Fungal nail infections (onychomycosis) are very common – affecting up to one in ten of the UK population. Around half of all nail problems are related to fungus. It affects men more than women and is more common as you get older. It is more common in toenails than fingernails and, because of this, the effects on the foot are more commonly mentioned. In either case, the treatment and subsequent results are similar.

Fungal infections are often unsightly. The nail becomes thickened or discoloured; it can turn yellow, brown, orange or white. There may be black areas of bleeding as a result of trauma or areas of dark green if a bacterial infection is present too. Nails can become brittle or can crumble, and may lift from the end of the digit. In some cases debris collects beneath the nail and becomes malodorous.

While some see the fungal infection as purely cosmetic, when the nail becomes thickened, heavily discoloured and crumbly it can cause significant embarrassment and self-consciousness. It can become painful in shoes, can develop corns down the side of the nail and also become impossible to cut or trim, causing ingrown nails. In addition it becomes a source of fungus that can constantly re-infect the skin of the foot..

This video clip from Channel 4’s Embarrassing Illnesses series describes one man’s nail fungal problem.

Fungal nail infections often result from damage to the nail plate or seal, which allows a fungus or athlete’s foot to invade the nail. Up to 30 per cent of patients with fungal nail infections also have this skin infection. Hot, sweaty feet in all-day shoes provide the ideal warm, damp environment for fungi to thrive.

Fungal infections are caused primarily by dermatophytes, but also candida and the various yeasts and moulds that thrive in these conditions. The dermatophyte Tricophytum Rubrum, for example, is responsible for about 90 per cent of all nail infections. Factors that increase the risk of nail infections are:

• nail damage or biting
• medical conditions such as diabetes, psoriasis, or a weakened immune system
• smoking
• general poor health
• activities involving impact or shared washing facilities
• trauma to the nail – for example, running or poorly fitted footwear

Serious medical conditions like diabetes and poor circulation can create the potential for worsening conditions, possibly secondary bacterial infections. The fungus can develop when the foot is contained in a warm damp shoe for too long. Common use of wet towels, poor foot hygiene, walking on contaminated floors and the use of badly sterilised nail cutting equipment are other ways the feet can be exposed to the fungus.

It is estimated that five to ten percent of adults and almost half of those aged 70-plus suffer from fungal nails.

Many people affected by nail fungus would have noticed changes in the texture, quality and colour of their nails. It can take some time before this becomes significant and even more time before any treatment or medical advice is sought. In the case of fingernails it is sometimes only evident once nail varnish or gels have been removed.

Typical first signs are a yellowing or brown discolouration of the tip or an area within the nail. Initially there may be a slight lifting of the end of the nail. There can be dry skin around the nail or chalky debris underneath also.

In clinic, diagnosis is made after discussion about the progression together with an inspection of the nail. The characteristic colour changes of brown, yellow, white or orange and crumbling or thickening of the nail are highly diagnostic. The nail often shows longitudinal lines of discolouration extending back from the tip. A nail sample can be sent for culture in some cases to confirm diagnosis if there is doubt, although this is not always conclusive. Colour and texture changes of the nail together with signs of athlete’s foot – whiteness between toes, red border and scales to the foot, small pus dots around the arch and border or itchiness – are considered to be diagnostic.

Skin and nail fungus is caused by an infection. The skin and nail has to come in contact with the fungi; there must be a route of entry and the immune system fail to respond effectively. Prevention is based on eliminating these items.

It’s essential to:

1. Know what athlete’s foot (tinea pedis) looks like and treat it early and effectively.
2. Take care around public areas, changing rooms and swimming pools. Wear flip flops, dry your feet well and apply an antifungal before putting your socks/shoes back on.
3. Let your feet breathe. Don’t wear the same shoes on consecutive days.
4. Keep your toenails trimmed and clean, as well as the implements you use.
5. Wear cotton or natural fibre socks and leather and breathable uppers in shoes.
6. For those at risk, use an antifungal daily – or weekly as a minimum.
7. Only attend nail salons for manicure or pedicure that have adequate levels of hygiene.
8. Podiatrists specialise in the treatment of the foot and nail. They would be able to care for your nails and general foot health. As a minimum, all instruments are sterilised between patients in an autoclave which kills every germ.