How to Get Rid of Thick or Discolored Toenails

By Melissa Gaffney, DPM

There is no reliable overnight fix for thick, yellow, white, or crumbly toenails. Toenail fungus, called onychomycosis, is common, but several other nail conditions can look similar. The right treatment starts with an examination and, when appropriate, a nail test before prescription therapy.

Toenail fungus can make the nail thick, loose, brittle, discolored, or painful. It can also contribute to ingrown nails and irritation of the nail bed. Treatment takes patience because the fungus may clear before the healthy nail has grown all the way out.

Key takeaways

• Not every thick or discolored toenail is caused by fungus.
• A clinician may examine the nail and obtain a sample before prescribing oral treatment.
• Topical medicines work best when the infection affects a limited portion of the nail and must be used consistently.
• Oral terbinafine can be effective, but it requires a medication and health-history review and may require blood tests.
• A healthy toenail can take 12 to 18 months to grow out after treatment begins.
• Keeping nails trimmed, feet dry, and shoes ventilated can reduce recurrence risk.
• Digging under the nail or removing the nail plate at home can cause wounds and secondary infection.
• Recurrence after treatment is common. See my guide to prevent recurrence at the end of the article.

What causes thick or ugly toenails?

Fungal infection is one common cause, especially when the nail becomes thick, yellow-white, crumbly, or separated from the nail bed. A dermatophyte is a common type of fungus, although other organisms may also be found.

Trauma can create an opening for fungus or can damage the nail without any infection. Repeated pressure from shoes, psoriasis, inflammatory skin disease, lichen planus, bacterial infection, and other conditions can also change the nail. Clean feet do not guarantee that a fungal nail will not develop, and having a fungal nail is not proof of poor hygiene.

How is toenail fungus diagnosed?

A podiatrist or other qualified clinician may diagnose a fungal nail from its appearance and history, but visual examination alone cannot always distinguish fungus from other nail problems. Testing is especially important before starting oral treatment.

A nail sample may be examined with a potassium hydroxide, or KOH, preparation, a periodic acid-Schiff, or PAS, stain, fungal culture, or PCR testing. Each method has limitations, and a sample taken from the wrong part of the nail can produce a false-negative result.

The sample should usually come from the abnormal debris beneath the nail and as close to the affected base as safely possible. Ask which test is being used, how much it costs, and whether insurance covers it before consenting to laboratory testing.

The original article cited an American Family Physician review on diagnostic methods. See the rapid evidence review of onychomycosis and the 2023 study on fungal and non-fungal nail organisms.

How is toenail fungus treated?

Topical prescription medicines

Prescription topicals such as ciclopirox, efinaconazole, or tavaborole may be considered when the infection affects a limited portion of the nail and has not reached deeply into the nail bed. They must be applied consistently, often for many months.

Topicals generally have lower complete-clearance rates than oral treatment, but they may be appropriate when the infection is mild or when oral medication is not suitable. Ask your clinician how long to use the medicine and what result to expect.

Example of distal onychomycosis; the type of toenail fungus that a topical antifungal may help.

Costs vary widely by medication, insurance, and discount programs. Ask your prescriber or pharmacist about current pricing and whether a manufacturer savings program is available for your insurance.

Oral antifungal medicine

Oral terbinafine is commonly used for toenail fungus and may be considered when a larger portion of the nail is involved or topical treatment is unlikely to work. It is not appropriate for everyone.

Terbinafine can affect the liver, blood counts, and other medicines. A clinician may review your medical history, medication list, and baseline liver tests before prescribing it and may order follow-up testing. Tell your clinician about liver disease, other medical conditions, pregnancy, alcohol use, and every prescription, over-the-counter medicine, and supplement you take.

Other oral antifungals may be used in selected cases, but they have different interactions, indications, and monitoring requirements. Do not use leftover medication or share a prescription.

Debridement and nail care

Regular trimming and professional debridement can reduce thickness, pressure, and loose crumbly material while the nail grows out. Debridement does not necessarily eliminate fungus by itself, but it can improve comfort and help topical medicine reach the affected nail.

Do not dig aggressively under the nail. If debris is loose and comes away easily after soaking, gentle cleaning may be reasonable, but forcing material out can injure the nail bed and introduce bacteria.

 

How long does toenail fungus take to clear?

Fungal growth may be controlled before the nail looks normal. After treatment clears the infection at the nail root and bed, the damaged nail must grow out. A toenail can take about 6 to 12 additional months to appear healthy, so the overall process may take 12 to 18 months.

Protect the growing nail from new trauma, keep it trimmed, and follow the treatment plan even when the nail starts to look better. Stopping too early can allow infection to persist or return.

Do home remedies cure toenail fungus?

Tea tree oil, oregano oil, vinegar, urea products, and mentholated ointments have been studied or used by some people, but evidence and product quality vary. These products can irritate skin and should not replace diagnosis or prescription treatment.

A urea product may soften thick nail material, but ask a clinician how to use it safely. Do not apply essential oils to broken skin, and stop any product that causes burning, rash, swelling, or worsening pain.

Should you remove the toenail?

Usually, no. Pulling off or digging out the nail can create a painful wound without removing the infection from the nail root or bed. A clinician may consider partial or complete nail removal when the nail is persistently painful, has a secondary bacterial infection, or has recurrent fungus after treatment.

If nail removal is considered, the clinician may obtain a culture or other testing and pair the procedure with appropriate topical or oral treatment. Laser treatment is another option marketed for toenail fungus, but it can be expensive, is often not covered by insurance, and may not provide lasting clearance.

