Introduction

Definition of toenail fungus (onychomycosis)

Onychomycosis is a fungal infection that affects the toenail. This occurs when a fungus enters the space between the toenail and the toenail bed, which is the tissue underneath.. This can occur when there is a crack or a cut in your nail.¹

It is a very common infection of the nails and is especially prevalent in the elderly, affecting around 1 in every 10 people.¹

Causes and risk factors

Fungal pathogens 

Toenail fungus is caused by a dermatophyte, which is a mould that feeds on a protein called keratin to grow. Keratin is an essential protein that makes your nails hard. These dermatophytes are responsible for most toenail fungal infections.^1,2

Common sources of infection^1,3,4

Most nail fungi love to grow in moist, warm and dark places, so you can get toenail infections  from:

• Public showers
• Walking around the perimeter of swimming pools
• Nail salons
• Tight footwear
• Walking barefoot in public areas

Risk groups^1,2,4

Anyone can get toenail infections, but they usually affect the elderly over the age of 60 years old. You can be at a higher risk of getting toenail fungus if you have any underlying conditions, such as:

• Athlete's foot - common in athletes or those who wear tight footwear
• Hyperhidrosis
• Diabetes
• Peripheral vascular disease
• Nail injury
• Psoriasis
• People who have a weakened immune system

Symptoms^1,5,6

Toenail fungus can affect your nails in various ways:

• Change in colour - which occurs suddenly and growing white, yellow or brown parts
• Thickened nail
• Looks chalky and cloudy
• The nails are cracked and broken in several places.
• Separated from the nail bed

Personal hygiene and foot care^1,4,5,6

You cannot guarantee that you will not get toenail fungus, but there are steps you can take to help prevent it, such as:

• Properly washing and drying your feet
• Keeping the toenails trimmed and clean
• Avoid sharing nail tools and footwear
• Using antifungal powders and or sprays - normally found at your local pharmacies
• Trimming toenails after a shower or after soaking your feet in warm water 
• Not ripping or tearing your toenails
• Cleaning your nail trimmer before using it 

Footwear and socks selection^1,4,5,7

You can also prevent toenail fungus by selecting appropriate footwear, including:

• Choosing breathable shoes -  shoes that provide ventilation and are made of  moisture-wicking materials
• Rotating shoes to prevent damp environments
• Wearing moisture-absorbing socks –cotton, wool, or  synthetic blends
• Avoiding tight-fitting or non-breathable shoes
• Wearing shoes that fit correctly - they should not be too loose or too tight around your toes

Environmental and lifestyle measures^1,2,4,5,6

Other ways you can also prevent it are by:

• Using shower sandals in public areas
• Regularly disinfecting your footwear and nail tools before using them 
• Keeping your feet dry, especially after sweating
• Strengthening the immune system - by following a healthy diet and regular exercise

Nail salon and professional care tips^1,2,4,5,6

You can also prevent it by:

• Ensuring proper sanitation occurs in nail salons 
• Bringing personal nail care tools
• Avoiding artificial nails and nail polish for prolonged periods

It is important to seek professional podiatric advice if your toenail infection is recurrent. 

Early intervention and monitoring^1,5,6,7

You can help reduce symptoms by making sure you are monitoring:

• Early signs - discolouration, thickening of nails, and  brittle nails 
• Using over-the-counter antifungal treatments when necessary, found at your local pharmacy
• Consulting a doctor for persistent or severe cases

Conclusion

Toenail fungus is a common nail infection that can happen to everyone, but especially affects the elderly. Though it is not harmful, it is quite difficult to treat. You may feel self-conscious about how your foot looks. If you start to notice any signs of infection, speak with your local pharmacist, who may give a cream or spray, but if it persists, it is important to speak with a trained specialist, such as a doctor or a dermatologist, who can guide in helping you treat it.