How to Know if Toenail Fungus Is Dying: A Comprehensive Guide

Last updated on January 26th, 2025 at 10:50 pm

Toenail fungus, or onychomycosis, is a persistent and often stubborn infection that affects millions of people worldwide. It is something I see in my clinic almost every day. While treatment can take months, knowing the signs that your toenail fungus is dying can motivate you to stay consistent with your care plan. In this evergreen guide, we’ll cover what toenail fungus is, its treatment options, and how to know if toenail fungus is dying. Read on to find out more.

What Is Toenail Fungus?

Toenail fungus is a fungal infection caused by dermatophytes (Trichophyton rubrum and trichophyton mentagrophytes), yeasts, or molds that invade the nail bed. The infection often starts as a small white or yellow spot under the toenail and can spread, causing thickened, discoloured, brittle nails and often odor. It thrives in warm, moist environments like public showers, gyms, and swimming pools.

How Long Does Treatment Take?

Treatment duration depends on the severity of the infection and the chosen treatment method. Toenail fungus treatment may take:

• Topical antifungals: 6-12 months
• Oral antifungals: 3-6 months
• Laser treatment: Several sessions over weeks to months
• Home remedies: Variable, often longer and less effective

Topical Antifungals 

For topical treatment,  Amorolfine ( Marketed as Curanail in some regions) is generally recommended.These topical antifungal treatments require consistent application and may work best for mild to moderate cases of toenail fungus where the infection has not yet reached deep into the nail bed.

Oral Antifungals

For oral antifungal medications, terbinafine or itraconazole are commonly prescribed. These systemic treatments are more effective for moderate to severe infections or when the fungus has invaded the nail matrix. Blood tests may be necessary before and during treatment to monitor liver function, as oral antifungals can have potential side effects.

Laser Treatment

Laser treatment targets the fungal infection using focused light energy, which heats and destroys the fungus without damaging the surrounding tissue. This is a non-invasive option with minimal side effects, but results can vary, and it may not always fully eradicate the infection. Laser treatment is often considered for patients who cannot tolerate oral antifungals or have contraindications to systemic medications. There are reports that the Lunula laser is effective.

Home Remedies

For home remedies, such as tea tree oil, vinegar soaks, or Vicks VapoRub, evidence of efficacy is limited. These methods may help in early or mild cases but are generally less reliable and require prolonged and consistent application. Patients opting for home remedies, should try to maintain good foot hygiene and monitor for signs of worsening infection.

Nail Removal

In severe or recurrent fungal infections that do not respond to standard treatments, partial or total nail avulsion (removal) may be recommended. This can be performed surgically or chemically. For chemical removal, products such as Canespro or Canesten (containing urea) can gently remove the nail over several weeks. Once the nail is removed, a topical antifungal, such as Amorolfine, should be applied to prevent reinfection. This approach is often less invasive and more comfortable for patients compared to surgical nail removal.

Adjunctive Measures

• Practice excellent foot hygiene, including keeping feet dry and nails trimmed.
• Disinfect shoes and change socks frequently to reduce fungal spores.
• Avoid walking barefoot in communal areas like pools or locker rooms.
• Wear breathable footwear made of materials such as leather or mesh.
• Use antifungal sprays or powders in shoes to prevent reinfection.
• Avoid sharing nail clippers, socks, or towels with others.

Ultimately, the choice of treatment depends on the severity of the infection, preference, and any contraindications to certain medications. Regular follow-ups are crucial to monitor progress and adjust the treatment plan as needed.

Signs That Toenail Fungus Is Dying

Here’s what to look for as your toenail recovers:

1. Nail Color Returns to Normal

• What to Expect: The nail will gradually change from yellow, brown, or white back to a healthy pinkish tone.
• Why It Happens: As the fungus dies, healthy nail tissue grows from the nail matrix (the base of the nail).

2. Nail Becomes Thinner

• What to Expect: Thick, brittle nails will start to thin out (This does not always occur).
• Why It Happens: Fungal infections cause nail thickening, so thinning indicates the infection is receding. Keep in mind that some nails are thick due to trauma and not fungus. Trauma can make it easier for the nail to become infected with fungus. In such cases, it is unlikely that the nail will go back thin and pink, even though the fungus is no longer there.

3. Reduced Nail Brittleness

• What to Expect: The nail becomes less fragile, breaking less often.
• Why It Happens: Healthy nails are flexible and strong, unlike fungus-damaged ones.

