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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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
September 13, 2017
rapid appointment when I needed it and first class service. surgery went very well and recovery so far good with no pain. recommended without reservation.
Jenny 
Jenny Wootton
July 30, 2019 - Knowing Jonathan as a fellow podiatrist. He has a special gift in delivering information and motivating people, which is amazing. I have attended a number of his courses and talks, where he shares his knowledge and skills. An inspirational podiatrist!
Lynda Cowan
October 22, 2019Excellent 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
February 23, 2018 - After knee surgery I experienced ankle problems, a couple of visits to Jonathan has sorted the problem out. Thank you.
Judith Mary Piper
October 24, 2019 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
February 2, 2020 - I have had persistent pain with my toenails for years, but did not know the cause of the problem.
Previous visits to a different podiatrist left me with no answers! After researching local podiatrists I found that Health First came highly recommended.
Mr Small quickly found out the cause of my problem and recommended the best treatment options.
The staff were all very friendly and made me feel welcome. All very professional.
I cannot recommend them enough to anyone! Will be going back for my follow up treatment in the new year.
Millie Hefferan
December 3, 2019Excellent service. The clinic was efficient enough that Jonathan was able to undertake toe surgery on the same day of my first appointment (just minutes after the problem was diagnosed!). The staff were very friendly and informative, and kept me very much at ease during the entire process. I was very appreciative and will be returning if I have any similar problems in the future. Highly recommended!
Joe Miller
April 9, 2018 - It was nice to be greeted by pleasant and friendly reception/admin staff.
Johnathan (the podiatrist) was very professional and he was very willing to share his knowledge.
The pain in my foot was laser treated and on the last treatment it was manipulated which was amazing.
I would highly recommend Johnathan.
Ann
Ann Maria Forster
December 4, 2020 Absolutely great, two big toes up! 
Gary Shaw
April 9, 2020 -
Excellent service. I am so pleased with the help, advice and treatment recieved. Many thanks
Jackie Dewdney
September 13, 2017Couldn't be more thankful for the quick and friendly service. I needed help fast (I couldn't wait 2-3 months for nail surgery on the NHS) and Jonathan sorted me out just three days after I phoned to enquire. I felt very confident and relaxed in Health First. Thank you all!
Amy Duffin
July 12, 2018 - Last night I attended a talk by Jonathan on diabetes. What an amazing resource of knowledge the local NHS has lost by no longer employing him. But thankfully we still have his private practice in Warwickshire and I will be referring all my diabetic patients to find out their level of risk. Thanks Jonathan for a very interesting evening you should do more talks to spread the word about diabetes to other FHPs.
Chris Nock
September 5, 2019 hi everyone
I've been battling with planter fasciitis in my heel for 15 months, Jonathan small was highly recommended. I got no such luck from my doctor. I give these a ring and got me in straight away. Met Jonathan had a brief chat the knowledge and information given was very helpful put me on a 6 week course and my foot is the best its been in a long time.
From start to finish my experience was great. highly recommend Jonathan and his staff all very friendly. 
Cheryl Higgins
June 24, 2021 - Highly recommend this practice. Jonathan and his team are extremely professional and friendly. As a cancer patient I was anxious to find a podiatrist whom I could trust completely. Jonathan took time to fully understand my medical situation and on-going difficulty with my toes. He was proactive in communicating with my Oncologist and the required nail surgery took place 2 days after my initial appointment. Everything was carefully explained and skilfully carried out. I am one very satisfied customer!
Angela Terry
February 12, 2020 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
November 14, 2019 - Jonathan Small has been treating me for a range of foot and gait problems for a number of
Years including plantar fasciitis, Morton’s neuromas and joint hypermobility. As well as physical
Treatment he has supplied me with various orthotics which have really helped me keep
Mobile and reasonably fit. I am undergoing treatment at the moment and I fully expect that
Jonathan will be as successful as he has been in the past. All the staff at Health First are
Friendly and helpful.
Pam Alexander
April 2, 2020My problem was immediately identified and expertly treated. The follow up advice has been do-able and effective to undertake at home. Thanks Liz Bones
Liz Bones
March 17, 2022 -
Mr Small and team provided a really excellent service for my elderly mother and kept her on her feet, mobile and active for the two years she lived near Southam, thank you very much!
Charlotte Gath
February 10, 2018 Everything you can think of is available here! 
Jane Vaughan
September 9, 2021