What is toenail fungus?

Fungal Toenail.

A fungus is a micro-organism a bit like a bacteria but from a different family. Fungus causes thrush on mucous membranes, tinea / athlete’s foot on the skin and can also infect fingernails and toenails. The nail will become discoloured and lose its solid nature, becoming crumbly and dead looking. Actually, all nails are in fact already dead. The only living part of a nail is below the skin at the base. This is important because it means that nails don’t have any potential to fight off an infection. Your nail’s only protection from being infected by fungal spores, which are everywhere – all the time, is the shiny surface of the nail. With this intact, the spores can’t settle in and grow but just slide off. Think of it like a concrete driveway: no cracks means no weeds. If cracks occur, no matter how clean you keep the environment, weeds will grow.

Fungal nails need not be painful – because the nail is dead, it has no feeling. If the nail is painful, it s almost certain to be a growth under the nail called onychophosis. This can be easily and painlessly removed by the podiatrist.

How do fungal infections in toenails happen?

Fungus gets in when the nail is damaged. Perhaps the nail was scuffed up by a close fitting shoe, gouged while you were using a nail tool or damaged by any kind of trauma. Leaving nail polish on for extended periods paints the fungus into place. Be particularly wary about communal nail polish pots and pedicure salons. Only an autoclave will kill fungal spores and they cost up to $10 000. Consider whether the local pedicurist has invested in one of these and whether the customer before you may have wanted their nails painted to hide an ugly nail fungus.

How might you damage a nail to let fungal toenail infection in?

It is easy to abrade the surface of the nail enough to allow entry to fungal spores. Perhaps the nail was scuffed up by a close fitting shoe, gouged while you were using a nail tool or damaged by any kind of trauma. Events that cause a blood blister to form or the nail to lift at all would be especially suspicious.

Leaving nail polish on for extended periods is also an excellent way to develop the infection as it can ‘paint’ the fungus into place instead of falling off the shiny nail surface. Nail polish also traps moisture within the nail and in the skin below the nail so that it takes hours to properly evaporate. This body heat, moisture and darkness creates perfect breeding conditions for the bugs. You should be particularly wary about communal nail polish pots such as you might find in pedicure salons. Here, you may well pick up fungal spores from the person before you. After all, who better to want their nails polished than someone with unsightly fungal toenail infection that they want to hide?

Of all of the cleaning methods that you might think a nail salon would use, only an autoclave will kill fungal spores. These sterilisers cost up to $10 000. All podiatrists are obliged to autoclave nail tools between uses but nail salons are not covered by this sort of legislation in Australia. Consider then whether the local pedicurist has invested in one of these expensive devices. Some do – particularly as legislation does require salons who do cosmetic tatooing and piercings to have their tools sterilised between uses. It is well within your rights to ask questions about how the salon cleans their tools and environment between customers before you try them out. As podiatrists, we see hundreds of people per year damaged by nail salons. Each one will take up to a year of podiatric treatment to restore to proper nail health. For more fungal toenail information, see our printable Fungal Nail Info Sheet or information about Pinpointe fungal nail laser.

How do you treat fungal nail infection?

If you have a fungal nail, you have millions of fungi reproducing and spreading the infection through the nail. It is best treated early to prevent infection spreading to adjacent nails and other members of the household.  The podiatrist may recommend laser treatment for the nail to efficiently kill the existing infection. You can find out more about fungal nail laser treatment here. A medication in tablet form is available through your GP that is very effective, although it can be harsh on the liver. Consideration is needed if you have known liver problems, drink or have drunk significant quantities of alcohol or take other drugs that rely on the liver to metabolise them.