4. New, Healthy Nail Growth

• What to Expect: A clear, smooth nail will begin growing from the cuticle area.
• Why It Happens: The fungus is no longer damaging new nail cells, allowing healthy growth.

5. Less Debris Under the Nail

• What to Expect: Less buildup of white or yellowish keratin debris beneath the nail.
• Why It Happens: Debris forms as fungus breaks down nail tissue, so its reduction means healing is underway.

6. Reduced Odor

• What to Expect: The foul smell often linked to toenail fungus will diminish.
• Why It Happens: Odor occurs due to fungal by-products, so its absence suggests the fungus is dying.

7. Improved Nail Texture

• What to Expect: The nail surface becomes smoother and less uneven.
• Why It Happens: The damaged nail is replaced by healthy tissue over time.

How to Support the Healing Process

1. Stay Consistent With Treatment: Follow your doctor’s prescribed regimen without interruption. In my experience this is key – lack of compliance is often the reason most people don’t get resolution form fungal nail infection.
2. Practice Good Foot Hygiene: Keep feet clean and dry.
3. Trim Nails Properly: Cut nails according to their contour and keep them short.
4. Avoid Nail Trauma: Wear well-fitted shoes to prevent damage.
5. Use Anti-fungal Sprays and Powders: These help prevent reinfection. Use them in your footwear as well.
6. Disinfect Shoes and Socks: Regularly wash and disinfect to eliminate fungal spores.

When to See a Podiatrist

If you don’t see improvement after several months of treatment, if the infection seems to worsen, or if you are getting pain under the toenail, consult a podiatrist. They can offer advanced treatments such as prescription medications, laser therapy, or even nail removal in severe cases. You don’t need a referral to see a podiatrist, so it may be  more cost effective to see one first, since they are foot specialist.

Final Thoughts

Treating toenail fungus requires patience and persistence, but knowing the signs of healing can keep you motivated. Watch for colour improvement, healthier nail growth, and a reduction in symptoms like thickness, brittleness, and odor. By staying proactive with treatment and good foot care, you’ll be on your way to clearer, healthier nails.

Remember: Toenail fungus recovery is a gradual process, but with the right approach, success is within reach. Keep up with your treatment and consult a podiatrist when needed for the best results. That’s it on how to know if toenail fungus is dying. Best of luck!

1. Can Toenail Fungus Heal on Its Own Without Treatment?

Toenail fungus rarely goes away on its own. In most cases, the infection worsens over time, causing further nail damage and potential spread to other toes. Early treatment with topical or oral antifungals can prevent complications.

2. How Long Does It Take for a New Toenail to Grow After Fungus Treatment?

It typically takes 6-12 months or longer for a new toenail to grow completely, depending on the toe involved (big toenails grow slower). Healthy growth starts at the nail matrix and progresses outward, so visible improvement can take several months even after successful treatment.

3. Can I Wear Nail Polish While Treating Toenail Fungus?

It’s best to avoid traditional nail polish during treatment, as it can trap moisture or cause the nail to dry out and worsen the infection. However, antifungal nail polishes are available and can be used while undergoing treatment. Be sure to consult your podiatrist for recommended brands.

4. Is Toenail Fungus Contagious and How Can I Prevent Spreading It?

Yes, toenail fungus is contagious. It can spread through shared surfaces like showers, pools, and even nail tools. To prevent spreading:

• Wear flip-flops in public areas.
• Disinfect shoes and socks regularly.
• Avoid sharing nail clippers and files.
• Keep feet dry and clean.

5. Can Diet Affect Toenail Fungus Recovery?

While diet alone cannot cure toenail fungus, a healthy immune system can support faster healing. Eating foods rich in vitamins C, D, E, zinc, and biotin can promote nail health. Consider incorporating probiotics to balance gut health, which may indirectly strengthen your body’s ability to fight infections.

References 

1. Gupta, A.K., Mays, R.R., Versteeg, S.G., Shear, N.H. and Piguet, V., 2018. Update on current approaches to diagnosis and treatment of onychomycosis. Expert Review of Anti-infective Therapy, 16(12), pp.929-938.
2. Lipner, S.R. and Scher, R.K., 2019. Onychomycosis: Treatment and prevention of recurrence. Journal of the American Academy of Dermatology, 80(4), pp.853-867.