If you haven’t looked down in horror upon your own feet to see this phenomenon, you likely know someone who has. A nasty fungus settles in under the nail plate, causing it to grow thick and yellow. VoilaÑnow you have a “funky” toenail. What can you do about it?

Toenail fungus is extremely common and pesky. Every year thousands of people spend a lot of time and money trying to get rid of the problemÑonly to see it return time and time again.

One reason it’s so hard to get rid of toenail fungus is that toenails, especially when covered in socks and stuffed into shoes, provide the perfect dark, damp location for a fungus to settle in and thrive.

For many years, the most common treatments have included topical ointments and creams, oral medications, and laser therapy with or without a combination of the above therapies. However, I believe a different treatment approach is in order.

Laser treatments for toenail fungus have been around for approximately 25 years. Today this treatment generally costs around $900, and is not covered by most insurance. It would still be a bargain if it worked for the long term, but that doesn’t seem to be the case.

Based on my own experience with patients, and from many discussions with colleagues, laser therapy does help up to 70 percent of patients for the short term. However, the fungus recurs within a couple years just like it would with any other brief, singular toenail fungus therapy.

The best way to combat the opportunistic toenail fungus for the long term is with ongoing hygiene and maintenance, much like brushing and flossing your teeth daily.

To keep your toenails fungus-free, I find that a comprehensive, long-term approach works best:

• Disinfect shoes regularly.
• Use a good antifungal cream once or twice a day until the nail disease grows out.
• Once the fungus is gone, continue using the cream two or three times a week to prevent recurrence.
• Continue disinfecting shoes as prescribed by your doctor.

It may seem like a lot of work and dedication, but my guess is that you’ll do just about anything to get rid of that funky toenail. It’s just not a good look. So try to get in the mindset of an ongoing regimen like brushing your teeth, instead of a quick fix, and your toenails will have the best chance at being clear and infection-free for the long haul.

— Brad Naylor, D.P.M., M.S.