Professional nail debridement

Thickened and damaged fungal nail can be carefully reduced by our podiatrists.

This is known as debridement.

Reducing the thickness of the nail can improve comfort, reduce pressure inside footwear and make the nail easier to manage. It may also help some topical treatments reach the affected nail more effectively.

Debridement alone does not necessarily eradicate the fungal infection, which is why it may form one component of a broader treatment plan.

Topical antifungal treatment

Topical antifungal preparations can be applied directly to the affected nail.

They may be particularly useful when fungal involvement is relatively limited or as part of combination treatment.

Because toenails grow slowly and topical medications need to penetrate the nail plate, treatment usually needs to be continued consistently for a prolonged period.

Our podiatrists can advise patients on appropriate application and how topical therapy fits within their overall treatment plan.

Oral antifungal medication

For appropriate patients, prescription oral antifungal medication may provide another treatment option.

Oral terbinafine is commonly used for dermatophyte fungal nail infections, although it is not suitable for everyone.

An important advantage of the HealthiClinic setting is that assessment and prescriptions for oral medications can be arranged on the HealthiClinic premises through an appropriately authorised prescriber when clinically indicated.

Before oral antifungal medication is prescribed, factors such as the diagnosis, other medications, relevant medical history, contraindications and the need for laboratory testing or monitoring should be considered.

This allows fungal nail treatment to remain part of a coordinated clinical pathway rather than requiring patients to independently organise different components of their care.

Laser treatment

Laser treatment is also available as part of the fungal toenail management options at HealthiClinic Podiatry.

Laser uses energy directed through the nail plate and may be considered as an adjunct to other treatments.

However, patients should receive realistic information about the evidence.

Laser should not be promoted as a guaranteed cure for fungal toenails, and current evidence does not support suggesting that every patient requires laser treatment.

Instead, we may incorporate laser into a multi-pronged treatment plan for selected patients alongside measures such as debridement, topical antifungal therapy, oral medication where appropriate and management of potential sources of reinfection.

Why use a multi-pronged approach?

A fungal toenail can be challenging because several factors may contribute to persistence or recurrence.

For example, a thick nail can make topical penetration difficult, fungal infection may also be present on the surrounding skin, footwear can provide an environment for reinfection, and a severely involved nail may respond differently from a mild infection.

For selected patients, addressing several of these factors simultaneously may therefore be reasonable.

At HealthiClinic Podiatry, a treatment plan may combine:

Debridement + topical antifungal treatment + oral medication when appropriate + laser where indicated + treatment of associated skin infection + reinfection prevention.

This does not mean every patient automatically receives all of these treatments.

The combination should be determined after assessment.

Treating the surrounding skin

Athlete’s foot or tinea pedis commonly occurs alongside fungal toenails.

If fungal infection remains on the surrounding skin, it may provide a reservoir from which the nail can potentially become reinfected.

Our podiatrists therefore assess the skin as well as the nails and may recommend appropriate treatment when tinea is present.

Reducing the risk of reinfection

Treatment does not finish with the nail itself.

Patients may also be advised about:

• Drying carefully between the toes
• Changing socks regularly
• Allowing shoes to dry between use
• Managing excessive moisture
• Avoiding sharing nail clippers
• Cleaning nail-care instruments
• Wearing appropriate footwear in communal wet areas
• Treating athlete’s foot promptly
• Reducing repeated trauma to the toenails

A realistic expectation

Even when treatment is successful, the abnormal part of the nail does not immediately become normal.

A healthier nail needs to grow progressively from the base of the nail toward the end of the toe.

Because great toenails grow slowly, visible improvement can therefore take many months.

The aim of treatment is to provide an evidence-informed combination appropriate to the individual patient while setting realistic expectations about treatment duration, nail growth and the possibility of recurrence.