Unattractive toenails are common but have many causes, including fungus, trauma and autoimmune disease. Athletes can develop dystrophic toenails from repeated sudden-stop trauma associated with basketball, soccer and tennis. The great toes are most often involved in fungal disease and trauma-related dystrophy but exclusive little toe involvement is likely related to trauma.
The diagnosis of toenail fungal infection should be confirmed by laboratory diagnosis. Treatment courses are long and can be expensive, failure rates are high and recurrences are common.
FDA has approved efinaconazole topical solution, or Jublia, for the treatment of toenail onychomycosis (toenail fungus). This is applied like nail polish daily for 48 weeks and the manufacturer claims a 25% cure rate. A product already on the market, ciclopiox (Penlac) has a 7% cure rate after 48 weeks.
Oral medications, such as Lamisil (terbinafine), are usually the treatment of choice since the initial cure rate is as high as 76%. Liver toxicity is a concern and blood tests are needed during treatment. Medication is taken for twelve weeks but it may take a year to assess.
Preventing infection is best: Keep feet clean and dry, avoid sharing nail tools such as clippers and scissors and wear flip-flops or other footwear in the gym shower or locker room.
More information, including a discussion on non-prescription treatments.