Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Nail Fungal Infection


A nail fungal infection is a common disorder, usually caused by fungi that can infect the toenails and, less commonly, the fingernails. In severe cases, the nails can loosen or come off completely.  

Nail fungal infections are more common in the toenails than the fingernails because socks and closed shoes provide perfect conditions for the fungi to grow and because the toenails are more exposed to repeated trauma from shoes and activities.


If you have a nail fungal infection, your nails may be:

  • Breakable and ragged.
  • Misshapen and thickened.
  • Dull, with no natural sheen.
  • Discolored. The nail may turn yellow, white, or dark. The dark color is caused by debris or dry blood that builds up under the skin as the nail deteriorates. 
  • Detaching from the nail bed. In severe cases, the infection can cause the nail to come away from the nail bed completely.
  • Emitting an unpleasant odor.
  • Causing you to feel pain (uncommon).

Causes and Risk Factors

A nail fungal infection is usually caused by a specific class of fungus called a dermatophyte. The fungi are common in the environment and so it's difficult to completely avoid exposure. However, although many people are exposed, most do not develop toenail fungus. You are more likely to develop an infection if the fungi are able to get into your nail or into the nail bed as a result of an injury or trauma to the toenail that breaks the skin of your toe. Risk factors include:

  • You are older than age 60.
  • You have a weakened immune system.
  • You have a family history of toenail fungus.
  • You have psoriasis of the skin that affects the nails.
  • You have diabetes.
  • You shared nail clippers with someone who has toenail fungal infection.
  • You consistently wear pointed or ill-fitting shoes.
  • You have athlete's foot.


Although it is not possible to completely avoid the organisms that cause nail fungal infections, it is possible to take some steps to reduce the risk that they will infect you. These self-care steps include the following:

  • After bathing, dry your feet well, especially between the toes.
  • Use topical antifungal medication if you have athlete's foot, which is another fungal infection of the skin.
  • Wear shoes or sandals that allow your feet to breathe and stay dry.
  • If your feet perspire a lot, try using antiperspirant spray and/or foot powder to keep your feet dry.
  • Wear socks that keep moisture away from the skin.
  • Change your socks frequently.
  • Use your own nail clippers, socks, shoes, and other personal items and do not share these items with others.
  • Wear shower sandals or rubber flip-flops in wet public areas like beaches, showers, and pools, to prevent contagion.


Nail fungal infections are most commonly diagnosed by a clinical examination of your toenails. They usually have a specific appearance. We look for:

  • Thickening of one or more of your toenails. The nails can become thick, chalky, or crumbly, making them difficult to cut.
  • Discoloration. The initial change can be white, yellow, or brown discoloration affecting all or part of the nail.
  • White spots. Sometimes dull white spots, which can spread, may occur in the middle of the nail.

In rare cases, we may want to confirm the presence of a fungus to be sure of the diagnosis. We send a scraping of your nail to the laboratory to identify the specific fungus that is causing the infection. This can help us determine the most effective treatment.

Treatments and Medications

It's extremely difficult to completely cure toenail fungus. The topical medications that are available from any drugstore are generally ineffective for curing toenail fungus, although they can help slow its progression. Oral medications can have serious side effects. If your toenail is not causing pain or disability we may recommend that the best approach is to leave it untreated. If your toenail fungus is causing pain or making it difficult for you to wear shoes, we may discuss permanently removing your toenail. This is a common and safe procedure with predictably good results.   

Oral medications

Anti-fungal medications that are taken by mouth for several months usually work better than topical medications. However, they can have serious side effects that include liver damage. Additionally oral medications have a relatively high failure rate and the fungal infection often recurs. Because of the potential for serious side effects and the low effectiveness of oral medications, we don't commonly recommend them.

If you are interested in trying an oral medication, please ask your personal physician if it is appropriate for you.

Laser treatment

Laser toenail treatment is not currently supported by clinical research and is considered a cosmetic treatment. Laser treatment is not covered by your KP health plan benefits.

Nail Removal

If your toenail fungus is causing pain or making it difficult for you to wear shoes, we may discuss permanently removing your toenail. This is a common and safe procedure with predictably good results.   

The procedure is performed in our medical offices under local anesthesia. You can generally go back to work or school the same or next day; however, it will take 4 to 6 weeks for your toe to heal.

As with all procedures, there are some risks involved. These include:

  • Infection
  • Regrowth of the nail
  • Scarring
  • Reaction to the chemical used that may cause excessive swelling

Additional References:

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.