Fungal nail infections

What is a fungal nail infection?

Fungal nail infections are also known as onychomycosis. It is usually a painless condition when the fungus infects the toenail causing it to become discoloured and unsightly. It can also affect the finger nails, though is less common.

What causes fungal nail infections?

The fungus that causes nail infections can be found on floors and in socks and clothing. It can be spread from person to person by contact with these objects and is highly contagious. The fungus can enter the nail and nail bed if the nail has become damaged or broken.

What are the signs and symptoms of a fungal nail infection?

You are unlikely to experience any pain or discomfort from a fungal nail infection, though you may see one or more of the following signs -
  • Discolouration of the nail (dense white to yellow to brown)
  • Thickening and distortion of the nail
  • Crumbling, splitting or pitting of the nail
  • A soft layer of debris under the nail
  • Unpleasant odour
  • Lifting of the nail away from the nail bed
  • Spreading of fungus to the skin causing itching, peeling or burning skin, known as Athlete's foot (see Athlete's foot)

Treatment of fungal nail infection

Since fungal nail infections rarely resolve unaided, it is essential to treat them, particularly to prevent spreading to the other toenails, finger nails and skin. Many of the treatments available are in the form of a nail lacquer or paint that is applied to the surface of the nail. In some cases the nail bed can become infected and your GP may wish to prescribe a course of oral antifungal tablets which can be used in combination with a nail lacquer. Creams, sprays and powders used to treat Athlete's foot are not suitable for fungal nail infections as they are unable to penetrate the layers of the nail.

Be prepared to be patient! It takes 9 to 12 months for a toenail to grow its length so you are advised to continue applying the nail surface treatments until all traces of infection have grown out.

It is also important that fungal skin infections are treated to prevent cross infection to the nails. See Athlete's foot.

Your podiatrist, GP or pharmacist can advise on the most suitable treatment for you.

What can a Podiatrist do?

  • Recognise the signs of a fungal nail infection. To aid the diagnosis, they may also send a sample of the nail away for examination.
  • Cut and thin thickened and distorted nails.
  • Smooth nail edges to prevent any loose pieces catching on hosiery.
  • Check for signs of spreading to other nails and skin.
  • Discuss treatment regimes and advise on the most suitable treatment for you.

Prevention of Fungal nail infections

  • Without proper growing conditions (a warm, moist environment), the fungus will not infect the nails. Avoid keeping your feet in warm, dark, airless places for long periods of time (such as trainers).
  • Avoid footwear and hosiery made of synthetic materials. Leather shoes and cotton socks both allow your feet to breathe. Also, change socks daily and try and alternate footwear daily, particularly trainers.
  • If you wear trainers for sport or at the gym, make sure they get a good airing after use and are not left to fester in your sports bag!
  • When in communal areas (such as changing rooms or around a swimming pool) avoid walking barefoot. Wear flip flops and make sure you dry them after use!
  • Don't share towels with others and use a separate towel for your feet to avoid spreading the fungus around your body.
  • Keep feet clean! Wash them daily with a mild soap and take care to dry them properly paying particular attention to the spaces between the toes.
  • Apply cream to your feet after bathing and drying. Spread liberally over the feet with particular attention to the heels but avoid applying cream on and between the toes - this creates a moist environment for the fungus.

When should I seek medical care?

If you notice any redness, increased swelling, bleeding, or if your infection is not clearing up, see a podiatrist or your GP. If bacterial infection is present, antibiotics may be necessary.