Condition Spotlight: Fungal Nails (Onychomycosis)

big toe with a fungal nail infection

Fungal nails – most people have heard about them, have experienced them or know of someone who has them.  Fungal nails is a condition that often makes patients very uncomfortable and embarrassed, but we are here to tell you that you don’t need to be!

Whist fungal nails are notoriously difficult to treat, there are treatment options to help improve their appearance and reduce any pain you may be experiencing.

What Are Fungal Nails?

Fungal nails, also know as onychomycosis, are an infection of the nail plate and underlying nail bed.  They can present as thickened yellow nails which have a chalky texture – meaning that they crumble when cut.

Fungal nails have what is called an ‘insidious onset’, meaning that they come about slowly and progressively, with most patients being unable to pinpoint the time when the infection first occurs.

It is a condition that does not resolve immediately and requires long term ongoing treatment.  Our nails are made of keratin and it is this substance that the fungus is attracted to and inhabits.

There are a few different types of fungal nails which include:

  • Distal and Lateral Onychomycosis – This affects the edges of the nail, as well as the at the end of the nail.
  • Superficial White Onychomycosis – This appears as flaky white patches on top of the nail.
  • Proximal Subungual Onychomycosis – this involves an infection that has penetrated the nail bed as well as the nail plate.  It can be seen at the cuticle region of the nail.
  • Total Dystrophic Onychomycosis – This occurs when the entire nail plate is infected and distorted.  Often, the nails will be extremely thick and chalky.

What Causes Fungal Nails?

It can be caused by a number of organisms including trichophyton rubrum and trichophyton mentagrophytes.

Fungal infections are opportunistic, meaning that if given an opportunity such as a damaged nail, they will take it!

They can be contracted in a range of settings including pools, spas, communal change rooms and nail salons.

Who Do Fungal Nails Affect?

Fungal nails primarily affect the adult population and are rare in children. It affects approximately 5-10% of the population and is more common in men than women. The organisms responsible for fungal infections thrive in moist, wet and dark environments. Those most at risk include people who:

  • Use communal areas and do not perform good foot hygiene. 
  • Attend a nail salon regularly where the same tools are used on each person. 
  • Have diabetes.
  • Have a weakened immune system.
  • Have sustained an injury to either the nail or its surrounding skin. 
  • Wear occlusive footwear for long periods including work boots. 
  • Suffer from excessive sweating of their feet
  • Have a tinea infection, as quite often they occur simultaneously. 
  • Are over the age of 65.

How Are Fungal Nails Diagnosed?

Fungal nails can sometimes be tricky to diagnose. There are a few other conditions that result in the nails having a similar appearance to fungal nails including psoriasis, eczema or onychogryphosis, which is a thickening of the nails that is common in older people.

Most fungal infections can be diagnosed just by observation. Fungal infections can also be diagnosed via labroratory testing. This is where we take a sample of the infected nail and send it off to a lab for testing. However, it is important to note that this procedure can often return what is called a ‘false negative’ result. This means that the results state that there is no fungal infection, when there is a very high chance there may be. This is due to the fact that the fungal infection inhabits a nail which is attached to a host. When it is removed, it does not have the correct environment to thrive and may die. Therefore, it is important that lab testing is conducted as soon as possible after a sample is taken.

How Are Fungal Nails Treated?

It is important to note that unfortunately, there is no ‘quick fix’ treatment for fungal nails. All treatment options take time (6 months or more) and require regular ongoing treatment. It is a condition that requires patience to treat and you may need to try a few different treatment options. 

There are a number of treatment options available to help with fungal nails. These include:

  • Regular treatment of the nail – This includes cutting and filing of the nails. This helps to not only expose the fungal infection to allow for topical treatments to penetrate the nail plate more effectively, but to also avoid the nail becoming thick and painful.
  • Natural treatments – Tea tree oil and apple cider vinegar have natural antifungal properties and can be effective in the treatment of fungal nails. 
  • Topical treatments from a chemist – These treatments are easily accessible and contain either amorolofine or terbinafine, both of which are antifungal agents. The use of these lacquers requires regular at home treatment including cutting and filing of the affected nail. 
  • Nail surgery – In some cases, we can perform a procedure known as a total nail avulsion where we remove the fungal nail/s. We can then apply a chemical called phenol to the nail bed to stop the nail from growing back, or we can allow it to grow out on its own whilst treating the underlying nail bed with an antifungal agent. This treatment option is only recommended for those who have suffered with fungal nails for an extended period of time or those who are in pain. Know more about this procedure.
  • Oral antifungals – You will need to consult your GP if you would like to be considered for oral antifungal treatment. You GP will firstly take a sample of the nail for testing before prescribing medication and will perform a kidney function test. This is due to the systemic nature of this treatment, meaning that it has to travel through your body to be effective rather than being applied directly to the nail itself. Oral antifungals include terbinafine, itraconozole, fluconazol and grisefluvin. 

How Can I Reduce the Risk of Contracting a Fungal Nail Infection?

Maintaining good foot hygiene is key to protecting yourself from a fungal nail infection.

Some tips to help prevent a fungal nail infection include:

  • Wearing shoes around a pool, spa or communal change room.
  • Washing and drying your feet properly before putting on shoes. 
  • Regular cleaning of your bathroom and shower, particularly if you live with someone who has a fungal nail infection. 
  • Avoiding nail salons or taking your own tools. Sterilisation procedures are not in place in nail salons, therefore the risk of contracting a fungal nail infection is very high. If you require skin and nail care, visit a podiatry clinic instead, as we must adhere to extremely high levels of infection control and sterilisation of our tools. Find out more about the differences between podiatry clinics and nail salons here.
  • Avoid long term use of nail polish. If you would like to wear nail polish, avoid leaving it on for more than a few days and ensure you spend more time without it on.

If you need assistance with fungal nails, or any other pain or discomfort in your feet or lower limbs, give us a call on (03) 9432 2689, or you can book an appointment with one of our superstar podiatrists online here.


Aaron Dri