenail about 12 months to grow out and look normal again.

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