What is a fungal nail?
Fungal infections on your feet are much more common than you might think. Fungus survives in warm, moist and dark environments and can be found anywhere on your body. Unfortunately, your feet naturally provide a perfect place for the fungus to thrive. It’s rare that our feet are not in socks or sweaty shoes, especially for those that lead an active lifestyle.
Your toenails are also particularly susceptible to fungal infections, a lot more so than your armpits or groin. When this happens, it is known as Onychomycosis. As mentioned previously, our feet naturally provide the perfect environment for fungus to grow; this is why we must be diligent in preventing fungus before it becomes an issue. If you feel you may already have a fungal infection, call us for a correct and proper diagnosis and we can begin to discuss treatment options.
How is a fungal nail diagnosed?
Podiatrists have a great knowledge and understanding of all things foot-related; experienced podiatrists can usually diagnose Onychomycosis just by looking at the nail. The nail will usually show some signs of damage or indication of a fungal problem by becoming crumbly and brittle or turning a yellow or brownish colour. Fungal nails become even more apparent if there are signs of fungal infection on the skin of the foot.
To ensure our diagnosis is correct, we will always run a test just to be sure. This can be done in a couple of different ways:
Microscopy and Culture (M&C)
This method is the one most often used by the NHS; however, in my opinion, it isn’t the best. It can take several weeks to attain results and is often inaccurate or incorrect. These inaccuracies are usually due to the way the nail sample is collected.
Diafactory fungal testing (AKA the FiveMinuteFungus test)
This test operates in a similar manner to a covid 19 lateral flow test. It takes only a few minutes and has an accuracy percentage rate of 95%. This is the type of fungal nail test we use here at our podiatry clinic in Southam because of its accuracy and great results.
Treatments For A Fungal Toenail In Southam, Warwickshire
Treatment options for fungal nails can vary. We use a couple of different methods, depending on the severity of the fungal nail and its location. When treating fungal nails, there are two main aspects that we should consider before we look at other treatment options, these are:
Prevention
Preventing a fungal nail is one of the best ways to treat them. To do this, we need to change the environment in which they survive; this means treating your shoes with anti-fungal spray, ensuring you change your socks regularly and maintaining good personal foot hygiene. Making it difficult for the fungus to survive on your nails or foot will help to prevent reoccurrence.
Toenail Removal
One of the most direct treatment options is removing the nail entirely and destroying the nail matrix; there will be no nail for the fungus to infect. Destroying the nail matrix also stops the nail from growing back, preventing the risk of further infections. The alternative to removing the entire nail is temporary removal; upon doing this, we can apply a fungal nail treatment directly to the nail bed to treat the infection.
Toenail Fenestration
This process involves drilling a number of tiny holes into the nail, allowing a topical anti-fungal treatment to more easily penetrate the nail bed and kill the fungal infection. When drilling holes, you must be careful not to damage the nail bed underneath; if you think this will be the best option for you, you should look out for podiatrists that offer Clearanail or Lacuna methods of treatment.
Toenail Debridement
Toenail debridement involves shaving back the nail, and removing as much of the damaged, crumbly or thickened nail as possible. This increases the efficiency of anti-fungal agents such as amorolfine paint. This filing can be done in a couple of different ways, but it is most often completed using a diamond deb file/foot file or a drill. You should always visit a professional podiatrist to have this completed; trying to do this yourself at home could lead to further injuries.
Photodynamic Surgery
Laser therapy and treatments such as PACT have been found to be a useful method to treat fungal nails in more recent times as it is less invasive, and you can destroy the fungal cells using light. Similar to most of the other treatments above; however, this treatment method takes time. You will likely need multiple sessions for the best chances of success using this treatment method.
Oral Treatments
Terbinafine and itraconazole are two fungal nail treatment methods that are both available in tablet form, meaning they can be delivered straight to the nail matrix through oral ingestion. However, this method of treatment comes with some risks and should always be discussed with your podiatrist or GP before being undertaken. NICE (NHS) guidelines advise that a minimum of 3 nail matrices should have an infection present before oral treatment should be considered.
How to prevent fungal toenails
As mentioned previously, the best way to treat a fungal nail, is to prevent it from occurring in the first place. Good foot hygiene is essential, as well as remembering to wash your feet regularly and dry them thoroughly between the toes. Changing your socks frequently is also a good way to prevent infection; try to opt for socks made of natural fibres or moisture-wicking socks to prevent the build-up of excess sweat. You should also wear socks or sliders when in public spaces like swimming pools and locker rooms, as fungal infections can be contagious and easily spread.
If possible, you should also rotate your choice of footwear daily, allowing one pair of shoes to dry fully while wearing another. You can also treat your shoes with anti-fungal sprays like Daktarin to reduce fungal loads.
