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Common foot complaints:

Fungal nail infections. (onychomycosis)

Definition
Fungal type nail infections are a common cause of discolouration and thickening of toe nails. Certain fungi feed on a component of nail, keratin. As fungi thrive in moist, dark environments, the conditions within footwear are ideal for growth.

When a nail is infected by a fungus the nail will often appear chalky, yellow or brown; the nail may become brittle. The nail may thicken and become loose on its leading edge. It is usual for a fungal infection to start in one nail, however spread to the other nails is likely.

It should be noted that there are many other possible causes of thickening and discolouration of nails. It is essential to gain expert advice so that the cause can be identified.

Incidence / Age
All ages can present with fungal nail infections, however they are more common with increasing age. The prevalence in the general population of the United Kingdom is in the region of 3%. Particular attention should be paid to nail changes that occur to a number of nails simultaneously as the cause may not be local infection, but systemic.

Treatment
There are a large variety of treatments available for fungal nail infections, ranging from conservative to surgical. When treating discoloured or thickened nails it is essential to establish a diagnosis. Once fungal infection is established by a health care professional one of the following treatments may be initiated.

Creams, ointments, lacquers etc: There are a variety of treatments that are applied to the nail plate directly (topical). Some can be bought directly from a pharmacist while others require a prescription. All topical treatments require a certain dedication to their application, which may be required for several months. Even with carefully and regular application many fungally infected nails do not resolve with the use of topical drugs. It is usually the case that nails need to be reduced to aid the penetration of the drug being applied. This can be done with a file, however if the nail is excessively thickened it will be necessary to consult a State Registered Podiatrist for reduction using a small nail drill.

Tablets: There are a number of tablets available for the treatment of fungal nail infections. Some are taken daily while others are taken for periods with a break in between, until resolution occurs. All treatments need to be used for at least a few months and often several. A cure is unfortunately not guaranteed however tablet treatment does offer the best chance of a permanent cure, especially if the infection is caught early enough.

Surgery: Surgery used in the treatment of a fungal nail infection does not offer a cure of the infection, it usually offers the permanent removal of the nail so that it no longer troubles. Some Podiatrists remove the nail and then treat the new growing nail with drugs.

Outcome / Prognosis
Fungal nail infections are not usually troublesome. They can change the appearance of the nail and make it brittle. If the nail thickens it may be poorly accommodated in shoes. There are a variety of treatments available for fungal nail infections that may cure, but certainly prevent a nail infection from becoming a significant problem.

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