Fungal Toenails

Got a stubborn fungal toenail infection you can't get rid of?

Fungal Toenails

Got a stubborn fungal toenail infection you can't get rid of?

Toenail fungus is a common and persistent problem that affects millions of people worldwide. Fungal toenails can cause pain, discomfort, and embarrassment, and if left untreated, can lead to more serious complications. There are several different types of toenail fungus, each with their own unique characteristics and symptoms. In this informative article, we will explore the different types of toenail fungus, their causes, and the most effective treatments available to help you find relief and restore the health of your nails. Whether you have recently noticed the signs of toenail fungus or have been struggling with it for some time, this article will provide you with the knowledge and insights you need to better understand the condition and take control of your treatment.

What is a Fungal Toenail Infection?

Toenail fungus is a common condition that affects many individuals globally, causing discomfort and embarrassment. It is a type of toenail infection that develops underneath the toenail, leading to discolouration, thickening, and brittleness of the nail. This condition can be persistent and difficult to treat if not detected early. Toenail fungus is prevalent in older adults, athletes, and those with weakened immune systems, and can also affect those with poor hygiene habits. There are a variety of different types on toenail fungus, however all fungi thrive in warm and moist environments, making toenails particularly vulnerable to infection.

The most common signs of a fungal toenail infection include:

  • Discolouration of the nail plate; white, yellow, brown, black.
  • Visible changes to the toenail; thickened, lifted, brittle, crumbly, or ragged
  • Darkening in colour, caused by debris building up under your nail.
  • Malodour; smelling slightly foul.

What causes Fungal Toenails?

Fungal toenail infections are most commonly a result of direct trauma to the toe or nail plate in which the nail plate is cracked or separated from the nail bed creating a portal of entry for fungus to enter and grow.

Fungal toenail infections can result from a number of different types of fungi, including dermatophytes, molds and yeast-like organisms. There are types of fungus such as candida, is a naturally occurring flora of the skin and can be opportunistic, causing infection when a nail or skin break occurs. Whereas others are picked up from external environments such as:

  • Footwear
  • Public swimming pools
  • Public showers
  • Public locker rooms
  • Public saunas and spas
  • Non-sterilised footcare equipment

Common Types of Toenail Fungus

Toenail fungus can present in different forms, depending on the type of fungus that causes it. The most common types of toenail fungus are Distal Subungual Onychomycosis, Superficial White Onychomycosis, Proximal Subungual Onychomycosis, Endonyx Onychomycosis, and Total Dystrophic Onychomycosis.

Fungal toenail infection treatment Sydney

Distal Subungual Onychomycosis

Distal Subungual Onychomycosis (DSO) is a fungal infection that commonly impacts nails, particularly toenails. The infection is mainly caused by a group of fungi known as dermatophytes, which thrive in warm and moist environments. DSO is often characterised by nail thickening and discolouration, as well as separation of the nail plate from the nail bed.

DSO is a chronic infection that can be challenging to treat and may last for years if left untreated. The infection typically starts at the distal end of the nail and slowly progresses towards the nail base. The nail may become discoloured, and it may also become brittle and crumbly.

DSO can be transmitted through direct contact with infected nail clippings, shoes, or socks. It is also more common in individuals with a weakened immune system or a history of nail trauma or frequent exposure to water.

Superficial White Onychomycosis

Superficial White Onychomycosis (SWO) is a fungal infection that impacts the nails. The condition is caused by different types of fungi and is characterised by white spots or streaks on the nails. The fungus grows on the nail surface and can appear similar to dry nails. The infection is generally painless but can cause the nail to become brittle and crumbly.

SWO is more prevalent in toenails than in fingernails and is often observed in individuals with weakened immune systems or those who frequently expose their feet to warm and moist environments. The fungus responsible for SWO can be transmitted from person to person or from one nail to another.

Proximal Subungual Onychomycosis

Proximal Subungual Onychomycosis (PSO), is a fungal infection that primarily affects the toenails. This condition is typically caused by dermatophytes, a type of fungi that thrive in warm and moist environments such as the inside of shoes or socks.

The infection starts at the base of the nail and gradually spreads towards the tip. As the condition progresses, the nail may become discoloured, thickened, and crumbly. PSO is more commonly seen in individuals with weakened immune systems, such as those with HIV/AIDS or diabetes, as well as in people who frequently expose their feet to warm and moist environments, such as athletes or those who wear closed-toe shoes for extended periods.

Early detection and treatment are crucial in preventing the infection from spreading and causing further damage to the nail and surrounding tissue.

Endonyx Onychomycosis

Endonyx Onychomycosis is a type of fungal infection that affects the nails. Unlike other types of onychomycosis, endonyx onychomycosis primarily affects the nail bed, which is the tissue underneath the nail. This type of infection can cause the nail to thicken and become discoloured, often turning white or yellowish in colour.

Endonyx onychomycosis is caused by a variety of fungi, including dermatophytes and yeasts. It can be difficult to diagnose, as the nail may not show any visible signs of infection. In some cases, a fungal culture may be necessary to confirm the diagnosis.

