For anyone who has experienced toenail fungus, we can agree that it can be painful, uncomfortable, and embarrassing. Toenail fungus, also called onychomycosis, happens when fungal organisms start to live under your toenails. These fungi grow best in warm and damp places like bathrooms, shoe racks, and swimming pools. 

Onychomycosis is an infection that lasts for a long period, making it difficult to treat. It affects about 10% of the general population, with more occurrences in adults than children. 

If untreated, it can lead to worse problems, like being a breeding ground for opportunistic infections – infections that occur as a result of an opening caused by a health condition.

Preventing toenail fungus entails committing to personal hygiene such as keeping your feet clean and dry, wearing loose shoes, even the use of natural remedies etc.

This article aims to help you identify toenail fungus early enough to stop the spread of the fungus and relieve discomfort using Natural and alternative remedies.

The toenail

The toenail grows from the nail matrix, known as the nail’s “growth centre.” As new cells form in the matrix, they move forward, harden, and become part of the nail plate (the hard part of the nail). The visible part of the matrix that looks like a small “half moon” is called the lunula. The rest of the matrix is hidden under the skin near the base of your nail.

The visible part of the nail we see is the nail plate, made up of keratin (a protein that supports nail growth and structure). It is the largest part of the nail, and it grows by sliding forward over the nail bed, which is the skin underneath the nail. As the nail moves forward, the end of the nail eventually separates from the nail bed, becoming the free edge of the nail.

At the very tip of the nail bed is the hyponychium, which is a layer of skin similar to the tough skin on the palms of your hands or soles of your feet.

Toenail fungus

Toenail fungus makes up about 50% of all diseased nails and about 30% of cutaneous fungal infections. It can be caused by dermatophytes (e.g Trichophyton rubrum) and non-dermatophytes (e.g Yeasts, Molds, etc).

Trichophyton rubrum is a dermatophyte fungus indicated as a major cause of onychomycosis, with an indication in about 90% of cases of toenail fungus. 

How does nail fungus start?

Nail fungus usually begins when fungi find a way into your nail. This can happen through small cuts or cracks in your nail or the skin around it. 

Once fungi penetrate the nail, they begin to feed on keratin, the structural protein that forms nails by breaking it into bits by the help of an enzyme known as keratinases. As they feed, they are able to grow, multiple and spread. 

Within the nail, they live as colonies. These colonies give a yellow, brown, or white colour to the nail either at the nail plate, nail bed, or both. This discolouration is often one of the earliest signs of the presence of a fungus.

Because the protein that gives structure to the nail is fed on, the nail becomes weak and begins to break easily and may begin to separate from the nail bed, a condition called onycholysis. This space between the nail and the bed becomes a breeding ground for more fungus.

As the infection progresses, and more fungi break down the tissue under the nail, an offensive smell will set in.

Common causes and risk factors

• Age
• Genetics
• Nail injury
• Wearing Tight shoes
• Sharing public facilities
• Weakened immune system 
• Health conditions that restrict blood flow

Age

Toenail fungus is more common in adults than in children due to the ageing of their nails. As one ages, the nails become thickened, due to decreased blood supply to the toe. As the nails thicken, it cracks, boring spaces into the skin surrounding the nails. These spaces aid fungi growth in the toenail. Aside from this, reduced effort on personal hygiene comes with age and can contribute to toenail fungus.

Genetics

Some people naturally have weak body defense, making them disposed to infection. Also, where a parent has experienced toenail fungus, there’s a likely possibility of the offspring inheriting the same.

Nail injury

When the nail is damaged, it’s easier for fungi to enter the nail bed and start growing. Engaging in physical activities can put pressure on the feet, especially when protective gear/shoes are not worn. The pressure can cause cracked skin, blisters and even corns. This is why athletes, dancers, or anyone who regularly puts stress on their toenails are at higher risk.

Wearing tight shoes

Shoes that are tight trap moisture, and this can create an environment for fungi to grow. In addition, as your toes brush against the shoes, you can sustain injuries and coupled with the already moist environment in the shoes, it makes it easier for fungus to breed.

Sharing public facilities

While you may be sure of taking your personal hygiene seriously, others may not. As such, sharing facilities with others in a public space may increase the likelihood of getting infected.

Weakened immune system

The immune system stands on guard for the body, defending it from unwanted and foreign entities like viruses, fungi, bacteria, allergic triggers like dust, pollen grains or even inflammatory responses. This defence may be weakened due to genetics, health conditions and even medications, encouraging fungal growth. 

Health conditions that restrict blood flow (E.g Diabetes)

Research shows a 34% prevalence of onychomycosis in diabetics, making them three times more likely to develop onychomycosis than non-diabetics. One of the complications of diabetes is decreased foot sensation. Even in the face of harm, a diabetic patient may not be sensitive enough to withdraw themselves. Consequently, this causes a person to have a foot injury. With injury comes an opportunity for fungi to come in and make for themselves a breeding place.

Classification of toenail fungus

To classify Toenail fungus, one has to note the area of the nail affected and the severity of the infection. The primary types of toenail fungus are:

Distolateral Onychomycosis (DSO)

Distolateral Onychomycosis is the most common type of toenail fungus and starts from the nail edge to the cuticle. It can infect the nail bed and the skin under the tip of the nail.

First, you observe a white or yellow discolouration at the nail edge, which then spreads toward the cuticle. Most times, the fungus responsible is the Trichophyton spp. at other times, Candida spp. can be the cause. After a while, the nail separates from the nail bed. 

