A fungal toenail infection is hard work

They are challenging. This type of infection is caused by a fungal bug that gets into the nail causing it to not look very good. Once it is well established it can distort and deform the nail. The reason that they are so challenging is that the fungal bugs thrive in dark and moist environments, which is the exact environment that we put the foot into when wearing shoes. This means that no matter how good the treatment is, the fungal bugs are in the environment they like. The other challenge with fungal nails is that the nail plate behaves like a “plastic” and protects the bug – this means that when something is applied to the nail to treat it, it is more difficult to penetrate the nail than it would be to treat a fungal infection of the skin where it is easy for topical medicine to penetrate.

Some things to note about fungal toenail infections:

There are no magic instant cures. Treatment takes time. If someone is promoting an “instant” cure, then it is most likely just some sort of bleaching agent that improves the colour of the nail. It does not treat the nail infection.

No matter what treatment is used, as soon as you put the shoe back on, the fungal bug is back in the environment it likes and it will keep trying to do its job.

There are many different treatment options. Using more than one at the same time may be more helpful and trying one and if that does not work, then try another and so on.

There is a high chance that the infection can happen again after a successful treatment as the fungal bugs love that environment inside the shoes.

If the infection has progressed to the extent that the whole nail is affected and the infection spreads down into the nail base, this may damage the growing cells at the base of the nail, leaving a thick and distorted nail plate. There is nothing that can really be done with that except for regular filing back of the nail plate.

Nail polish may cover and hide the infection, however, it may also create a micro environment that may encourages the infection.

Treatment may take 3, 6 or 12 months as the treatment has to be used as the nail grows out. Toenails grow slowly. It is a hard slog.

The thickness and deformity of the nail plate acts as a barrier for any applied treatment to get deep enough to where the infection is.

There are lab based tests that can be done to confirm the diagnosis, but they have a high rate of false negatives and can often not be that useful because of that.

If left untreated, it can spread to the other toenails and to other family members.

If you want to self treat a fungal toenail infection, then try this:

1. Practice good foot hygiene. Wear clean socks every day. Clean and wash the feet thoroughly every day. Go barefoot as much as possible (so the fungal infection does not get the environment it likes).
2. Aggressively cut and debride the nails to get rid of as much of the infection as possible and so the nail plate is thin so anything that is applied to it can penetrate into the nail. Podiatrists have special tools that allow them to do this. If you want to do this at home, then we have this nail drill. This is really important.
3. Apply some topical medicine to it EVERY day. We have the Walker’s fungal nail solution.
4. Consider using a blue light device to also work as disrupting the fungal bugs. This will add a different approach to the treatment of the topical medicine and has a different mechanism.
5. Read the above ‘Some things to note ..’, so that you have a good understanding of what you are dealing with.
6. There are some oral prescriptions medicines that can also be used. They rely on the blood supply to the base of the nail for the medicine to be incorporated up into the nails as they grow, so they fight the fungal bug from inside (rather than the outside of the topical medicine). They do need to be taken for 3 to 6 or more months as the nail grows out. Like any drug it can have side affects, so this needs to be considered as to the risk benefit. If you do take this medicine, still do the above to help it work.
7. The infection can recur at any time in the future, so do (1) every day.

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