Your Renton and Seattle Area Podiatric Care Center
Valley Foot and Ankle

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Nail Fungus

What is a Nail Fungus?

Nail fungus is an infection of the nail plate and is called Onychomycosis. It can present to a single nail or all toenails at once. The infection can appear on the top of the nail or underneath the nail itself. In our practice we find that there is often an additional bacterial infection in the nail that will not resolve with the use of antifungal therapy. We use the term infectious onychodystrophy when there is both a fungal and bacterial component.

These are often signs toenail fungus.


  • There are many signs of nail infection.
  • Nails may appear thick, yellow and brittle.
  • A white appearance may be present on the top of the nail. This is often noticed once nail polish is removed.
  • Green or other discoloration can be a sign of bacterial infection


  • There are many ways in which a nail can become infected.
  • Fungus and bacteria are present in the environment and especially shoes. A moist environment is a breeding ground for fungus and bacteria.
  • Often nail infection is the result of repetitive trauma to the nail allowing for bacteria or fungus to infect the nail.
  • Nail fungus can develop on the top of the nail when it becomes trapped under nail polish.


  • Clinical diagnosis is very helpful in determining when a nail disorder is the trauma or and infectious process.
  • In our office we typically biopsy the nail and send it to a Pathology Lab for definitive analysis.
  • If we are highly suspicious of a bacterial component to the infection a DNA analysis is often performed.


  • Nail dystrophy due to fungus, bacteria or both can be treated with medication.
  • A fungal infection of the nail can be treated with topical antifungal solutions and oral medications. Some oral antifungal medications may require a blood test to evaluate liver health prior to starting treatments.
  • A bacterial infection of the nail can be treated with a topical antibiotic solution.
  • For a mixed bacterial and fungal infection a combination of both topical and oral medications can be used.
  • In very rare cases is a procedure required to remove the nail. This can be performed and often a topical medication is used after the nailbed has healed.
  • In addition to medication, good foot hygiene and antibacterial sprays are recommend for shoe gear to help reduce the spread of the infection.