Fungal nail infection (onychomycosis) can make toenails thick, discoloured and crumbly. Not every thick or discoloured nail is fungal, though, so we assess your nails first and then talk you through the options that suit you.
About fungal infections
Fungal infections are really common and can go undiagnosed for a long time. They can make nails and skin change colour, smell, itch or become painful, and can even lead to wounds.
The fungus often starts in the skin of your feet, looking like nothing more than dryness, and can live there for years. It then moves into the nail bed. By the time you notice colour changes in your nails, the infection has usually been there for a long time. That’s why, if you have a fungal nail infection, we also treat your skin for tinea (athlete’s foot).
You’re more likely to pick up a fungal infection if your feet are often in moist environments, your immune system is weakened, your skin is dry and cracked, or you’ve had an injury to your nails or skin.
Signs of fungal nails
- Yellow, white or brown discolouration
- Thickened or crumbly nails
- Nails lifting away from the nail bed
- Nails that are hard to cut or uncomfortable in shoes
- Dry, itchy or smelly skin on your feet
Is it definitely fungus?
Thickening and discolouration can also come from injury, footwear pressure, psoriasis and other conditions. We assess your nails and skin, and if needed, we have fungal testing kits in the clinic that give a result during your appointment.
Treatment options
Treatment is usually a combination of options, chosen to suit you and your nails:
Nail and skin reduction
Regular thinning of the nails and debridement of the skin to reduce the fungal bulk. The less fungal nail there is, the less there is to treat, which can help treatment work more quickly. It also lets topical treatments reach the infection.
Topical treatments
Treatments for your nails and skin. Your podiatrist will talk you through which ones are most appropriate for you, and how to rotate through different products for different stages of the infection. We often recommend this rotational approach.
Lunula laser
A cold (low-level) laser used alongside nail care and topical treatment in the management of fungal nail infection. Usually at least six weekly sessions.
Oral medication
A GP referral for oral medication where appropriate.
Why regular podiatry appointments matter
- Thinning the nail: fungal nails often become thick and start growing upwards. If they aren’t thinned down, topical treatments can’t reach the nail bed. We trim and file the nails at each visit (mechanical debridement)
- Treating your skin too: even if your skin looks perfect, if you have a fungal nail we treat your skin as well, to help prevent reinfection. Appointments fairly close together for the first few months help get on top of it
- Tracking progress: we take photos at each review so we can see how the infection is changing
- Adjusting early: if something isn’t working, we can change your plan early to help prevent a relapse
- Your accountability buddy: regular check-ins make it easier to stick with your home care routine, which makes a real difference
How long does it take?
- Big toenails take around 12 to 18 months to grow out completely
- Smaller toenails take around 6 to 8 months
- Keep treating discoloured nails for 2 months after the nail looks completely clear
Fungal infections take patience. Sticking with the plan for the full time gives you the best chance of clearing it.
Helping stop it coming back
Fungal nail and skin infections can be hard to clear completely without some changes at home:
- Wash your feet daily with a low pH body wash, about 20 seconds per foot. A long-handled scrubbing brush helps you reach your feet and gently exfoliate. Rotating between a couple of low pH brands can help
- Dry well between your toes, then apply a urea-based cream at night
- Change your socks daily, or more often if your feet get sweaty
- Throw out shoes that smell or that you’ve worn throughout the infection
- Clean your shower regularly
Sometimes advice is all you need
Not everyone needs treatment. Sometimes the most helpful thing is a clear explanation of what’s going on, practical advice and a plan you can manage yourself. We’ll always talk you through every option, including no treatment, so you can decide what’s right for you.
Frequently asked questions
What is Lunula laser?
Lunula is a cold, low-level laser that uses two laser beams and a process called photobiomodulation. It treats all five toenails on a foot at once, including the nail plate, nail bed and the root of the nail. Because it’s a cold laser, it doesn’t heat or burn the skin.
Can Lunula be used on its own?
It can, and some people choose to. Lunula can be a good option for people who can’t reach their feet to apply topical treatments or can’t take oral medication. We always combine a Lunula treatment cycle with home care education, and for most people we also recommend regular nail and skin debridement and topical treatments for the nails and skin. Your podiatrist will go through the options with you.
How many Lunula sessions will I need?
It depends on how severe the infection is and how closely you follow the rest of your plan. Most people need at least six weekly sessions. Your laser sessions may be done by one of our podiatry assistants, following your podiatrist’s treatment plan.
Is Lunula laser suitable for me?
Lunula can be used for many people, including people with diabetes or circulation problems. It isn’t suitable if you are pregnant, have active cancer anywhere in the body or past cancer of the foot, or are having chemotherapy. Talk to your podiatrist first if you take blood thinners, take medications that make you sensitive to light (such as Roaccutane or hydroxychloroquine), have sunburn on the area, or have a weakened immune system. Your podiatrist will check whether it suits you before you start.
Can I wear nail polish?
We recommend against nail polish while treating fungal nails, as it can hide changes we need to see and get in the way of topical treatments. We understand you may still choose to wear it for short periods for special occasions. Just let your podiatrist know.
How long does fungal nail treatment take?
Big toenails take around 12 to 18 months to grow out completely, and smaller toenails around 6 to 8 months. We recommend continuing treatment for 2 months after the nail looks completely clear.
Can fungal nails come back?
Yes, reinfection is common because fungal spores are everywhere in our environment. We focus on building you a post-treatment routine to help reduce the chance of it coming back, and aim to give you the skills to manage your foot health yourself in the long term.
Do I need a referral?
No. You can book directly with one of our podiatrists.
Can I claim on private health?
We don’t offer on-the-spot claiming. If your extras cover includes podiatry, you can claim with your fund using your itemised receipt. Check with your fund about your level of cover.