My toenails look funky

UpToDate.com

My right big toe nail cracked across in the middle and I noticed that the left big toe is starting to crack too.  It does not hurt but what should I do?

Certain (kinda rare) medical conditions can cause nails to warp or crack, but when you’re talking just the big toes, you’re usually dealing with a fungal infection. 

People tend to get really creeped out when I mention the word fungus, but it has nothing to do with poor hygiene or anything like that.  Fungi are germs that normally live on our skin; they just happen to like warm, moist places so sometimes they overgrow and cause trouble.  If it happens between the toes, we call it “athlete’s foot”; in the groin area, “jock itch”; under the toenails… “funky toe nails” I guess.  (The actual medical term is onychomycosis).

People who swim or whose feet sweat a lot might have a higher chance of getting a fungal nail infection, but we really don’t know why some people get them and others don’t.  

They happen in the toenails a lot more often than the fingernails and usually start on the big toe, occasionally affecting the nails on the smaller toes.  A fungal infection can cause a nail to:

  • Turn white, yellow or brown
  • Get thick, change shape, or raise up from the nail bed
  • Get crumbly and break off easily
  • Hurt

If your infection is mild or doesn’t bother you very much, you don’t have to do anything about it; it probably won’t go away, but it probably won’t cause any long-term problems either.

There are some over-the-counter creams or nail polishes you can try, but honestly, they’re a waste of money.  If you want to have it treated, you’ll need to take some prescription antifungal pills for about 12 weeks.  Your health care provider may order some blood tests before you start the medicine because they can affect the liver. 

But be warned – these infections can be a pain to deal with.  It can take months for a normal looking nail to grow back in, the treatment doesn’t work 25-40% of the time, and when it does, there’s a 20-50% chance that the infection will come back.  

To reduce your chance of getting a fungal toenail infection:

  • keep your feet clean and dry
  • Avoid sharing nail clippers
  • Wear flip-flops or other footwear in a gym shower or locker room

If you think you have a fungal toenail infection, come in and see us.  We can usually tell just by taking a look at it and asking you a few questions.  If there’s any doubt about what’s going on, we may take a small sample of the nail (cutting or scraping) and send it to a lab where another doctor can confirm which germs, if any, are causing the infection.

John A. Vaughn, MD
Student Health Services
The Ohio State University

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