Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Fungal Toenail Treatment from a Michigan Podiatrist
Onychomycosis — fungal infection of the toenail — is one of the most common nail conditions treated in podiatry, yet one of the most frequently undertreated due to frustration with ineffective over-the-counter products and incomplete medical management. The thick, discolored, crumbling nails characteristic of onychomycosis are not merely cosmetic — they indicate active fungal invasion of the nail plate and matrix that requires targeted antimicrobial treatment. Dr. Tom Biernacki at Balance Foot & Ankle provides expert fungal nail diagnosis and evidence-based treatment throughout Southeast Michigan.
What Causes Toenail Fungus?
Dermatophytes — particularly Trichophyton rubrum and Trichophyton mentagrophytes — cause the majority of onychomycosis cases. These fungi thrive in the warm, moist environment of enclosed footwear and spread readily in communal areas including swimming pools, locker rooms, and nail salons. Non-dermatophyte molds and Candida species cause smaller proportions of nail infections, particularly in immunocompromised patients. Accurate species identification via culture guides antifungal selection, as different fungi respond differently to treatment agents.
Who Gets Toenail Fungus?
Onychomycosis is more prevalent with increasing age — approximately 20% of adults over 60 are affected. Risk factors include diabetes, immunosuppression, peripheral vascular disease, prior nail trauma, athlete’s foot (tinea pedis), hyperhidrosis, and communal facility exposure. Men are affected more commonly than women. The big toe (hallux) is most frequently involved due to repetitive microtrauma and slower nail growth rate that gives fungi more time to establish infection.
Diagnosis: Why Culture Matters
Clinical appearance alone is insufficient for fungal nail diagnosis — multiple conditions mimic onychomycosis including psoriasis, lichen planus, trauma, and other nail dystrophies. Prescribing oral antifungals without confirmation wastes treatment and exposes patients to drug interactions and hepatotoxicity unnecessarily. Dr. Biernacki obtains nail clippings and subungual debris for mycological culture and PAS (periodic acid-Schiff) histological staining to confirm fungal infection and identify the causative organism before recommending treatment.
Treatment Options for Fungal Nails
Prescription topical antifungals — efinaconazole (Jublia) and tavaborole (Kerydin) — represent a significant advance over older OTC products. Applied daily for 48 weeks, they achieve mycological cure in approximately 50% of patients with mild-to-moderate involvement. Oral terbinafine is the gold standard pharmacological treatment, achieving 70–80% mycological cure rates with 12 weeks of therapy. Baseline liver function testing and monitoring are required. Laser therapy using Nd:YAG wavelengths heats fungal elements without systemic drug effects — an excellent option for patients with hepatic concerns or medication interactions.
Debridement: The Critical Adjunct
Regular mechanical debridement of infected nail — reducing nail thickness, filing the surface, and removing subungual debris — significantly improves topical antifungal penetration and accelerates visible clearing. Dr. Biernacki performs professional nail debridement at treatment initiation and follow-up visits, dramatically improving outcomes compared to topical treatment alone. Surgical nail avulsion (removal) of severely infected nails may be indicated in refractory cases to expose the nail bed to topical treatment.
Prevention of Recurrence
Recurrence rates after successful treatment are significant — up to 40–60% over 4 years without preventive strategies. Dr. Biernacki provides specific recurrence prevention guidance: treating coexisting athlete’s foot that serves as a fungal reservoir, using antifungal foot powder in shoes, wearing moisture-wicking socks, avoiding communal barefoot exposure, and using antifungal prophylactic sprays in footwear. Long-term nail health monitoring with periodic podiatric visits catches early recurrence before significant nail destruction recurs.
Dr. Tom's Product Recommendations
Fungi-Nail Anti-Fungal Solution
⭐ Highly Rated
Maximum strength OTC antifungal treatment for mild early toenail fungus and athlete’s foot. Undecylenic acid formula approved for initial mild cases — best used early and alongside podiatric care for moderate-to-severe infection.
Dr. Tom says: “My podiatrist recommended this for the mild nail on my smaller toes while we focused prescription treatment on my big toe. Good adjunct product.”
Early mild toenail fungus and as adjunct to prescription treatment for surrounding skin — not adequate as sole treatment for established nail infection
Moderate-to-severe onychomycosis involving multiple nails or the big toe — those require prescription antifungals or laser treatment from Dr. Biernacki
Disclosure: We earn a commission at no extra cost to you.
