What is a Fungal Toenail?
A fungal toenail, also known as onychomycosis, is an infection of the nail caused by fungi. These microscopic organisms thrive in dark, warm, moist environments, making your feet the ideal breeding ground. The infection can lead to thickened, discoloured, and brittle nails, and depending on the degree of deformity to the nail it may feel uncomfortable, loose or become painful.
How Do Fungal Toenails Occur?
Fungal toenails occur when fungal spores make their way under the nail plate (or in some cases on top of the nail plate, which I’ll discussed later). Most of the time fungus will not infect a healthy nail with a healthy attachment to the nail bed. This generally means there was a preceding trauma to the nail that helped create an ideal environment for the fungi. The list below can give you an idea of how fungal nails occur:
- Exposure to fungal spores: Places such as swimming pools, communal showers, gardens and your footwear
- Trauma: Either high impact aka dropping something on the toe or repetitive small trauma aka tight shoes putting repeat pressure on the nail.
- Wearing shoes: Shoes that allow the foot to become sweaty, lock in the moisture and don’t allow for drying i.e. soccer boots or leather work books
- Sharing Personal Items: Using someone else’s nail clippers, socks, or shoes can spread fungal spores.
- Compromised Immune System or Systemic Infection: People with weakened immune systems are more susceptible to infections and people with systemic fungal infections or candida may also be at risk of developing fungal nails.
Different Types of Fungal Nail Infections
There are different forms of fungal nail infections, they vary in colour, location and infecting organism.
Most Common: Distal Subungual Onychomycosis: This sits at the end of the toe, under the nail plate and may have a yellowy/white appearance. You may also have a streaking extending from the infection down the nail plate or a thickening of the nail in that area.
Next Most Common (especially in ladies) Superficial White Onychomycosis: This type affects the surface of the nail, leading to white, powdery patches. This can occur in anyone however the reason it affects mostly ladies is due to nail polish use! Long term use of nail polish creates the perfect breading ground for fungi as it settles in the layer between the nail polish and nail plate. Because it’s hidden by nail polish, it can go unnoticed and can eat its way through the nail plate to get to the nail bed.
Proximal Subungual Onychomycosis: This is where the fungal infection starts at the nail cuticle/base of the nail and is far less common. It’s more likely to occur in people with weakened immune systems.
Candida Onychomycosis: This type is caused by yeast, this infection can affect the nail and surrounding skin, leading to inflammation and discomfort. There is usually some degree of skin peeling around the nail edges. Usually if most (or all) nails are affected there may be systemic involvement.
How Can a Podiatrist Help?
If you suspect you have a fungal toenail infection, I would highly recommend seeking professional treatment early. As podiatrists we are trained in nail care and treatments to help the appearance of the nail. If the look of the infection bothers you then treating it early will give you the best chance of regaining the healthy look and feel of the nail.
1. Initial Assessment
First, we’ll examine your nails and discuss your medical history to understand the root cause of the infection. In the first treatment we will always trim and clean the toe nails with our sterile instruments and with your consent remove any infected nail. Physical removal of any infected nail is extremely helpful in clearing the infection and regrowing a healthy nail.
2. Discussion of Home Care
Next we’ll discuss ways to keep your nail bed clean and nurture the regrowth of the new nail. I always begin with advising on manageable and accessible topical treatment options for home use in-between appointments.
3. Preventive Care and Advice
We’ll provide you with practical advice on how to keep your feet clean and dry, choose appropriate footwear, avoid habits that could lead to reinfection, Ideally we like to keep regular follow-up visits, (these are generally between 4-6weekly depending on your nail growth) to help monitor your progress and make any necessary adjustments to your treatment plan.