At Health First Foot & Gait Clinic, we have a footwear sanitisation device called a Klenz machine. This can be used to lower the fungal load in up to 3 pairs of shoes & socks at once. The process takes about 20 minutes, so can be done while you wait. Further details on this are available at our reception on 01926 811272.
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100% recommendation. I walked in with significant foot pain and walked out strapped up and reasonably pain free. The initial consultation was delivered with expert knowledge, professionalism and clearly explained diagnosis and treatment plan.
I had attended another foot clinic for a diagnosis but my instinct told me to walk away and consider their treatment proposal and seek another opinion. I felt disappointed that I had no immediate temporary solution to reduce constant foot pain..
I was then recommended to contact Jonathan and the rest is history. His manner and professionalism exceeds, not only am I working towards pain free walking I know I have the confidence in approaching a clear expert. Thank you Jonathan and your team. I have already recommended. 
Helen Keast
Jonathan is very helpful and knowledgeable, he has looked after my feet over the years and I trust him completely. He is always polite, kind and considerate Tracey Bianciardi
- Everything you can think of is available here!
Jane Vaughan
After knee surgery I experienced ankle problems, a couple of visits to Jonathan has sorted the problem out. Thank you. Judith Mary
- Excellent well informed professional service. Treatment options discussed, and every effort made to deliver appropriate care promptly.
Thank you to Jonathan and the team.
Carol Brewer
I wouldn't trust anyone else with my foot-care. With severe circulation issues, my feet are comprised - Health First have treated me for 15 years and I highly recommend them.
Angela Navarro
- Thank you Jonathan for inviting me along to your Dynamic & Disasters of The Diabetic Foot seminar and thank you for sharing your wealth of knowledge. For anyone who has been diagnosed as diabetic I would urge you to visit Jonathan for a comprehensive diabetic foot assessment. You only have one pair of feet so treat them with respect and they will last a lifetime. I look forward to working with you on our quest to treat and educate on foot health. Kind regards - Debbie Hewitt, Foot Health Practitioner (Rugby)
Debbie Hewitt
My 15 year old son had an ingrown toenail which was very painful. We were able to see Jonathan very quickly who explained everything really clearly, he advised minor surgery to remove part of the nail and said he could do the procedure there and then. The procedure was carried out professionally and with every care for my son. I would highly recommend Jonathan and his clinic. Excellent aftercare also. Thanks so much. Karen Grant
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Jonathon looked after my mum's feet for a number of years and despite her being a difficult patient at the best of times especially after her stroke he was never anything but cheerful and polite. I was always very grateful for the way he looked after mum and I would highly recommend his services.
David Buchholz
I have received first class treatment and my foot is feeling less painful especially after the
laser treatment I had on it. Mary Richardson
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Excellent!!! Very professional service, great treatment and aftercare. Definitely recommend. Thanks for fitting me in at short notice too!!
Clare Everest
I experienced a very accurate diagnosis. Treatment was good and the pain is easing very nicely. Greeted by a pleasant lady on reception and advised of the need to follow PPE. Met with Jonathan who is very friendly and professional just as you would expect. Highly recommend him to help solve your feet/foot problems. John Dewar
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They have always been helpful, professional, courteous and caring
John Veasey
A great practice. Have been using for the past 5 years and always have excellent service. Very friendly and helpful staff. My feet are in great shape
Emily Harris
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Very professional and friendly service - solved my foot problems where many others had failed -highly recomended.
John Newbold
Excellent treatments fully recommend. Jonathon is very professional and knows what he is doing. Very experienced and takes into account your needs. I am currently relaxing with a hot wax treatment.
Valerie Jukes
- I visited Jonathan with terrible foot pain, he diagnosed it as plantar fasciitis after a full check and I was given sets of exercises to heal my foot, I have just left after my third visit and the pain has all but gone, I found Jonathan and Kate very friendly, would and have recommend to others, Thank you.👣
Paul Fogg
Had a fantastic day observing in clinic yesterday!
Jonathan AMAZED me with his extensive knowledge, he was very supportive & I learnt so much just in 1 day!
I admire Jonathans determination & drive to help his patients resolve any issues they may have & I hope to follow in his footsteps once I graduate from university.
Thanks again for the opportunity your useful and excellent advice will always remain with me.
Faye 🙂 Faye Green
- Jonathan is great - passionate, knowledgeable and dedicated to getting people’s foot problems sorted.
I had the pleasure of helping him recently with promotion material for a podshealheels and he delivered a superb lecture to a group of patients and professionals.
Dave James
Jonathan Small and his team have been excellent. A person centred, straight forward approach and really genuine team. I had been told by NHS and other podiatrists that the healing after ingrowing toe nail would take up to 12 weeks yet after the surgery at Health First Foot, it has completely healed in just over 3 weeks. Going privately was one of the best investments I've made. Thank you Health First ! Nikki Jackson