Total Dystrophic Onychomycosis

Total Dystrophic Onychomycosis is an “end-stage” fungal infection in which there is total destruction of the nail plate. This type of fungal infection can affect both the toenails and fingernails and is characterised by thick, discoloured, and brittle nails that may crumble or separate from the nail bed. It can be the result any of the fungal infections caused by dermatophytes or yeast-like fungi.

People with compromised immune systems, diabetes, or peripheral vascular disease are more susceptible to developing total dystrophic onychomycosis. It can also occur due to poor foot hygiene, wearing tight shoes, or walking barefoot in public places.

Knowing the type of toenail fungus you have is important for proper diagnosis and treatment. Understanding the different characteristics and symptoms of each type can help you identify the condition and seek appropriate medical attention. In the next section, we will explore the symptoms of toenail fungus in more detail.

Signs and Symptoms of Fungal Toenails

The signs and symptoms of toenail fungus can vary depending on the severity of the infection. However, the most common signs and symptoms of a fungal infection include:

  • Change in the colour of the toenail. The nail may become discoloured and develop white, yellow, or brown spots. The nail may also become darker and appear black in severe cases.
  • Thickening of the nail. The infected nail may become thicker than usual and can be difficult to cut with a nail clipper.
  • Brittleness of the nail. The infected nail may become dry and brittle, making it more likely to crack or break.
  • Changes to the shape of the nail may also occur as the infection progresses. The nail may become distorted and appear curved or twisted.

Other symptoms of toenail fungus as it progresses include:

  • A foul odour
  • Pain or discomfort in the affected area
  • Separation of the nail from the nail bed

It is important to note that not all cases of toenail fungus cause symptoms, especially in the early stages of the infection.

If you suspect you may have toenail fungus, it is important to seek medical attention promptly to receive an accurate diagnosis and appropriate treatment. Early detection and treatment can help prevent the infection from spreading and causing further damage to the nail and surrounding tissue.

Causes and Risk Factors

Fungi thrive in warm, dark, moist environments, so people who frequently expose their feet to such conditions are at a higher risk of developing toenail fungus. The infection most commonly results from direct trauma to the toe or nail plate, in which the nail plate is cracked or separated from the nail bed creating a portal of entry for fungus to enter and grow.

Fungal toenail infections can result from a number of different types of fungi, including dermatophytes, molds and yeast-like organisms. Some types of fungi such as candida, naturally occur on the skin and can enter the nail when trauma occurs. Whereas other infective organisms are picked up from external environments such as:

  • Footwear
  • Public swimming pools
  • Public showers
  • Public locker rooms
  • Public saunas and spas
  • Non-sterilised footcare equipment

Other risk factors include:

  • Nail trauma
  • Sharing nail care equipment
  • Poor hygiene
  • Wearing ill-fitting shoes
  • Having a weakened immune system
  • Male gender
  • Diabetes
  • Peripheral artery disease
  • Certain medications, such as those used to treat cancer and autoimmune disorders, can also weaken the immune system
  • Athlete’s foot (tinea pedis

It is important to note that toenail fungus is not always caused by poor hygiene or lifestyle habits. It can also occur due to genetics or a family history of fungal infections. People with a family history of toenail fungus should be extra vigilant about taking preventive measures to reduce their risk of developing this condition.

Additionally, older individuals are more prone to this condition, as toenails become thicker and more brittle with age, making them more susceptible to fungal infections.

Fungal Toenail Treatment

Treatment options for fungal toenail infections include topical agents, oral medications, and fungal laser therapy. The most effective treatments will largely depend on the presenting symptoms and situation. A podiatrist will consider several factors before recommending the most appropriate treatment plan based on presentations and desired patient outcomes.

Topical Medication

Topical medications are applied directly on the nail or treatment area and treat the fungi over time. There are many different types of topical antifungal medications available, and each can work differently for different types of fungal infections depending on the infective organism resulting in the fungal infection. For best results topical applications should be chosen based on the specific infective organism resulting in the fungal infection. Current literature suggests terbinafine (Lamsil®), amorolfine (Loceryl®), and efinaconazole 10% (Jublia®) to be amongst some of the most successful topical applications for fungal toenail infections. However, results may vary depending on the specific infective organism and this should be discussed in detail with your podiatrist. Furthermore, topical medications are most effective when paired with oral medications.

Oral Medication

Oral antifungal medications such terbinafine (Lamisil®), itraconazole (Sporanox®) and fluconazole (Diflucan®), are prescribed by a doctor and taken based on the drug specific recommendations. Doctors may use blood tests to assess liver function and check for potential medication side effects. Oral medications can cause adverse reactions, affect the liver, interact with other medications, so it is important to discuss this in detail with a doctor or podiatrist before commencing.

Fungal Laser Therapy

At Bespoke Health and Performance, we utilise the Lunula laser in the treatment of fungal toenails. The Lunula is a cold laser, cold laser therapy works by using low-level laser energy to stimulate the cells in the affected area. The laser energy penetrates the skin and nails without causing any damage or pain. The laser energy is absorbed by the cells in the toenail, which then stimulates the cells’ metabolism and enhances their ability to regenerate and repair.