Foot Sense Natural Foot & Shoe Powder
⭐ Highly Rated
Antifungal zinc-based foot and shoe powder for daily fungal recurrence prevention. Keeps the shoe environment dry and inhospitable to dermatophytes — critical for preventing reinfection after successful treatment.
Dr. Tom says: “My podiatrist emphasized prevention after clearing my nail fungus. Using this powder daily in my shoes has kept the fungus from coming back for over a year.”
Daily prevention of fungal recurrence after successful onychomycosis treatment — maintains dry, antifungal shoe environment
Active nail fungal infections — powder is preventive, not curative; established infection requires prescription treatment
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Accurate diagnosis with culture guides antifungal selection and improves cure rates
- Oral terbinafine achieves 70-80% mycological cure in confirmed dermatophyte infection
- Professional nail debridement dramatically improves topical antifungal penetration
- Laser treatment is an excellent option for patients who cannot take oral antifungals
❌ Cons / Risks
- Fungal nail treatment requires sustained commitment — 3-12 months of active treatment
- Nail appearance improvement lags 6-12 months behind mycological cure as new nail grows
- Recurrence rates are significant without ongoing prevention strategies
- Oral antifungals require liver function monitoring and may interact with other medications
Dr. Tom Biernacki’s Recommendation
Toenail fungus is one of those conditions that patients try to manage on their own for years before coming in — and then are surprised at how much better we can do with proper diagnosis and treatment. The biggest mistake is using over-the-counter products on moderate-to-severe nail involvement. They simply don’t penetrate enough. If your nail has been thick and yellow for more than 6 months, come in — we’ll culture it, confirm it, and treat it properly.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Can toenail fungus go away on its own?
Rarely. Fungal nail infections are chronic and progressive without treatment — over time, more nails become involved and existing infections worsen. The fungi establish themselves in the nail matrix (the root), making the infection self-perpetuating. Early mild infections have the best response to treatment. Waiting and hoping almost always means more extensive infection and more difficult treatment later.
Is oral terbinafine safe?
Yes, for most patients. Terbinafine is well-tolerated with a good safety profile. Liver toxicity is rare — occurring in approximately 1 in 50,000 treated patients. Dr. Biernacki orders baseline liver function tests before prescribing and monitors during treatment in patients with hepatic risk factors. Terbinafine has some interactions with other medications that Dr. Biernacki reviews at your consultation. For patients with liver disease or concerning drug interactions, topical or laser treatment are alternatives.
How long before my toenails look normal?
Toenails grow slowly — approximately 1.5mm per month for big toenails. Even after successful fungal eradication, it takes 12–18 months for a clear nail to fully replace the previously infected nail. Patients often see improvement in nail texture and color within 3–6 months of starting treatment, with progressive improvement thereafter. Complete cosmetic normalization requires patience and continued monitoring.
Can I get laser toenail fungus treatment in Michigan?
Yes — laser treatment for onychomycosis is available at Balance Foot & Ankle. The laser heats fungal elements within the nail without damaging surrounding tissue or causing systemic drug effects. It is an excellent option for patients with hepatic concerns, multiple drug interactions, or preference for non-pharmacological treatment. Multiple sessions are typically needed; Dr. Biernacki evaluates your specific nails to recommend the appropriate laser protocol.
Does toenail fungus spread to other nails?
Yes — fungal infection is contagious and spreads within the individual from nail to nail and to the surrounding skin (causing athlete’s foot). It can also spread to household contacts via shared showers, bath mats, and nail implements. Treating all infected nails simultaneously, using dedicated nail tools for infected nails, wearing shower shoes in communal areas, and daily antifungal powder in footwear are critical steps to prevent spread during and after treatment.
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How long does it take a toenail to grow back?
6-12 months for a full big toenail. Smaller toenails 4-6 months. Speed varies with age, circulation, and nutrition.
Will this affect other nails?
Trauma affects only the injured nail. Fungal infection can spread without treatment. Systemic causes affect multiple nails simultaneously.
Should I cover the nail or leave it open?
Cover with a breathable bandage during work or activity. Leave open at night for healing. Keep dry and clean.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot issues, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.