Ask the Coach: Toe Fungus

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Treating toenail maladies


At the behest of my wife, I am writing to find the best treatment for toenail fungus. I have heard scary things about the various over-the-counter medicines.
—Alan Hall, Houston, TX

It’s prudent to start by having a pathologist confirm the presence of dermatophytes (fungal elements). As Dr. Jamie Mieras, sports-medicine podiatrist at Boulder Valley Foot and Ankle Clinic, says, “Not all thick, flaking or discolored nails are caused by fungus. Trauma, genetics or underlying bone protrusions can also cause nail changes.”

If your condition is identified as fungus, treatment depends on how much of the nail has been affected. If it’s just the tip of the toenail, then a topical antifungal treatment may work, but the research shows that option to be only 30-percent effective, even when applied twice daily.

If the fungus has infiltrated the whole nail, many nails or has been around for a long time, Mieras suggests using “oral anti-fungals and terbinafine (Lamisil), which has a much better resolution rate of 75 percent.”
As far as side effects of oral anti-fungals, Mieras suggests a liver-function-panel lab test before you start, and then a re-check following a month of use. But, she adds, “It is unlikely that a healthy person’s liver would be adversely affected.”

Remember that these medications won’t save the affected nail; rather, a new nail will grow out fungus-free. Since toenails grow only millimeters per month, be patient. In the meantime, make sure you wear your flip-flops in showers and public swimming pools to avoid bacteria and re-infection.


This article originally appeared in our September 2014 issue.


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