Understanding Fungal Nail Infections: Causes, Prevention and Treatment

Fungal nail infections are common, particularly in the toenails. They can cause nails to become discoloured, thickened, brittle or crumbly and can sometimes be difficult to treat.

As a podiatrist, one important thing I tell people is that not every thick or discoloured toenail is fungal. Repeated pressure from footwear, nail trauma, psoriasis and other nail conditions can produce a similar appearance. If you're unsure what's causing a change in your nail, it's worth having it assessed before beginning treatment.

In this guide, we'll look at what causes fungal nail infections, the common signs to watch for, ways to reduce your risk and the different treatment options available.

What Is a Fungal Nail Infection?

A fungal nail infection, also known as onychomycosis, occurs when fungi infect the nail.

Toenails are affected more commonly than fingernails. Fungi tend to thrive in warm, moist environments, which is one reason the feet and toenails are particularly susceptible.

Fungal nail infections can involve one or several nails and often develop gradually.

What Does a Fungal Nail Infection Look Like?

The appearance can vary, but common signs include:

Yellow, white or brown discolouration Thickening of the nail A brittle or crumbly nail edge Changes in the shape or texture of the nail Debris accumulating underneath the nail Part of the nail lifting away from the nail bed Difficulty cutting particularly thick nails

Some people experience little or no discomfort, while a significantly thickened nail may become uncomfortable inside shoes.

However, these changes don't automatically mean you have a fungal infection.

Trauma, repeated pressure from footwear and some skin and nail conditions can cause similar changes. A podiatrist or doctor can assess the nail and, where appropriate, arrange testing to help confirm whether fungus is present.

What Causes Fungal Nail Infections?

Fungal nail infections are most commonly caused by fungi known as dermatophytes, although yeasts can also be responsible.

Several factors can make fungal nail infections more likely.

Warm and Moist Environments

Fungi thrive in warm, damp conditions. Communal showers, swimming pool areas and changing rooms are environments where fungal organisms may be encountered.

Tinea or Athlete's Foot

Fungal infections of the skin, commonly called tinea or athlete's foot, can sometimes spread to the toenails.

Treating fungal infections of the surrounding skin may therefore be an important part of looking after your nails.

Nail Trauma

Damage to a toenail can make it more vulnerable to infection.

This doesn't necessarily have to be a major injury. Repeated pressure against the front or top of a shoe can also traumatise the nail over time.

Footwear

Shoes that keep the feet hot and damp can create an environment in which fungi are more likely to thrive.

Footwear that repeatedly presses against the toenails may also contribute to nail trauma.

Age

Fungal nail infections become increasingly common with age. Toenails can become thicker and grow more slowly as we get older, while other changes in general foot health may also increase susceptibility.

Certain Health Conditions

People with diabetes, reduced circulation or conditions or medications that affect the immune system may have a greater risk of developing foot and nail problems.

If you fall into one of these groups and notice significant changes to a toenail, seek advice from your doctor or podiatrist rather than relying solely on self-treatment.

How Can You Help Prevent Fungal Nail Infections?

There isn't a guaranteed way to prevent every fungal nail infection, but there are some simple measures that may help reduce your risk.

Keep Your Feet Clean and Dry

Wash your feet regularly and dry them thoroughly, particularly between the toes.

If your feet become sweaty during the day, changing into dry socks can also help reduce prolonged moisture around the feet.

Look After Your Toenails

Trim your toenails regularly and generally cut them straight across rather than digging deeply into the corners.

If your toenails are particularly thick or difficult to cut, a podiatrist can reduce and trim them safely.

Choose Appropriate Footwear

Where possible, choose shoes that fit properly and provide adequate room around the toes.

Allow damp footwear to dry thoroughly before wearing it again and consider alternating between pairs rather than wearing the same shoes every day.

Change Your Socks Regularly

Wear clean socks and change them if they become damp.

Moisture-managing socks can be useful for people whose feet perspire heavily.

Wear Footwear in Communal Areas

Wearing thongs or shower shoes around communal showers, swimming pools and changing rooms can help reduce direct contact with potentially contaminated surfaces.

Don't Share Nail Equipment

Avoid sharing nail clippers, files and other personal foot-care equipment.

If you visit a nail salon, choose one that follows appropriate hygiene and instrument sterilisation procedures.

How Are Fungal Nail Infections Treated?

Treatment depends on factors such as how much of the nail is affected, how many nails are involved and whether the diagnosis has been confirmed.

Fungal nail infections can be stubborn, so treatment often requires patience and consistency.

Topical Antifungal Nail Treatments

Topical antifungal treatments are applied directly to the affected nail.

