How to treat a toenail infection

Have a toenail that’s yellow and crumbly? Or maybe your big toe feels super tender when you wear closed-toe shoes. These symptoms are red flags for a toenail infection.

“The most common types of toenail infections are ingrown toenail and fungal infections,” says Saylee Tulpule, DPM. She’s a podiatrist with Foot and Ankle Specialists of the Mid-Atlantic in Washington, D.C. These 2 types of infections have different symptoms. And each requires a separate type of treatment plan.

Here’s what you need to know to find relief for painful infections.

Fungal nail infections

Fungal nail infections are typically not serious, and lots of people get them. These infections affect up to 14% of people every year, according to the Centers for Disease Control and Prevention. Fungal infections can be uncomfortable and painful. And they’re definitely not pretty, so you might be a bit self-conscious about how they look.

“Most fungal infections are caused by a group of fungi called dermatophytes,” says Marie Leger, MD. She’s a dermatologist at Entière Dermatology in New York City. At first, the infection might appear as a yellow or white spot on the corner of the nail.

As the infection progresses, it can affect the entire nail (usually the big toenail). It can even spread to other nails if you don’t treat it. Your nail may also be:

• Discolored
• Thick
• Brittle
• Foul-smelling

Fungal nail infections are highly contagious. The fungus spreads, entering cracks in your nail or broken skin on your toes. Yeast or mold can be to blame as well. But fungus is most common. Having a nail injury puts you at a higher risk of a fungal infection. So does a condition such as:

• Diabetes
• Poor circulation
• Weakened immune system

Are you spending too much on medication? You might be surprised at what you can save on prescriptions at the Optum Store.

Ingrown toenails

Ingrown toenails are caused by pressure. “For instance, if your toes are constantly getting pressed on by shoes or during exercise, you might get an ingrown nail,” says Dr. Tulpule. You can also get one if you clip your toenails improperly.

The first sign of an ingrown nail? You’ll notice a tender, sore spot in one corner of your toenail. That’s a sign that the nail is growing into the surrounding skin. Then the pain gets more intense, and the skin around it gets red and swollen. This most commonly happens to the big toe, per the Mayo Clinic.

If you also see some pus, you’ve got a bacterial infection. And you may have other symptoms, such as:

• Fever
• Fatigue
• Swelling
• Pain

You’re more likely to get an ingrown toenail if you have tight shoes, wear high heels or have very sweaty feet.

Preventing toenail infections

There are steps you can take to keep your nails healthy and infection-free.

Since fungal infections are contagious, it’s best to avoid walking barefoot in public places.

So wearing flip-flops in spots like locker rooms and public showers is a good idea.

“Nail salons are hot spots for contracting the infection, too,” says Dr. Tulpule. If you love getting pedicures, make sure the salon cleans its instruments regularly. They should also place fresh plastic liners in the foot bath before they fill it with water.

You can lower your risk of an ingrown toenail by being extra careful when you clip your nails. Don’t cut them too short. And try to clip straight across.

Also, take a look at the shoes and sneakers you wear. You might want to get rid of any pairs that feel tight around the toes. And when you shop for new shoes, look for a wider toe box if you need it, says Dr. Tulpule.

Treating infections

Fungal infections don’t usually clear up on their own. Your doctor may start by trimming back your infected nail. They may also scrape away debris under your nail to get rid of some of the fungus, says the American Academy of Dermatology.

Then your doctor will prescribe an antifungal medication. Options include:

• A medicine you apply to your nail, such as ciclopirox (for mild infections)
• An oral medication such as terbinafine or fluconazole (for more severe infections)

It’s important for you to have a full exam by your doctor, says Dr. Leger. You may take terbinafine for months, for example, and see no improvement. In that case, your infection could be caused by a less common fungus. And it may require a different antifungal prescription.

Ingrown toenail treatment depends on how bad the pain and infection are. Your doctor might treat a mild infection with oral antibiotics. But if the ingrown toenail is infected, they may need to remove the affected part of your nail. (Don’t worry, your doctor will give you a shot to numb the area first.)

Bottom line: If you think something is wrong with your toenail, get it checked by a doctor. The sooner you start treatment, the better.

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Additional sources
Fungal infections: Centers for Disease Control and Prevention (2022). “Fungal nail infections”
Ingrown toenail: Mayo Clinic (2022). “Ingrown toenails”
Treatment: American Academy of Dermatology (n.d.). “Nail fungus: Diagnosis and Treatment”