White superficial onychomycosis 

This is the second most common toenail onychomycosis. The area infected is the surface of the nail. 

When observed, the surface of the nail has small, white spots. The fungus responsible is Trichophyton mentagrophytes, another type of dermatophyte fungus. It is easier to treat this onychomycosis because of the settlement on the surface of the nail, without involving other parts of the nail. 

Proximal onychomycosis 

Proximal Onychomycosis is less common and affects people with weak body defences. For example, in HIV/AIDS patients. Unlike the distolateral, you observe a white or yellow discolouration at the base of the nail, which then spreads toward the edge of the nail. Once you observe this, know that there is an underlying condition, so seek the advice of a healthcare professional. 

Endonyx onychomycosis

This presents like the White superficial onychomycosis affecting the surface of the toenail. However, it can spread further into the nail plate.

To differentiate this type of fungal invasion from the white superficial onychomycosis, observe for nail splits, dips, and white patches. This is mainly caused by T. soudanense and T. violaceum. 

Total dystrophic onychomycosis 

This is the last stage of toenail fungus infection. Here, the toenail is destroyed completely by crumbling into bits and then entirely. 

Natural treatments for toenail fungus

People’s choice of natural treatments for toenail fungus is mostly because they are affordable, topically applied and they do not need to deal with possible side effects of oral medications like nausea, vomiting, swallowing, adherence with dosing regimen, etc, in addition, to the wholesome treatment it gives the body. For example, Coconut oil doesn't just fight the fungus, it also hydrates and nourishes your skin, making it softer and healthier. 

Examples of natural and alternative treatments for Toenail fungus are;

Baking soda

It is also known as sodium bicarbonate or bicarbonate of soda. Commonly used for domestic activities such as baking, teeth whitening, mouthwash, air freshener, even deodorant, etc, A study showed it can be used to treat toenail fungus with increased activity on dermatophytes and yeast, with less activity on molds at varied pH level. 

Tea tree oil

Tea tree oil has terpinen-4-ol as its active ingredient. This active ingredient is responsible for its antifungal activity. Other ingredients are α-terpineol, γ-terpinene, and 1,8-cineole, with an added antibacterial (by helping to fight opportunistic bacterial infections that may affect the nail during the course of the fungal infection), and anti-inflammatory properties. 

Its antifungal activity is not fungicidal (kills fungus), rather it is fungistatic (inhibits the fungus growth). 

It should be diluted to avoid skin irritation in a carrier oil such as coconut oil, cloves etc before it can be applied topically on the affected toenail by few drops, twice daily for several months. To dilute, mix one part of tea tree oil with three parts of carrier oil. For example, 10 ml of tea tree oil should be diluted in 30 ml of carrier oil.

Snakeroot extract

Also known as Ageratina pichinchensis, has shown effective antifungal activity and is used to treat toenail fungus. This was confirmed in a study.

Apple cider vinegar

Due to its antifungal and acidic properties, apple cider vinegar creates an inhospitable environment for fungus, making it suitable for use to treat toenail fungus. 

For a localised effect, soak the affected toes in a vinegar-water mixture to avoid skin irritation. To get a proper dilution, mix 1 part of cider vinegar with 3 parts of water. For example, 10 ml of cider vinegar should be diluted in 30 ml of water.

Coconut oil

Caprylic acid is the main constituent of coconut oil that is responsible for its antifungal properties. In addition to its antifungal actions, it can act as a moisturiser. It can be applied directly to the affected toes. 

Garlic

Garlic contains allicin, a compound with antifungal and antimicrobial properties. To use it, crush the garlic root and mix with carrier oil in parts to avoid a strong odour and possible skin irritation.

Epsom salt 

Epsom salt is a mineral from a combination of Magnesium and sulphate. While there are no scientific research to support its use as an antifungal agent, it can aid in healing toenail fungus by reducing discomfort and inflammation when the feet are soaked in warm water.

Alternative treatment for toenail fungus

Proper foot hygiene

While treatments whether conventional or natural may not work, we can manage toenail fungus by keeping feet clean and dry. In addition, avoid tight shoes, rather choose breathable footwear, especially if you are a sportsman. Ensure to trim and clean toenails regularly.

Diet

 Plays a huge role in boosting immune function with antifungal foods like Garlic, ginger, and coconut oil. Supplements such as probiotics to support overall health and fight fungal infections

Wearing protective footwear

Wearing protective footwear in communal spaces (gyms, pools) and regularly changing socks and airing out shoes.

Avoiding sharing sharps and clothes.

Own your nail clippers, towels, and footwear to prevent contracting infection. Avoid sharing these things. 

Summary

Toenail fungus is a common problem that can cause discomfort and frustrate many people. 

There are natural and alternative treatments that can help. Such as tea tree oil, apple cider vinegar, coconut oil, and even snakeroot extract, have antifungal properties that may help clear up the infection. While these treatments tend to be safer and kinder on the body, you won’t see results overnight. It requires time, patience and dedication.

For alternatives, practice good foot hygiene – keeping your feet clean and dry, trimming your nails regularly, and wearing breathable shoes can all help prevent toenail fungus from returning or spreading. 

Although natural remedies may take longer than prescribed treatments, they can offer a more affordable, wholesome way to manage this condition.

By sticking to your treatment and being mindful of your foot care, you can manage toenail fungus and feel more confident about your feet again.