Feet@TheClinic, High Street Chambers, 25 High Street, Loughborough, Leicestershire, LE11 2PZ

Extreme close up view of toenail infection on hairy man foot

Causes, Symptoms and Treatments of Fungal Toenails

There is no doubt we rely on our feet during almost every waking hour of our lives. Work or leisure, our feet play a vital role. And yet, they are probably the most neglected part of our bodies. Being out of sight and out of mind, these appendages get used, and very often, abused.

There is a myriad of afflictions that can befall our feet. Some are inherent, but many are due to injury, neglect or even prolonged abuse. Many issues that threaten the health of our feet are avoidable, thankfully the majority of these are treatable by skilled practitioners. There is one foot complaint that is on the rise in the UK is that of fungal nail infection.

Fungal Nail Infections in the UK

Fungal nail infections are not uncommon, and everyone is at potential risk. Problems of this type can cause discomfort, or even sever pain in extreme cases. They also make the sufferer self-conscious of how their feet look. This is very likely to curtail many leisure activities that could otherwise be enjoyed with carefree confidence.

Fungal nail infections are on the increase throughout the UK, which may be due to a number of different factors, including lifestyle or medical conditions. Infections of this type affect all generations with the 19-50 age group being those most likely to seek help from their local independent clinic.

Our bodies are covered in diverse fungal ecosystems. The feet can play host to these microbe communities with a density of up to 80 times greater than that of other parts of the body. So. It is easy to understand how easy it is for the toe nails to become infected.

The most common form of fungal nail infection is Distal Subungual Onychomycosis, second most common is White Superficial Onychomycosis. Thirdly, and less common, is the yeast infection, Candida Onychomycosis, this form of fungal infection affects the surrounding skin as well as the nail.

What are the Causes of Fungal Toenail Infection?

Quite simply, fungal nail infection occurs when harmful fungi are allowed to over populate. Fungi are ever present in and on our bodies, coexisting with the masses of bacteria. Just as with any microorganism, there is the good and the bad. Fungi are present in water and in the air, in soil and plants, in fact, just about everywhere. Given the right circumstances, fungi can develop to excessive levels. It is, at this point, that infection from the fungi becomes a real possibility.

Who is at Risk?

Everyone is at potential risk of fungal nail infection. Fungal infection will normally afflict the finger and toe nails, although, due to the environment in which our feet function, they are at a far higher risk than the finger nails. The feet tend to be encased in shoes and socks for prolonged periods, this is a warm moist environment in which fungi can thrive. Due to the perceived norm of footwear fashion, men are at a greater risk than women.

Although everyone is at potential risk, there are high risk groups in our society. The one single factor that raises the risk of infection is poor blood circulation. Some indicators of circulatory deficiency are; having cold hands and feet, tingling sensations in the extremities, fatigue, muscle aches or cramping and varicose veins are all signs of possible circulatory issues.

Restricted blood circulation can be due any of a number of conditions. Peripheral Artery Disease (PAD), or the narrowing of the arteries, and the associated condition, atherosclerosis, the stiffening of the arteries, are common causes of restricted blood circulation.

Another high risk group are the, approximately, 10 million people, knowingly or unknowingly, suffering with Raynaud’s disease. Although lesser known, this results in reduced blood circulation. Usually affecting the hands and feet, Raynaud’s disease causes the small arteries to narrow. This reduces the free blood flow that the hands and feet require to keep them warm and maintain their ability to fight any potential infection.

It should also be noted that diabetics will almost certainly suffer with reduced blood flow to the feet. Although this, in itself, doesn’t increase the likelihood of contracting a fungal infection, it can make the treatment more difficult and protracted. It is therefore essential that diabetics and anyone with a diagnosed blood circulatory issue should seek professional advice at the earliest signs of a fungal infection.

Particular lifestyles can also increase the risk fungal nail infection. Those who undertake athletic or physical activities, which could be work or leisure, are at greater risk due to sweating of the feet. This creates the ideal environment for fungi to grow to threatening levels. Also, being in any environment bare foot, be it wet or dry terrain, will increase the probability of falling victim to fungal nail infection.

