Going barefoot is one of life's simple pleasures, but if your toenails are tarnished by a fungal infection, the thought of exposing your feet can be unbearable.

The fungi responsible for nail infections are relatively easy to acquire: They can spread from one person to another, or they can be picked up from inanimate objects. The microscopic organisms survive on dead skin cells that cling to shoes, towels, and public showers.

The fungi are close cousins to mold and mildew, and they thrive in warm, dark, moist conditions. Sweaty feet in tight-fitting socks and shoes provide a perfect environment for the organisms to grow and spread.

Once they get a toehold, the fungi set up housekeeping in the nail bed and feed on keratin, the protein that makes up your nails. Although fungal infections can strike any nail, the big toe and little toe are most frequently affected.

Because they can make nails thick, crumbly, and yellow, the infections are mainly a cosmetic concern, but in some cases, they can be considerably painful. For people with diabetes and compromised immune systems, they can lead to more serious complications, including open sores and ulcers that are resistant to healing.

The infection usually begins as a white or yellow spot under the tip of a nail. As the organisms grow and multiply, the area of discoloration spreads, and the nail becomes thick and brittle.

Most doctors can make the diagnosis after a simple visual exam, but if there's any question, scrapings of your nails may be collected and sent to a lab for analysis.

Although fungal infections of the nails are relatively easy to acquire and recognize, they're notoriously difficult to treat, even with prescription medications. Oral anti-fungal drugs, including Lamisil and Sporanox, are reasonably effective, but they're definitely not for everyone.

Side effects range from skin rashes to liver damage. Throughout the treatment period, regular blood tests are required to monitor liver function.

Prescription anti-fungal drugs must be used for several weeks or months to be effective, and the entire treatment may end up costing as much as $1,000. Since many health insurance companies consider nail infections a cosmetic problem rather than a medical condition, you may end up footing the bill yourself.

If anti-fungal pills aren't right for you, your doctor may prescribe a topical medication called Pen-Lac Nail Lacquer. The liquid medicine is painted onto your infected nails once a day.

After a week, the piled-on layers are removed and replaced with a fresh coat. The topical treatment is generally safer and less expensive than anti-fungal pills, but it doesn't seem to be quite as effective in eliminating infections.

Tea tree oil is a natural remedy that has been proven effective as a treatment for a variety of fungal infections, including those of the toenails. Because the oil is a strong organic solvent, it can penetrate the thickest nails to reach the fungi responsible for the problem.

Even with regular application, tea tree oil doesn't eradicate fungi as quickly as prescription medications, but it is far less expensive. It's also considered to be a safer alternative to oral anti-fungal medications.

If you've never had a fungal infection of your nails you can count yourself lucky, but you shouldn't let your guard down. After the age of 40, toenails grow more slowly and begin to thicken, making them more vulnerable to attack.

When it comes to keeping toenails healthy, an ounce of prevention is worth a pound of cure. A few simple steps can help feet and nails remain fungus free.

For starters, keep your nails clean and dry by toweling your feet and toes thoroughly after bathing and swimming. If you have sweaty feet, wear absorbent socks, and change them at least once during the day.

Make sure your shoes are dry, and douse them with an anti-fungal powder or spray before you wear them. If you're going to be spending time in damp public places like locker rooms or swimming pools, it's a good idea to invest in a pair of shower shoes or sandals, and allow them to dry completely between outings.

Once you acquire a fungal infection of a toenail, there's a good chance it will stay with you for life. Since the condition rarely goes away on its own, you should see your doctor at the first sign of trouble.

With proper treatment, you can have healthy, fungus-free feet and nails in a matter of months.

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Rallie McAllister, M.D., M.P.H., is a family physician in Kingsport, Tenn., and author of "Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim." Her Web site is [http://www.rallieonhealth.com].

From HSI Forums:  

Here is another recipe: Neem, thyme, clove, pine bark extract, eucalyptus, oil of oregano, Arq-e-hyat (a camphorated oil), tea tree, DMSO, calendula, Castor Oil, Jojoba (Oils to dilute and aid penetration). DMSO, could be the key to making those other ingredients effective. DMSO is a natural solvent that helps the anti-fungal oils penetrate the nail. Oregano oil is a particularly effective anti-fungal, but it's very strong and may need to be diluted with a little olive oil to prevent irritating the surrounding skin.