Fungal nail infections are common, particularly in older adults. Around 1 in 5 people over 60, and up to half of those over 70, may be affected. It is seen more often in men. It is not usually serious, but it can be unpleasant in appearance and at times difficult to treat.
The infection develops gradually. Over time, the nail may:
- Change colour (white, yellow, brown or black)
- Become thicker and misshapen
- Be harder to cut and manage
It usually starts at the top or edge of the nail and can gradually spread from nail to nail as it progresses.
What causes it?
Most infections are caused by the same fungi responsible for athlete’s foot.
These fungi can live on the skin without causing harm but may lead to infection when conditions allow them to grow, especially in:
- Warm
- Damp
- Enclosed environments (such as inside shoes)
Who is more likely to get it?
You may be at increased risk if you:
- Have sweaty feet or wear enclosed footwear for long periods
- Walk barefoot in shared areas (e.g. swimming pools, gyms, changing rooms)
- Have untreated athlete’s foot
- Have damaged or injured nails
- Have conditions such as diabetes, psoriasis or poor circulation
- Have a weakened immune system
- Have poor foot hygiene
Signs and symptoms
In the early stages, there may be little or no discomfort.
As the infection progresses, you may notice:
- Discolouration of the nail
- Thickening or distortion in shape
- Nails becoming brittle, crumbly or breaking away
- Difficulty cutting the nail
Some people may experience:
- Pain or discomfort, especially when wearing shoes
- Changes to the surrounding skin, such as redness, itching, flaking or swelling
If the skin around the nail becomes inflamed or infected, seek advice from your GP or pharmacist.
Do you always need treatment?
Treatment is not always necessary if the nail is not painful or causing problems.
However:
- Fungal nail infections do not usually clear on their own
- They may spread or worsen over time
Good nail care can help keep nails comfortable and prevent complications.
Looking after your nails (self-care)
- Trim nails regularly, cutting straight across
- File down thickened areas
- Avoid cutting into the corners of the nail
- Keep feet clean and dry
Routine podiatry is not usually required for fungal nail infections.
Treatment options
Medicated nail lacquers, may be suitable for mild or early infections.
- Usually applied once or twice weekly
- Require regular use for several months
- May not change nail thickness or shape
- Always check with pharmacist to check if this is suitable for you to use.
Tablets may be prescribed if the infection is more severe:
- A nail sample is usually tested first to confirm fungal infection
- Treatment typically lasts 3–12 months
- Blood tests may be needed before and during treatment
- Not suitable for everyone
Important to know about treatment
- Improvement takes time, often up to 12–18 months
- Healthy nail should begin to grow from the base
- The damaged nail will gradually grow out
- The nail may not return completely to normal
Other treatment options
This may be considered if the nail is very painful or severely affected, usually after other treatments have not worked. If you wish to explore whether this is appropriate, please contact the podiatry service for advice.
- May be considered if the nail is very painful or severely affected
- Usually, a last option if other treatments have not worked
- The nail may regrow, sometimes still affected
This may be an option for stubborn fungal nail infection and is usually accessed privately. NHS Forth Valley Podiatry Services do not provide this treatment.
How to reduce your risk
Do:
- Keep feet clean and dry
- Change socks daily
- Wear well-fitting shoes made from breathable materials
- Replace old footwear if needed
- Treat athlete’s foot promptly
- Maintain regular nail care
Avoid:
- Walking barefoot in communal areas
- Sharing towels, socks or nail care equipment
- Wearing tight or non-breathable footwear for long periods
- Nail injury or trauma where possible
When should you seek advice?
Seek advice from your GP or pharmacist if the skin around the nail becomes red, swollen, itchy, flaky or infected. Contact the podiatry service if you wish to discuss whether nail surgery may be appropriate.