How can you prevent toenail fungus from returning?

Toenail fungus can be stubborn, and even after successful treatment, it can return. These are the prevention strategies I discuss with patients to help reduce the risk of reinfection and protect healthy new nail growth.

1. Keep toenails trimmed and filed safely

Long toenails are more likely to bump against the inside of your shoes, especially during running or hiking. Trim nails straight across and gently file sharp edges. Avoid cutting them excessively short or digging into the corners.

2. Give your toenails a break from polish

Avoid leaving toenail polish on continuously, especially during treatment. Removing it regularly lets you check for changes in nail color, thickness, or texture. Products marketed as “antifungal nail polish” should not replace prescribed treatment.

3. Protect your cuticles

The cuticle helps form a protective seal around the nail. Avoid aggressively pushing it back, cutting it, or allowing these practices during a pedicure. Damaging that seal can create an opening for infection.

4. Use prescribed topical antifungals consistently

If your clinician recommends a topical antifungal, apply it exactly as directed. In some cases, a topical is used alongside oral medication or as part of a follow-up plan. Ask how long to continue it rather than stopping as soon as the nail looks better.

5. Address nail injuries early

Repeated pressure from tight shoes, running, or a stubbed toe can damage the nail. Choose shoes with enough room for your toes, and seek care if an injured nail becomes painful, lifts, thickens, or changes color. Tea tree oil is not a proven way to prevent fungal infection after an injury and can irritate the skin.

6. Focus on drying, not sun exposure

Letting your feet air out can help reduce moisture, but sunlight is not a reliable treatment for toenail fungus. You do not need to expose your skin to ultraviolet light to prevent recurrence. Dry your feet thoroughly, including between the toes, and avoid sunburn.

7. Keep shoes clean and dry

Rotate shoes so each pair has time to dry between uses. Ask your clinician whether an antifungal shoe spray or a shoe-sanitizing device would be a useful addition during and after treatment. Follow the product’s instructions, and consider replacing worn shoes that stay damp or are difficult to clean.

8. Control sweaty feet

Change damp socks promptly, and choose moisture-wicking socks, such as merino wool or performance fabrics. Breathable footwear and regular time out of shoes can also help. If sweating remains a problem, ask about a foot antiperspirant or a stronger treatment, such as prescription Drysol. Use these products as directed and avoid applying them to irritated or broken skin.

9. Ask about care for thickened nails

Products such as Kerasal can help soften thickened nails and improve their appearance, but they are not antifungal treatments and do not cure the infection. Ask whether a nail-softening product or professional thinning would be appropriate alongside your treatment.

10. Treat athlete’s foot, too

Fungus on the skin can be a source of reinfection for the nails. Athlete’s foot may cause peeling, scaling, or cracking, and it does not always itch. If you notice these changes, ask about treatment. Over-the-counter options such as terbinafine cream (Lamisil) or butenafine cream (Lotrimin Ultra) may be appropriate for athlete’s foot, but skin creams do not replace treatment for an infected toenail.

The bottom line

There is no quick fix for toenail fungus. Successful treatment takes patience and consistency while the healthy nail grows out. Keeping feet dry, protecting nails from injury, treating athlete’s foot, and following your prescribed treatment plan can help reduce the chance of the infection returning.

 

When should you see a podiatrist?

Arrange an evaluation for a thick, discolored, painful, loose, or crumbly nail, especially if more than one nail is involved or the problem keeps returning. Seek prompt care for redness, warmth, drainage, swelling, fever, or rapidly increasing pain.

People with diabetes, poor circulation, neuropathy, immune-system problems, or a history of foot ulcers should not self-treat a damaged or infected nail without medical guidance.

Please check my youtube video for more information:

Frequently asked questions

Can a thick toenail grow back normally?

It can, if the underlying cause is treated and the nail root remains healthy. Toenails grow slowly, so a normal-looking nail may take 12 months or longer to grow out.

Do I need a test before treating toenail fungus?

Testing is especially important before oral antifungal treatment because other nail conditions can look similar and oral medicines have risks. Your clinician can decide whether testing is needed for your case.

Are topical treatments effective for toenail fungus?

Topical medicines may help when the infection is limited and the treatment is used consistently for many months. More extensive infection may require a different treatment plan.

Is oral terbinafine safe?

Terbinafine is effective for many patients but is not appropriate for everyone. A clinician should review liver health, drug interactions, allergies, and monitoring needs before prescribing it.

Can I scrape the fungus out of my toenail?

Do not dig aggressively under the nail. This can injure the nail bed and introduce bacteria. A podiatrist can safely trim or debride the nail and decide whether additional treatment is needed.

Can toenail fungus come back after treatment?

Yes. Reinfection or recurrence can occur, especially after nail trauma or continued moisture exposure. Keeping nails trimmed, feet dry, shoes ventilated, and following a clinician's prevention plan can reduce the risk.

Conclusion

Thick or discolored toenails are not a cosmetic problem with a guaranteed quick fix. Confirm the cause, choose treatment with a qualified clinician, be patient while the nail grows out, and protect the nail from moisture and trauma during recovery.

For more foot-care information, visit my YouTube channel.

Medical disclaimer: This article is for general educational purposes only. It does not create a doctor-patient relationship or replace an examination, diagnosis, or individualized treatment plan. Prescription antifungal medicines, nail procedures, topical products, and home remedies may not be appropriate for everyone. Consult a podiatrist, dermatologist, physician, or pharmacist about your symptoms and medications.