Background: Onychomycosis is a common fungal infection of the toenails which has historically been regarded as a cosmetic problem. A previous study has suggested that this is not the case and that toenail and fingernail onychomycosis adversely impacts patient quality of life (QOL). Methods: A survey was used to self-assess the physical symptoms and psychosocial dimensions of toenail onychomycosis in 93 patients. Positive responses scored one point each, and points were summed for each patient. Results: Ninety-two per cent of patients reported experiencing negative psychosocial and/or physical effects. Forty-four per cent indicated that their toenails had a negative effect on their self-image, and 41% reported experiencing pain or discomfort as a result of onychomycosis. Conclusions: Toenail onychomycosis has a significant impact on the overall QOL of patients, and should be evaluated further to develop guidelines for total patient care.