This enhanced cellular metabolism helps to fight off the fungal infection by boosting the body’s immune system response. The laser therapy also helps to increase the circulation to the affected area, which delivers more oxygen and nutrients to the cells. The increased circulation also helps to remove toxins and waste products from the infected area, which aids in the healing process.

For more information about Lunula laser therapy, CLICK HERE.

What is the Fastest Treatment for Fungal Toenails?

For fastest results in treating fungal toenails and producing clear nails, combination therapy is advised. Combination therapy may involve a combination of oral medications, topical antifungal applications, and lunular laser therapy, which ever is best for the presenting fungal infection. Combination therapy may make treatment more effective and speed up healthy nail regrowth. A podiatrist can help determine which medications and applications are most suitable for the presenting type of fungal infection, as well as directing the most appropriate treatment options based on the specific infective organism for the presenting fungal infection.

It is important to remember that there are multiple different infective organisms that result in fungal toenail infections and depending on which treatment approach is taken, treatment can take several months. Patience, dedication, and compliance directly impacts outcomes.

For best outcomes fungal laser therapy should be used in conjunction with topical applications on toes prepared by a podiatrist.


To prevent toenail fungus, it is important to maintain good foot hygiene. This includes keeping feet clean and dry, wearing breathable and properly fitting shoes, and avoiding sharing shoes or nail clippers with others.

There are multiple steps you can take to help prevent toenail fungal infections.

  • Wear appropriate fitting shoes. Both, shoes that are too tight and or too loose can cause trauma to the toenails, creating a portal of entry for fungal organisms.
  • Avoid being barefoot in public or communal areas that are shared by other barefoot people. These areas may include public swimming pools, locker rooms, showers, and hotel rooms.
  • Do not pick or tear at your toenails. Use clean instruments to cut the toenails straight across, avoiding rounding the edges. Trauma or aggressive cutting can create portals of entry for fungus.
  • Thoroughly dry your feet, including between your toes after showering.
  • Maintain dry feet throughout the day and do not wear damp shoes.
  • If you have family members with foot or toenail fungal infections, avoid sharing common spaces barefoot.
  • If you have diabetes or reduced blood flow to the feet, follow the footcare recommendations from you podiatrist.

There is no way to guarantee you will avoid fungal toenail infections. However, following these steps can significantly reduce the risk of developing a fungal infection on your feet and in your toenails.  

For more information on Lunula Laser treatment for fungal toenails, please click here.

If you are suffering from fungal toenails and would like to have them treated safe and effectively, click here to schedule an appointment with one of our experienced podiatrists.

Overall, prevention and early treatment are key in managing toenail fungus. By practicing good foot hygiene and seeking prompt medical attention when needed, you can help prevent the spread of the infection and promote healing.

When to See a Podiatrist

In most cases, minor fungal toenail infections can be treated effectively with over-the-counter medications, providing that the appropriate medication is purchased for the specific infective organism. However, if the condition is severe or if home remedies are not effective, it may be necessary to seek medical attention from a podiatrist. If the suspected infection is black, and you have noticed it is starting to involve the skin surrounding the nail plate, seek medical attention immediately.

A podiatrist can diagnose toenail fungus by examining the affected nail, and if required, taking a sample for laboratory analysis. They can also recommend the most effective treatment options based on the severity of the condition and the patient’s medical history.

It’s important to seek medical attention if the toenail fungus is causing pain or discomfort, if the infection is spreading to other nails or skin, or if there are signs of an underlying medical condition, such as diabetes or a weakened immune system.

In addition, individuals who have a history of toenail fungus or other foot infections should consider seeing a podiatrist regularly for preventive care and early detection of any potential problems.

Overall, if home remedies or over-the-counter treatments are not providing relief or if there are any concerns about the condition, it’s best to schedule an appointment with a podiatrist for further evaluation and treatment.


Many types of fungal toenail infections are quite contagious and can readily spread to other toenails and areas of the feet including between the toes, under the foot, and may be passed on to other people through direct contact and by touching infected surfaces.

Fungal toenail infections are seen more commonly in older populations. There are several factors that appear to increase the risk of developing fungal infections, including:

  • Diabetes
  • Peripheral vascular disease
  • Immunosuppression

It is common for people with these conditions to have a reduced blood flow or ability to break down foreign pathogens. Occlusive footwear or warm, damp conditions. and close living conditions have been cited as risk factors. This may to some extent, explain the increase incidence of fungal toenail infections in older populations.

However, fungal infections are not limited to the elderly and can effect people of all ages.

Fungal infections of the toenails do not go away on their own. Left untreated, fungal infections spread and can eventually destroy the toenail.

The complete removal of a fungal toenail may be used as part of a comprehensive treatment plan for fungal nails but is not considered an effective treatment on its own. When treating a fungal infection, it is important to ensure that all fungal spores are eradicated otherwise the fungal infection can return. The complete removal of a toenail should be discussed in detail and performed by an experienced podiatrist.