My fungal toenail is an embarrassment – what can I do?

Fungal toenail infections are probably one of the most common foot problems we see as Podiatrists. Despite this, fungal toenails are probably one of the most difficult foot health conditions to treat and there are several treatment options available, which all have their benefits and drawbacks.

In this blog, I will take you through the main treatment options and some of the considerations that need to be taken when treating a fungal nail infection.  Your podiatrist will be able to advise you further according to your particular needs.

What causes a fungal toenail infection?

The fungal infection that affects the nail is called Tinea Unguium and is generally the same as the fungal infection that affects the foot called Tinea Pedis. Our enclosed footwear and socks, combined with perspiration, provide the ideal conditions for fungal infections of the foot. Couple this with trauma to the toenail or constantly wearing nail polishes, it is highly likely that a fungal toenail infection may take hold.

When our nails become infected with fungus, it is known as Onychomycosis.

What do we need to consider when treating Onychomycosis?

1. The extent of the nail infection needs to be considered. If the nail matrix is infected, it is unlikely that a complete resolution of the infection using topical treatment options will be successful.

• The environment needs to change so that the fungus struggles to thrive. This can be done with antifungal sprays, antiperspirants, and following strict hygiene and footwear advice to prevent recurrence.

• Use specific medications that have the best scientific evidence for successful resolution and destroy the fungus.  Medications such as Terbinafine, Amorolfine and Itraconazole are the best medications available and are available in different modes of application.

• The mode of delivery needs to be considered depending on the specific area and extent of infection. This can affect the success rate of treatment.

• We have to consider if it is a real fungal infection or a medical condition that mimics a fungal infection such as psoriasis or a yeast infection.  The Podiatrist will be able to tell you this and also back up the diagnosis with a 5-minute dermatophyte test in the clinic, which will confirm if a fungal nail infection is present.

What are the different treatment options available?

I will now take you through all the treatment options available, but please remember, not all the options may be suitable for you, and your Podiatrist will be able to advise accordingly.

1. Oral medication (tablets)

Terbinafine and itraconazole are available in tablet form so that they can be delivered systemically to the nail matrix from inside our bodies. They are available only on prescription from the GP and initially one tablet a day for up to 3 months. The infection grows out with the nail and an improvement can be seen at the base of the nail growing forwards.

Antifungal drugs are generally broken down in the body by the liver so anyone who takes these drugs must have a healthy liver to avoid problems. If your doctor is looking to prescribe them, you will need a blood test to ensure your liver is in good shape. 

All drugs potentially can have side effects and antifungal drugs are no different. Side effects such as stomach upsets and nausea are common. More serious side effects rarely occur, which could affect how your liver functions and for this reason, your GP may wish to take monthly blood tests if Terbinafine tablets are prescribed.

• Toenail Removal

If the nail is removed completely and the nail matrix(that part which produces the nail) is destroyed, then there will be no nail regrowing for the fungus to infect, Alternatively, the nail could be temporarily removed so that the antifungal treatment of choice can be applied directly to the nail bed. This removal can be surgically done by a Podiatrist or chemically achieved with application of a high concentration of urea cream.

• Toenail Fenestration

By drilling small holes in the nail plate, any topical antifungal agent such as terbinafine spray can penetrate through to the nail bed but it is unlikely to reach the nail matrix so it is more suitable for distal (in front of the nail cuticle) onychomycosis. Care is needed when drilling these holes to avoid damaging the nail bed, so look out for those who offer Clearanail or Lacuna methods of treatment.

We offer Fenestration by the Lacuna method every 6 to 8 weeks and use of terbinafine spray daily. Your progress is monitored at each appointment and adjusted accordingly.

• Toenail Debridement

Removal of as much fungal nail as possible will increase the efficacy of a topical antifungal agent such as amorolfine paint other topical treatments are available but their safety and effectiveness is debatable). This debridement can be done by filing (eg with a Foot File or Diamond Deb File, drilling and / or “shaving” the nail plate and is something that a Podiatrist can do for you.

• Photodynamic Therapy

Light itself has the potential to destroy fungal cells and the use of treatments such as PACT or laser therapy is an option. However, as with many of the above, they take time to be effective and repeated treatments are required, and success levels are variable.

I need this toenail infection gone!

Please note that some treatments or delivery methods may not be suitable for you, depending on your medical status and extent of the infection. It is therefore always worthwhile seeking advice from your Podiatrist.

Our Team at Reid Podiatry will provide you with a thorough assessment and go through all the appropriate treatment options for your specific requirements. We will provide a personalised treatment plan and support, and get you on your way towards healthier nails.

Contact us on 01889 801772 or book an appointment online at www.reidpodiatry.com