Fungal nail infection (onychomycosis)

When specific types of fungus come in contact with and infect our toenails, it can start a longstanding infection that will progressively degrade the appearance of our nails from one that is healthy and clear, to one that looks:

• Moth-eaten and flaky
• Thick and crumbly
• Spotted or streaked, either white or yellow
• Patchy and has the nail lifting away from the nail bed

This leaves many people hiding their feet and nails beneath closed-in shoes and socks, even in the summer months, or beneath layers of polish where the infection gets noticeably worse each time the polish is removed and reapplied.

Typically, a fungal nail infection will start on one toenail, and spread to the others over time. Being contagious, it also means that the infection can spread - both to your fingernails, and to other members in your household.

How does nail fungus spread?

The type of fungus responsible for fungal nail infections, which are most often called dermatophytes, tend to spread through direct contact - whether that’s with the infected nail itself, or with a surface that has been in contact with the fungus - most often the shower.

Technically, when someone has a fungal infection, it is likely that their shoes, socks, floors and bed sheets will contain high quantities of fungal spores, meaning that sharing these surfaces may put you at risk. Our podiatrists always recommend treating fungal nail infections as early as possible to help stop the spread.

As we mentioned, fungus is typically spread through contact with the fungus itself, or through infected surfaces. Fungus thrives in warm and moist environments - which is why areas like gym changing rooms, public showers, and sharing shoes and socks are high-risk environments. Unfortunately, more reports are also coming out of fungal nail infections being spread through cosmetic nail salons, where the instruments are not properly sterilised between their customers.

While only some people that come in contact with fungus will develop a fungal nail infection, your risk may be higher if:

• You have a weakened immune system, including having any illnesses or systemic conditions like diabetes.
• You’ve sustained trauma to your nail, which may be from a one-off incident like dropping something on your foot, or from wearing shoes that are too small and that have been rubbing against your toes.
• Your feet are prone to sweating, or you have not been drying your feet well when they get wet, whether that’s after a shower or wearing wet shoes throughout the day. This is as fungus thrives in moist environments.
• You wear the same closed-in shoes every day that become damp
• You have poor circulation to your feet

Fungal nail infections are notoriously tricky to treat for many reasons, including the possibility for re-infection from spores in the environment, and the difficulty reaching all of the fungus when it has penetrated deep into and beneath your nail. 

Nonetheless, there are several things you can do at home to help slow the progression of your fungus and help limit its spread, meaning that you can help prevent the appearance of your nails from worsening until you have a chance to treat the infection properly with your podiatrist. These include:

• Dry your feet very well after showering, swimming, and any time they get wet
• Remove damp shoes and socks as quickly as possible. If your work commute exposes you to the elements, complete your commute in an alternative pair of shoes that you can change when you arrive. Dry your damp shoes very well overnight, and don’t wear them unless they are completely dry
• Tea tree oil: there is limited evidence for tea tree oil preventing fungal nail infections, but it is proven to have some antifungal benefits, meaning that it may potentially have a role in preventing or slowing the progression of your infection
• Keep your nails free of polish, so they can breathe. Additionally, moisture can get trapped beneath the outer surface on the nail and the polish, particularly with gel coatings, which would otherwise speed up the rate of the progression of the fungus
• Keep your feet protected with a slip-on shoe in communal showers (like at the gym or your workplace showers), as well as swimming facilities
• Hot wash your socks in temperatures of 60 degrees to help destroy fungal spores, and invest in an anti-fungal booster to add to the wash

While fungal nail infections are often troublesome and frustrating to treat, our team at Matt Raden Podiatry have combined the perfect balance of evidence-based treatments with the right home care support to get rid of your fungal infection - and help keep it gone for good. 

Home care must be a critical part of an effective treatment approach because even if you were to kill 100% of the fungus currently living on your toenails, once you go back home and use your shower, socks and shoes, more fungal spores from these areas will quickly be covering your toes, and your infection will continue. This is often missed from fungal treatments, and is one of the ways we help our patients get a better success rate for their fungal nail treatments. We have several fungal treatments available for you, including:

The Lacuna Method

With one of the common problems with using topical antifungal agents being that many cannot penetrate into the nail or below the nail plate where fungus is present, the Lacuna Method overcomes this by having our podiatrist painlessly drill micro-holes through your nail plate every 6-8 weeks, enabling antifungal products to effectively permeate the nail and reach all of the crevices to act on the fungus.

Nail Burr

As a more cost-effective method to the above, we can also reduce the infected nail every 6-8 weeks using a safe and sterile burr, alongside trimming the nails at the same time. This reduces the total surface area of the affected nail, and can remove the infected superficial outer layer of the nail. This helps immediately remove some of the fungus, while also helping antifungal products to better permeate the nail. 

Both the Lacuna and Nail Burr options are paired with the following protocol for optimum results:

• Washing feet daily with an antimicrobial skin cleanser
• Applying anti-fungal agent daily to infected nails
• One week of using antifungal treatment to the skin surrounding the nails every 6-8 weeks 
• Sanitising regularly worn shoes using UV on a weekly basis, to help address the fungal spores present in the shoes 
• Using a hot wash for socks and bedding to help eliminate spores and prevent reinfection