This is a typical question from patients with mild cases of toenail fungus:

"Hi Doc...

I have a mild case of toenail fungus. Only the big toenails have the white spots and thicker nail that suggests a toenail fungal infection. However my dad’s toes are a different story. 

We recently had a house call podiatrist come to the home to check his feet. When I saw my dad’s toes, I was horrified at the sight of his toenails!  All of his toenails are yellow, thick and curving in odd directions. The big toenails are incredibly thick...nearly as thick as the toes themselves. They are crusty and flaking as well. Dad said that his toenails are so thick he hasn’t been able to cut them himself for years.

The podiatrist told us that super-thick fungal toenails are really not that rare in elderly people. He said that the appearance of dad’s fungal toenails is characteristic of a longstanding toenail fungus infection. 

My question is, “How long will it take for my mildly infected fungal toenails to get as thick as my father’s fungal toenails?”

The rate at which toenail fungus gets worse depends upon the type of fungus that has infected the toenail and your body’s ability to fight and slow the infection. 

Fortunately the most common forms of toenail fungus are not caused by overly aggressive organisms. Trychophyton rubrum and Trychophyton mentagrophytes are responsible for most of the toenail fungus infections. There are some less common fungal organisms that progress rapidly, but again, those are rare.

If you are young, healthy, have good blood circulation in your feet and have a strong immune system, you should expect the common forms of toenail fungus to get worse very slowly...almost unnoticeably slowly. You won’t notice any change from day-to-day. In fact, you may not see a change from month-to-month. 

If you takes pictures every few months and then compare over a long period of time, you may gradually notice that the areas of white and yellow discoloration are getting bigger. This may be your only indication that the toenail fungus is spreading and getting worse. If the fungus goes untreated for a long period, you may even notice that the toenail is getting thicker as well. 

But even if you are healthy and have a strong immune system that is fighting the toenail fungus infection, don’t expect your immune system to win. Toenail fungus is not something that you “get over” the way you might get over a cold or a case of the flu. When toenail fungus gets inside the toenail and starts to grow it is there to stay...unless you treat it. If you don’t treat the fungus it will simply continue to grow. 

Over time the fungus spreads throughout the toenail. As the toenail fungus grows, it begins to separate the keratin that forms the toenail. The cracks and splits in the keratin change the way light refracts through the toenail. Once that happens you notice white or yellow areas of the toenail where the keratin has been infiltrated and damaged by the thriving fungus. 

If the toenail fungus does enough damage, the nail plate may become misshapen enough to actually separate from the underlying nail bed. This usually creates large opaque white spot because the pink skin of the nail bed is no longer flush against the undersurface of the toenail. When this happens, it is usually at the end of the toenail in one of the corners.

As the fungal infection continues to get worse, the fungus bores its way through the toenail, moving closer to the root of the nail or “matrix.”  The toenails grows directly outward from the matrix. The matrix is the same size, same thickness and same curvature as a cross section of the toenail. 

If the fungus thickens the toenail and stretches out the matrix, the damage is permanent. At that point, even after you remove the fungus from the toenail, the matrix is permanently deformed and the toenail will always grow out thicker. 

If your immune system has been weakened by chronic disease, malnutrition, HIV infection or over-training, the fungus can grow and spread at a much faster rate. 

So, back to the real question. How long does it take for toenail fungus to become irreparably damaged and terribly thickened?

In many young healthy adults toenail fungus will worsen over the course of a year before the problem seems noticeable. In five years the common forms of toenail fungus can form substantial thickening and possibly permanent damage to the nail plate. But it may take ten years of more to develop the kind of grossly deformed thickened toenails like your father. The fact is, given what you describe, your father has likely had toenail fungus for decades. 

Dr. Christopher Segler offers concierge laser toenail fungus treatment services in San Francisco, Marin and Silicon Valley. If you have toenail fungus he will bring the laser directly to you.  If you have a question about laser treatment of toenail fungus, you can reach him directly at 415-308-0833.

Yes!  We firmly believe that if you pay for a doctor’s visit, you ought to see a doctor.  And the doctor ought to be the one delivering the care. 

We never, ever allow non-doctors to perform the laser toenail treatments. 

We have had patients tell us that some medical offices offer laser toenail fungus removal treatment, but that a nurse or “medical assistant” of some type is the person actually performing the laser toenail fungus removal treatment. Granted, there may be a doctor in the office, but the doctor isn’t the one doing the laser procedure.

All of our laser procedures are performed by Dr. Christopher Segler, a podiatrist who is Board Certified, American Board of Podiatric Medicine. 

