What is the treatment for foot fungus (onychomycosis)?

From the Guidelines

The treatment for foot fungus (onychomycosis) should be terbinafine (Lamisil) 250mg daily for 6-12 weeks, as it is superior to itraconazole and has higher cure rates, with 80-90% for fingernail infection and 70-80% for toenail infection, as reported in the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1.

Treatment Options

• For mild to moderate cases, topical treatments like ciclopirox (Penlac) nail lacquer applied daily for up to 48 weeks or amorolfine nail lacquer can be effective.
• More severe or resistant infections often require oral medications such as itraconazole (Sporanox) 200mg twice daily for 1 week per month for 2-3 months, or fluconazole (Diflucan) 150-300mg once weekly for 6-12 months.

Important Considerations

• Complete treatment requires patience as nails grow slowly, and full resolution may take 9-12 months for toenails.
• Keep feet clean and dry, wear breathable shoes and fresh socks, avoid walking barefoot in public areas, and trim nails straight across to prevent recurrence.
• Oral medications can have side effects including liver problems, so liver function tests may be necessary during treatment, as noted in the guidelines 1.
• Fungal infections thrive in warm, moist environments and can be difficult to eradicate because the fungus penetrates the nail plate, creating a barrier that makes topical treatments less effective for deeper infections.

Prevention of Recurrence

• It is essential to emphasize the importance of always wearing protective footwear to avoid re-exposure to fungal elements, as reported in the British Association of Dermatologists' guidelines 1.
• Other strategies include application of an absorbent powder, and antifungal powders containing miconazole, clotrimazole or tolnaftate in shoes and on the feet, and wearing cotton, absorbent socks.
• Shoes can contain a large number of infective fungal elements, and it is recommended to discard all ‘old and mouldy’ footwear or to eliminate fungal elements by putting naphthalene mothballs in the shoes and then leaving them enclosed within a tightly tied plastic bag for a minimum of 3 days, as suggested in the guidelines 1.

From the FDA Drug Label

Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor. Uses • cures most athlete's foot (tinea pedis)

The treatment for foot fungus (onychomycosis) is applying terbinafine (TOP) twice a day for:

• 1 week for athlete's foot between the toes
• 2 weeks for athlete's foot on the bottom or sides of the foot It is also recommended to:
• Wear well-fitting, ventilated shoes
• Change shoes and socks at least once daily
• Wash the affected skin with soap and water and dry completely before applying the treatment 2 2

From the Research

Treatment Options for Foot Fungus (Onychomycosis)

• Oral antifungal medications such as terbinafine have been shown to be effective in treating onychomycosis, with cure rates ranging from 67% to 85% after 6 to 24 weeks of treatment 3, 4.
• Topical antifungal medications, such as amorolfine and ciclopirox, can be used to treat milder cases of onychomycosis, and may be used in combination with oral antifungals for more severe cases 5.
• Intermittent itraconazole therapy has also been shown to be effective in treating onychomycosis, with a high cure rate after a short course of therapy 6.
• Proper foot hygiene and regular foot care are important components of treatment, particularly for patients with diabetic foot, to prevent complications such as bacterial infections and foot gangrene 7.

Treatment Duration and Efficacy

• The optimal duration of treatment for onychomycosis is still being defined, but studies suggest that 12 weeks of oral terbinafine treatment may be sufficient for toenail onychomycosis 3.
• Longer treatment durations, such as 18 or 24 weeks, may be necessary for more severe cases or for patients with extensive disease 4.
• Mycologic and clinical cure rates can vary depending on the treatment duration and the severity of the disease, but overall, oral antifungal medications have been shown to be effective in treating onychomycosis 3, 4.

Importance of Foot Care

• Regular foot care, including daily checks and nail care, is important for preventing complications such as bacterial infections and foot gangrene, particularly for patients with diabetic foot 7.
• Proper foot hygiene and foot care can also help to prevent the spread of fungal infections and promote healing 5, 7.