Fungal Toenail Infection – symptoms, causes, treatment, prevention and risks 

So you may be worried about a discoloured nail, or a nail that is splitting or is cracked. You may even have some pain when the nail is rubbing against a sock or shoe. And you may be a bit embarrassed that this may be a fungal toenail infection.

In reality there is nothing to be embarrassed about, fungus is everywhere about you, their spores are floating about all the time, and the chance is that at some point in your life you will end up getting a fungal nail infection – all it needs is the right conditions which in our modern lives is quite normal.

But what you will have are some questions about our fungal buddies and our feet, so let me give you some answers…

What are the Symptoms of a Fungal Toenail Infection?

Fungal nail infection (onychomycosis) is very common and affects most people at sometime in their life. It is not normally serious, but can be problematic to treat. The infection moves at a slow pace, with the nail becoming:

• Discoloured – turning white, black, yellow or green. 
• Thickened and Distorted – becoming an unusual shape or texture and be difficult to trim 
• Brittle – leading to breaking and tearing.
• Tender to touch – when pressure is applied, or as it rubs against shoes or socks. 

Sometimes the infection can spread to the skin nearby and it may become itchy, cracked, red and/or swollen.

With most ailments it is best to act quickly if you notice any of these symptoms, as it will most likely spread to other nails.

Diabetics please note – It is important that you should see a specialist to avoid any further complications that can result from a foot infection or injury. If you have any severe inflammation, bleeding or pus contact your Doctor, Nurse or Podiatrist as this can have further consequences.

What are the Causes of a Fungal Toenail Infection?

The fungi that cause nail infections normally can live without giving you any trouble on your skin, but they can spread into your nail tissue given the right warm, damp conditions.

Two types of fungi generally cause nail problems; Candida the fungus that causes thrush and more commonly Dermatophyte the fungus that causes athletes foot. When these affect nails, the fungal spores make their way between your toenail and the skin underneath (the nail-bed), and feed of the skin or the keratin in the nail.

How is Fungal Toenail Infection diagnosed?

As other infections or conditions can affect the nail and be confused with the symptoms of fungal nail infection, the only way to confirm a diagnosis is to see your Doctor or Podiatrist. They may take a clipping or scraping of the nail for further microscopic examination, or to send for laboratory analysis. 

What are the Treatments for Fungal Toenail Infections?

If you are concerned by the appearance of an affected nail, or it is causing pain and discomfort please see your Medical Practice. They will recommend one of the following:

• Antifungal nail creams or paints – This treatment can last for several months and is  applied directly to the nail. 
• Nail-softening kits – A paste is used to soften the nail, which is then covered by a plaster for 24 hours. The following day, this is washed off and the now softened nail is gently scraped to remove the infected area.  This is repeated daily for up to three weeks until no more of the infection is left. After this an antifungal paint is used to prevent a reinfection of the nail as it grows over the next few months. 
• Antifungal tablets – This prescription treatment has to be taken for several months in order for the infection to be cleared up. There are possible side effects, and this medication may conflict with other prescribed medicine. 
• Removal of nail using local anaesthetic – This numbs the area around the nail and allows for the removal of the badly infected nail.  
• Laser treatment – This expensive treatment, which is not available on the NHS, uses a high energy laser to kill the fungus over a number of sessions.

Hygiene note – Always wash your hands after applying a treatment.  Make sure that you use a separate towel for your feet when you’re drying them. Tell those that you share facilities with about your fungal nail infection so they can take precautions too. Do not share shoes or socks with anyone, as the fungus may be contagious.

How to prevent a Fungal Toenail Infection?

Constantly warm and damp feet are the ideal breeding ground for fungal nail infections. Some golden rules are:

• Treat athlete’s foot promptly to avoid it spreading.
• After washing feet, dry thoroughly, especially between the toes. 
• After washing moisturise your nails. 
• Wear clean natural fibre socks and change them every day. 
• Use well-fitting, breathable footwear and rotate them every 2-3 days. 
• Wear footwear in public showers, at the gym or pool.
• Bin old shoes, trainers, slippers and boots. 
• Treat everyday footwear with disinfectants or antifungal powders. 
• Cut toe nails straight across and smooth the edges with a file. 
• Do not share nail clippers or scissors with other people, and disinfect regularly.
• Wash towels regularly and do not share.
• If you touch an infected nail wash your hands thoroughly. 
• If you use a nail salon ensure they sterilise tools for each customer. 
• And never wear other people’s shoes or socks.

Who is at risk of a Fungal Toenail Infection?

You are at higher risk of developing fungal nail infections when you:

• Have Diabetes or Psoriasis.
• Have poor circulation.
• Are over 65.
• Have a compromised immune system.
• Have a family history of infection.
• Use artificial nails.
• Use public swimming pools or gyms.
• Have a nail injury.
• Have a skin injury close to the nail.
• Wear shoes with restricted ventilation, such as trainers or boots.
• Have moist feet for an extended time.