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If you have tried and failed over the counter treatments, and your nail fungus continues to be present, is causing pain or difficulty wearing shoes, or you notice that it is spreading, it is recommended that you seek evaluation with a medical provider. Toenail fungus is caused by an overgrowth of fungus in, on or under the nail plate. Risk factors for the development of fungus include advanced stage diabetes, immunocompromised status, male gender, the presence of athlete’s foot, poorly ventilated shoes and socks, circulation problems, nail trauma, nail damage, as well as a family history of fungal toenail infection.