With our greater awareness of our personal fitness and wellbeing, more and more people are making use of fitness centers, gyms or the local swimming pool. This is all to the good, but such places are also high risk environments for contracting a fungal infection. Fungal infections very often stem from tinea pedis, or athletes foot, and these communal environments are ideal for this condition to spread.

Identifying Fungal Nail Infection

It is very likely that, although having a fungal infection, it will be some time before a victim is aware of it. Visual manifestation, and thus diagnosis, of a fungal infection in its early stages is very difficult. The layman’s eye is not trained to spot the early signs, so by the time an individual realises they have a problem the infection will have taken a good hold.

If early diagnosis is not achieved the nails will become thickened and discoloured, whitish, yellow-brown or black. They will become brittle and flakey and may take on a distorted shape. Under the nail there will be a build-up of dark debris, and there is a possibility of an unpleasant smell. If left untreated the nail will become painful with even slight pressure and can result in permanent damage.

Treating Fungal Nail Infection

Podiatrist treating onychomycosis, a fungal infection of the toenails, with a laser in a hospital, closeup of the hands, laser and feet of the patient

Treating fungal nail infection can be difficult and it will often take 12-18 months for a sufferer to be completely clear, the key to successful treatment is early diagnosis. Identifying the problem early increases the possibility of successful treatment through the use of topical remedies.

In this area of treatment there is a myriad of products available to buy over the counter. However, this can turn out to be a waste of money. Given the multitude of remedies available, a lack of professional knowledge and the fact that over the counter remedies are aimed at the mildest of infections, it is most likely that none of these products will work.

By far the most efficient treatment is the Lacuna method. The name ‘Lacuna’ is very apt, derived from the Latin, meaning hole or gap, the process involves drilling a series of very small holes through the outer nail plate. These holes allow an appropriate antifungal solution to access the infection source below the plate. The nail is already effectively ‘dead’ and the holes will remain visible, but will grow out naturally with the new nail growth.

Only a skilled practitioner can diagnose and prefer to the patient the correct form of treatment and curative product. Caught early by your local foot health practitioner, the correct treatment can be administered. As an alternative to the Lacuna method, your practitioner may opt to thin, or debride, the nail. This will remove much of the dead matter and reduce the thickness of the nail. Note, debriding or drilling of the nails should not be undertaken by anyone that has not been fully trained in the process.

The thinning of the nail will allow the selected anti-fungal solution to more easily penetrate the nail surface and reach the infected area under the nail surface.

The Follow up to Treatment

Female cosmetician in safety glasses at work. She providing a foot treatment with a laser

Following the initial treatment, the practitioner will then instruct the patient on the frequency, and the correct way in which to, continue applying the product. Follow up visits are then recommended, usually every 6-8 weeks, where progress can be assessed and, where necessary, further treatment can be administered.

In extreme cases surgery may be required to remove the entire nail. However, removing the nail will not in itself cure the problem. The fungal infection will still need to treated to eradicate the problem.

Fungal nail infection can be extremely unsightly. It can go from being annoying, to inhibiting and irritating to painful. The one thing for sure is, that if allowed to go untreated, treatment can become very difficult and protracted. Early, expert diagnosis is desirable but not essential for the successful removal of fungal infection.

Locally based, skilled practitioners are the ideal port of call. Practitioners like Rebekah Henning at Feet@theclinic, Loughborough, Leicestershire have been highly trained to be able to identify the early signs of fungal infection. Practitioners of her ilk can administer the correct treatment, thus, optimizing the probability of successfully ridding the sufferer of the infection. At the earliest sign of a fungal problem, do not delay, contact your local practitioner.








Rebekah Henning is a Foot Health Professional (FHP) who has gone through specialized training at The SMAE Institute based in Maidenhead. She is fully trained and qualified in both the theoretical and practical aspects of foot health and care to enable her to assess the condition of your feet and treat as appropriate, referring you if necessary. She provides routine foot care and maintenance for your feet using the latest procedures and techniques to ensure that you receive the best possible treatment. Her knowledge and skills are up to date by undertaking continual professional development and she is also a Member of the British Association of Foot Health Professionals (MAFHP) and a Member of the College of Foot Health Professionals (MCFHP).

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