When you call our office, you will speak directly to Dr. Segler.  He will explain the options for toenail fungus treatment. If you are a candidate for laser toenail fungus treatment, he will bring the toenail laser to your home or office. You will not speak to a nurse or an assistant, but you will speak to a real doctor. A real doctor will perform your laser toenail treatment. 

If you think you have ugly, thick, white and yellow toenails you might have a toenail fungus infection. If so, you can call Dr. Segler directly at 415-308-0833. And yes, you will actually get to speak with a real doctor. We bring the toenail laser to you. Laser toenail fungus removal treatment is available in San Francisco, Oakland, Berkeley, Mill Valley, Tiburon, San Rafael and Palo Alto.

Yes!  When you have the laser toenail fungus removal procedure the fungus is dead. But the actually appearance of the toenail is no different at the conclusion of the laser treatment. 

You have to wait for the healthy non-deformed toenail to grow out.  This will take several months. 

If you have been using fake nails to cover the ugly, yellow, and white fungal toenail, you can go back to the nail salon to reapply the artificial nails. Eventually you may not need the artificial nails any longer if your toenails clear after the laser treatment. 

Dr. Christopher Segler is a podiatrist Board Certified, American Board of Podiatric Medicine. He performs laser treatments to remove toenail fungus in San Francisco, Oakland and San Jose. He even does House Calls!  That way we bring the toenail laser to you so that you can get rid of your toenail fungus without taking time off work to get laser treatment at a podiatry office. If you have a question about toenail fungus, you can call Dr. Segler directly at 415-308-0833.  You can also click here to get a HUGE DISCOUNT on laser toenail fungus treatment.  

This video explains how clear toenails turn into discolored fungal toenails.

A normal toenail is thin, clear and translucent allowing you to actually see right through the toenail to the pink nail bed underneath. However as soon as the fungal spores get in underneath the toenail the toenail fungus starts to grow within the keratin of the toenail itself. The growing fungus actually causes the layers of keratin to separate.

The separation of layers within the toenail causes the toenail to become thicker but it also changes the way that light refracts through the toenail. This causes a cloudy discoloration that is usually white or yellowish. Those thick, crumbling white and yellow areas of the toenail are the classic signs of a toenail fungus infection.

If you think you might have a toenail fungus infection, you can call 415-308-0833 to speak to an expert to find out if you might be able to get rid of the toenail fungus and have clear toenails again. 

Many medical terms seem unnecessarily long and complicated.  him and toenail fungus is no different. “White superficial onychomycosis”  is a purely descriptive term.  “White” of course refers to the color. “Superficial” implies that the fungal infection is only really affecting the surface of the toenail. “Onychomycosis” means fungal infection of the nail. 

When you put all of this together of course what it tells you or the doctor is that there is a fungal infection involving the toenail that is causing the toenail to become white and discolored and is only on the surface of the nail plate.

In general these superficial toenail infections do not penetrate the toenail itself.  The toenail will look like it has some white spots or speckled appearance. It sort of looks like there are powder sugar in splotches on the toenail. This particular form of a toenail infection can be related to applications of nail varnish or toenail polish base coats. 

Although this is not the most common form of toenail fungal infections, it can be easier to treat. The reason that it might be easier to cure is that the infective organisms are closer to the surface and not underneath the nail plate where they can be harder to reach.

Because the fungus is actually growing on the surface of the nail plate it is also easier for your podiatrist to take a sample of the fungus and evaluate it.  It may also respond to topical treatment more readily than a fungus that bores all the way through the nail plate down to the nail bed. The laser treatment is also effective for this type of toenail fungus infection.

Dr. Christopher Segler, DPM is board certified, American Board of Podiatric Medicine.  He believes that the best medicine can be fast, convenient and low-cost treatment. His innovative housecall podiatry practice model helps to keep costs down for patient with making expert care more convenient than ever.  

If you have a tight work schedule we can even see you in your own office.  We often do house calls for executives so that they can be seen between meetings.  When there is no time to waste, a house call is definitely the best treatment and just what the doctor ordered!  

We offer house calls all over the San Francisco area, including the Marina, Castro, the Sunset, Richmond district, North Beach, Presidio, Seacliff, Downtown, Nob Hill, Russian, and the Financial district. We will even see you at home in Mill Valley, San Rafael, San Bruno, Oakland or Berkeley.

If you have a question about toenail fungus and wonder whether or not the laser fungus removal treatment might be right for you, you can call and speak directly with a toenail expert by calling  415-308-0833.  And yes, you will actually get to speak with the doctor.