Are Podiatrists Really Treating Onychomycosis? A Professional Weighs In on Treatment Statistics

“Onychomycosis is the condition we see most commonly in practice,” Dr. Warren Joseph DPM writes in Podiatry TodayIn fact, onychomycosis toenail fungus accounts for about one-third of all fungal skin infections. Dr. Joseph adds, “The fact of the matter is: we are still not effectively treating it.” One need only look at the statistics for evidence, he suggests.

Toenail Fungus Statistics

– Between 35 and 36 million Americans have onychomycosis at any given time.

– Only 6.3 million have had their condition diagnosed by a podiatrist or general practitioner.

– Of the 6.3 million people diagnosed, only 2.5 million were treated for their foot fungus.

– That means 33 million people are not being treated! Many people do not even know the name for the disease.

toenail fungus statistics

The likelihood of having toenail fungus increases with age. Image Source:

Toenail Fungus Treatment History

A decade ago, patients visiting their podiatrists with the symptoms of toenail fungus — yellow, crumbling nails — would have portions of the nail cut away as part of their treatment. This procedure, called “debridement,” had several flaws, however. Cutting away the nail did not get  to the root of the fungal growth, so new nail growing in was often diseased as well. Shortly thereafter, the drug terbinafine debuted on the market and seemed like the infection treatment medical doctors had been waiting for.

Part of the problem, says Dr. Joseph, is that many podiatrists were worried that if they cured people of toenail fungus, all their business would suddenly disappear. Yet, that is simply not true. With 50% of the 70+ population and 40% of the 60+ population suffering from toenail fungus, there is plenty of business to go around. The average podiatrist sees 300 onychomycosis patients a month. Only 26 of these patients are in for their first visit. What that tells us is that people see real value in making regular visits to the podiatrist and become long-term customers once they are treated for toenail fungus.

lamisil ad

This ad for Lamisil touches upon the emotional issues associated with toenail fungus. Image Source:

Are Over-The-Counter Antifungals The Answer?

Forty-two percent of patients with toenail fungus use over-the-counter medication. The infection is disrupting lives so much that patients are willing to actively seek treatment. Many of these people have unsuccessfully tried soaking their feet in vinegar or bleach before that point. Many people only come to a podiatrist when OTC measures have failed. Only 12% of Americans with onychomycosis are getting a prescription antifungal, which implies most people are not getting the treatment they need.

Talk to a Podiatrist

Toenail fungus is notoriously difficult to treat, but that doesn’t mean you can afford to just sit back idly. Untreated toenail fungus can lead to a host of very serious complications. Unfortunately, over-the-counter lacquers and creams do not have a very good cure rate. You are better off making that appointment with a podiatrist to ask for the oral medications that actually work. This may require liver monitoring, since these drugs tend to be taxing on the system. If you are worried about this type of side effect, you may elect to pay out-of-pocket for laser toenail treatment.

Regardless of which treatment you choose, you will need to wait for the old fungus nail to grow out and treat your footwear with germicidal UV light to kill any residual fungus living there.


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