What are the main causes of toenail fungus?

Toenail fungus (onychomycosis) is caused by dermatophytes (fungi that infect keratin) in 80–90% of cases — primarily Trichophyton rubrum. Less common causes: yeasts (Candida species — often in fingernails, associated with chronic wet work) and non-dermatophyte molds (Fusarium, Scopulariopsis, Aspergillus). The infection pathway: dermatophytes from the environment or skin enter the nail through micro-trauma or from pre-existing athlete's foot, colonize the nail plate and nail bed, and gradually spread. Risk factors: advancing age (slower nail growth, reduced immunity), diabetes, poor circulation, athlete's foot, immunosuppression, tight footwear, excessive sweating, communal bathing facilities, and nail trauma. Balance Foot & Ankle (810) 206-1402 — Howell and Bloomfield Hills.

What are the different types of toenail fungus?

Onychomycosis has four main clinical patterns: 1) Distal and lateral subungual onychomycosis (DLSO) — most common; infection begins at the free nail edge and spreads toward the root, causing yellowing, thickening, and separation. 2) Superficial white onychomycosis (SWO) — infection on the nail surface causing white, powdery patches; more common in children and immunocompromised patients. 3) Proximal subungual onychomycosis (PSO) — infection enters under the proximal nail fold and spreads outward; rare in immunocompetent adults, strongly associated with HIV. 4) Total dystrophic onychomycosis (TDO) — end-stage destruction of the entire nail; secondary to any of the above. Identifying the type guides treatment planning at Balance Foot & Ankle.

Why do older adults get more toenail fungus?

Multiple age-related factors increase toenail fungus risk: slower nail growth (means longer exposure to fungal penetration per unit nail length), reduced peripheral circulation (less antifungal drug delivery to nail bed), accumulated micro-trauma over decades (more nail damage creating entry points), longer cumulative exposure to contaminated environments, reduced immune function (less effective anti-fungal cellular immunity), higher prevalence of comorbidities (diabetes, PAD), increased use of communal facilities (gyms, nursing homes, pools), and medications that suppress immunity. The prevalence of onychomycosis increases from ~3% in young adults to 20–30% in those over 60. Regular professional nail care at Balance Foot & Ankle becomes increasingly important for older patients.

Can nail trauma cause toenail that looks like fungus?

Yes — traumatic nail dystrophy (onychodystrophy) from chronic repetitive microtrauma mimics onychomycosis closely: thickening, discoloration (brown, yellow), brittleness, and nail separation. Common sources of traumatic nail injury: poorly fitting shoes (nails hit the toe box repeatedly during walking or running), sports activities (runner's toenail), barefoot walking on hard surfaces, heavy objects dropped on toes, and previous nail avulsion. The key difference: traumatic dystrophy won't respond to antifungals. A KOH scraping and nail culture at Balance Foot & Ankle definitively distinguishes fungal from traumatic nail disease — this diagnostic step prevents years of unnecessary antifungal treatment. Many 'toenail fungus' cases in active patients are actually traumatic dystrophy.

How does athlete's foot lead to toenail fungus?

Athlete's foot (tinea pedis) and onychomycosis are intimately connected: the same dermatophyte fungi (primarily T. rubrum) cause both conditions. The infection pathway: T. rubrum establishes in the interdigital skin (between toes), and with time, migrates from the skin to the adjacent nail via the hyponychium (the junction where the nail plate meets the nail bed) or through the lateral nail fold. Studies show that untreated athlete's foot dramatically increases onychomycosis incidence. Conversely, successfully treating toenail fungus while leaving athlete's foot untreated leads to rapid nail reinfection — both conditions must be treated simultaneously for lasting cure. At Balance Foot & Ankle, we always assess and treat both conditions together. Call (810) 206-1402.

What is the best treatment for toenail fungus?

Oral antifungal medication has 70-80% cure rate. Laser therapy and topicals work for milder cases. Dr. Biernacki creates individualized plans based on severity. Treatment takes 3-6 months. Call 810-206-1402.

Is toenail fungus contagious?

Yes, it spreads through direct contact and contaminated surfaces. High-risk: pools, gym showers, locker rooms. Wear shower shoes, keep feet dry, use antifungal powder, don't share nail tools.

How do I know if I have toenail fungus?

Signs: yellowing/whitening, thickening, crumbling edges, separation from nail bed, foul odor. Professional diagnosis recommended as it can be confused with nail psoriasis or trauma.

What are the different types of toenail fungus?

The main types include distal subungual onychomycosis (most common, starts at the nail tip), white superficial onychomycosis (white patches on the nail surface), proximal subungual onychomycosis (starts at the nail base, often seen in immunocompromised patients), and candidal onychomycosis (caused by yeast).

How is toenail fungus diagnosed?

A podiatrist can diagnose toenail fungus through visual examination, but confirmation may require nail clippings sent for fungal culture, KOH microscopy, or PAS staining. Accurate diagnosis is important because other conditions like psoriasis, trauma, and lichen planus can mimic fungal infections.

✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

What Causes Toenail Fungus & Onychomycosis? [Types of Toenail Fungus]

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Michigan Podiatric Care at Balance Foot & Ankle: Expert Treatment for Every Foot Condition

Michigan patients with any foot or ankle concern — from acute injuries and chronic pain to preventive care and high-risk foot management — receive expert podiatric care at Balance Foot & Ankle. Our fellowship-trained podiatrists provide comprehensive evaluation, accurate diagnosis, and evidence-based treatment that addresses root causes rather than simply managing symptoms. We are committed to transparent communication: patients always understand their diagnosis, their treatment options, and realistic expectations before any intervention is undertaken.

Related Treatment Guides

Our Howell office (4330 E Grand River) serves Livingston County, and our Bloomfield Hills office (43494 Woodward Ave #208) serves Oakland County. Both locations offer in-office X-ray, same-week new patient scheduling, and the full range of conservative and surgical podiatric services. We accept all major Michigan insurance plans and verify coverage before appointments — no insurance surprises at check-in. Michigan patients ready to take the next step toward better foot health can call Balance Foot & Ankle at (810) 206-1402 to schedule today.

Medical References & Sources

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Clinical References

Gupta AK, et al. “Onychomycosis: a review of diagnosis, classification, and treatment approaches.” J Cutan Med Surg. 2017;21(4):294-305.
Lipner SR, Scher RK. “Onychomycosis: clinical overview and diagnosis.” J Am Acad Dermatol. 2019;80(4):835-851.
Westerberg DP, Voyack MJ. “Onychomycosis: current trends in diagnosis and treatment.” Am Fam Physician. 2013;88(11):762-770.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.