They may be considered when the infection is relatively limited, although results vary and treatment usually needs to continue for an extended period.

One of the difficulties with treating fungal nails topically is getting the treatment through the nail plate to the affected area.

Keeping a thickened nail appropriately trimmed and reduced can sometimes form part of the management plan.

Oral Antifungal Medication

For some fungal nail infections, a doctor may recommend prescription oral antifungal medication.

These treatments aren't appropriate for everyone and may interact with other medicines or require medical monitoring. Your doctor can determine whether an oral antifungal is suitable for you.

Professional Nail Reduction

When a fungal nail becomes particularly thick, a podiatrist can reduce its thickness.

This doesn't necessarily eliminate the fungal infection itself, but it can make a thick nail easier to treat and may improve comfort in footwear.

Laser Treatment

Laser treatment is also sometimes offered for fungal nails. If you're considering it, discuss the likely benefits and costs with an appropriately with a podiatrist.

What About Home Remedies?

Tea tree oil, vinegar and various other home remedies are frequently suggested for fungal nails.

Evidence supporting many of these treatments is limited, and they shouldn't be relied upon in place of appropriate assessment and treatment, particularly when a nail is significantly affected.

How Long Does Fungal Nail Take to Clear?

This is one of the most important things to understand about fungal nail treatment: toenails grow slowly.

Even when treatment is working, the damaged part of the nail doesn't suddenly return to normal. Instead, you generally need to wait for healthier nail to gradually grow forward from the base.

A toenail can take many months to grow out completely, with the great toenail often taking around 12 months or longer.

This means fungal nail treatment requires consistency and patience. Improvement is usually assessed by looking for healthy new nail growth rather than expecting the existing damaged nail to quickly change appearance.

When Should You See a Podiatrist?

Seek professional advice if:

You're unsure whether the nail change is actually fungal Several nails are affected The nail has become very thick or difficult to cut There is pain, redness, swelling or discharge The nail isn't improving despite appropriate treatment You have diabetes, poor circulation or a condition affecting your immune system

Confirming what is causing the nail changes can help avoid spending months treating something that may not actually be a fungal infection.

Fungal Nail Care Products

There are several products available for the care and management of nails affected by fungal infections.

When choosing a product, it's important to distinguish between antifungal medicines designed to treat fungal infection and cosmetic or supportive nail-care products designed to improve the condition and appearance of the nail.

At The Foot Care Shop, we stock a range of fungal nail and foot-care products. Here are some options you may come across.

Spirularin NS Nail Serum

Spirularin NS is a German-made nail serum designed for the care of nails susceptible to fungal problems.

The serum helps condition and care for the nail and surrounding skin and can be incorporated into a regular nail-care routine.

FunghiClear Nail Spray with Manuka Oil

FunghiClear is a topical nail-care spray containing Manuka oil. It is designed for the care of brittle and discoloured nails and can be applied as part of a regular nail-care routine.

Walker's Fungal Nail Solution

Walker's Fungal Nail Solution is an Australian-made topical nail-care product supplied with a dropper for easy application.

When considering any fungal nail product, follow the manufacturer's directions carefully and seek professional advice if you're unsure whether your nail changes are fungal.

Frequently Asked Questions About Fungal Nails

Can a fungal nail infection go away on its own?

Fungal nail infections often persist without treatment. Because toenails grow slowly, even successful treatment can take many months before the affected nail has completely grown out.

Is every yellow or thick toenail fungal?

No. Nail trauma, pressure from footwear, psoriasis and other conditions can cause nails to become thickened or discoloured. If you're uncertain, having the nail assessed can help establish the cause.

Can tinea spread to the toenails?

Yes. The fungi responsible for tinea or athlete's foot can also affect the toenails. If you have fungal skin symptoms as well as nail changes, both may need attention.

Should I cut away a fungal toenail?

Keeping the nail appropriately trimmed can make it easier to manage, but you shouldn't aggressively cut or dig into the nail or surrounding skin. Very thick nails can be safely reduced by a podiatrist.

How long does a fungal toenail take to grow out?

Toenails grow slowly. A great toenail can take around 12 months or longer to grow out completely, so visible improvement following successful treatment is usually gradual.

Can fungal nail infections come back?

Yes. Fungal nail infections can recur. Keeping feet dry, treating tinea, avoiding repeated nail trauma and following good foot and footwear hygiene may help reduce the likelihood of reinfection.

Looking for Fungal Nail Care Products?

If you're looking for products for fungal nails, tinea or general nail care, you can browse our Fungal Nail & Tinea Treatments range at The Foot Care Shop.