Fungal infections are tinea infections that can affect both finger and toenails, although they are more frequently found in toenails. Fungal infections cause the nail to thicken, discolor, deform, crumble, split, and may have an odor. They are more of a cosmetic concern, but at times, they can become painful due to the thickening and deformity of the nail or lead to other infections.

Fungal spores are common in the general environment, but they can thrive given the right conditions, such as the dark and humid environment that occurs when your foot is inside a shoe. Athlete’s foot refers to a fungal infection that occurs in the skin. The infection can spread from the skin to the nails, mainly if the nail is damaged.

Fungal organisms can infect the nail superficially, which often occurs with the ongoing use of nail polish and shelack, which can trap fungal spores beneath this occlusive barrier. These are easier to treat but if left unchecked it can spread and become harder to treat. Fungal infections can also occur between the nail and the nail bed. Damage, often because of repetitive micro-trauma, such as shoe pressure, will cause the nail to lift from the nail bed, providing an access point for fungal spores to get under the nail.

Toenail fungus is rare in children but more common in people over 60. Factors that may put you at increased risk of developing fungal toenails include living or working in a hot, humid environment, sweaty feet, poor hygiene, poor circulation, and people with a compromised immune system, such as those with Diabetes.

If fungal infections are not treated, they can spread beneath the nail right up into the nail matrix. This is where nail growth occurs, and if infected by the fungus, it will cause permanent damage to the nail. While you may be able to eliminate the fungal infection, once the nail root is damaged, it will always grow deformed, and there is no way of restoring the nail to a normal appearance, so the best advice is to treat it early, as with any infection.

If you suspect you have developed a fungal toenail infection, you should see your podiatrist, who can diagnose and treat the condition. Treatment options include topical medication, oral medication, and medical laser treatment.

There are a few medicated nail paints available without prescription from a pharmacy. They are applied either daily or weekly, followed by debridement of the nail. This needs to be continued for up to 12 months. There are minimal side effects, and it can be quite effective for superficial infections. Unfortunately, it has a low level of success for deeper infections as the medication doesn’t easily penetrate into the nail or nail bed to reach the fungus.

Oral antifungal medications such as Lamisil are much more effective than topical medications but are generally reserved for severe infections affecting multiple areas. Lamisil has to be taken daily for between 1 and 2 months and has the potential to affect liver function, particularly if you need to be on it for extended periods. A blood test to check liver functions may be required.

Lasers can be used to treat onychomycosis, with success rates that claim to be around 80% effective. The laser light penetrates the nail plate, generating heat that destroys the fungus but does not damage the nail or the skin. The treatment has minimal pain and no side effects. After the treatment, the nail will grow out free of fungal infection; however, if the nail plate has been damaged due to the fungal infection, it will not reverse the damage back to a normal-looking nail. 

It is not a cheap option at around $300 – $400, but the convenience of having one or two treatments is a big consideration. It is, however, cost-effective when you consider other treatment options.   Daily or weekly treatment with topical medication for up to 12 months is time-consuming, and the cost of medication is not cheap either. It also has a relatively low success rate, particularly in more advanced infections.  Oral medicines, which have a success rate similar to laser treatment

Fungal skin and superficial nail infections respond well to treatment. Infections in the nail bed are much harder to treat. The nail provides a protective covering that allows the fungus to grow underneath the nail unimpeded. This is one reason why they are so hard to treat, as it is difficult to get any medication, either topical or oral, to the site of the infection.

The diagnosis of fungal nail infection is made by physical examination. Several nail disorders may mimic fungal nail infections, including psoriasis and leukonychia, which is the lifting of the nail due to damage to the nail bed. If there is doubt about the diagnosis, nail clippings may need to be sent to a pathology laboratory for microscopy and culture. This will take about 30 days to get the results back, as unlike bacteria, fungus is very slow to grow.

Nails are made of protein like hair and skin and can’t regenerate to a normal appearance immediately. Treatments are directed at killing the fungus and allowing the portion of the nail affected by the fungus to grow out. It takes a long time for the nail to appear normal again, as toenails only grow about 1.5mm per month, which is half the rate of fingernails.

While it is difficult to kill off fungal infections in the nail bed, they are very easy to come back. Reoccurrence is very high because of the warm and moist environment in your shoes. Footwear and socks can harbor fungal spores, which can reinfect your feet, so shoes must also be considered.

Fungus do not grow in areas that are dry or exposed to sunlight as they do not like UV light.  Reducing the moisture is very important. If you have sweaty feet, this must be managed. You must also treat your shoes and socks to eliminate any fungal spores. Wash socks in Napisan, dispose of old shoes, and treat new shoes with antifungal sprays or UV light. You can do this by opening the shoes right up, removing the insole, and placing them in direct sunlight for a while. Rotate shoes regularly and not wear them for more than one day at a time to let them dry out. If you use nail polish, you should give your nails a break without polish and expose them to the sunshine.