What are Fungal Toenails?
Fungal toenails (medically called onychomycosis) cause the nail to thicken, change colour become crumbly.
Fungal nail infections usually occur when living fungus invades the toenail and nail bed. The fungus feed on the keratin (structural protein making up the nail) which causes changes in the appearance. Fungus thrives in warm, dark environments, so closed in shoes provide the perfect environment for nail fungus to grow.
Not all nails that come into contact with fungal spores will become infected. If your nail is weak and vulnerable, either through damage or a compromised immune system, you are at a greater risk of developing fungal toenails.
What causes Fungal Toenails?
Factors that may put you at risk of a fungal nail infection include:
- Nail trauma- direct trauma such as stubbing your toe, or repetitive trauma such as footwear rubbing on your toes
- Sweaty feet
- Poor hygiene
- Compromised immune system (Diabetes, illness)
- Poor circulation
- Ongoing use of occlusive footwear (sneakers or work boots with steel or composite cap boots)
- Working in a wet environment
- Prolonged nail polish use
Why do we treat fungal toenails?
Usually there are a number of reasons someone chooses to treat their fungal nail infections.
The most common reasons we see in clinic are:
- Cosmetic appearance of the toenail
- To avoid the infection spreading to other toes
- Painful toenails caused by thickening of the nail
Podiatrists are the expert to see when it comes to fungal toenails and will provide full treatment to heal your toenail.
Often people will seek help from their GP and be sent straight to Podiatry to commence nail treatment. No referral is required to see us!
Treatment is based on severity of the toenail. Severity depends on how far the fungus has affected the toenail and how many nails are affected.
This basic principal will dictate what treatment options are pursued.
Treatment Options Include (listed below)
- PACT Photodynamic Treatment
- Podiatry Mechanical Nail Reduction
- Topical Anti-Fungal Treatment
- Oral Anti-Fungal Treatments
PACT Treatment (Photodynamic Treatment)
- Treats nail fungus safely and pain-free
- Uses photo-dynamic therapy to destroy fungus
- Treatment involves application of urea pre-treatment, thinning the toenail down, and application of the Pact unit on the affected toenails
- Treatment once weekly for 4 weeks, then every 4 weeks thereafter until healed
- No side effects have been reported with this treatment
- Safe during pregnancy
- Figueiredo et al. 2016 reported that PACT had a 100% success rate for mild to moderate and a 63.5% success rate for severe onychomycosis infections
Podiatry Mechanical Nail Reduction
Seems basic but it’s really important to ensure good nail hygiene!
Keep the nails short, smooth and regularly filed down. Don’t forget to refrain from using nail polish as this often encourages fungal growth!
Learn more about Podiatry nail and skin care here!
Topical Anti-Fungal Treatments
- In the form or anti-fungal nail paint/lacquer and applied directly to the nail
- May be applied daily, twice weekly or weekly dependent on the nail paint brand
- Required to be used for 12-18 months to allow the nail to grow out completely, thus compliance can be challenging and a barrier to success rates!
- Can be used well in a mild/superficial infection (white spots/streaks)
- Gordochom tincture and SolvEasy cream and spray are stocked at the clinic
TAKE HOME MESSAGE: Most of the time topical treatments don’t work well for moderate-severe infections as they are unable to penetrate the nail plate or get into the nail bed where the fungus is growing.
Oral Anti-Fungal Medications
- Needing to be prescribed by a GP-usually after a nail scraping
- Oral antifungals (Terbinafine and Griseofulvin) can be effective for moderate-severe infections- success rate shows they can be about 50% effective
- Usually take at least 3 months to work (possibly more time)
- While effective these medications can have side effects and are not suitable for some clients with liver impairments
Get Fungal Toenails sorted once and for all!