What Kills Toenail Fungus The Fastest?

Posted 13 Nov

Overview: this article is for you if you’ve struggled to treat a fungal nail infection, if pharmacy lacquers and ointments aren’t working (they don’t work for most people with notable infections), and if you want to find out what your options that have proven results to help you have much healthier, clearer nails come summer.

There’s a reason why finding fixes, cures and solutions to fungal nail infections is a very popular search term online. Fungal toenails are a big problem, and it’s also unlike any other problem that we treat as podiatrists. 

Nail Fungus Is Stubborn

Fungal nail infections are notorious for being “stubborn”. It’s because so many people have no lasting results when they use all the recommended pharmacy medications to treat their nail fungus at home. If you’ve had this experience, you should know that the topical ointments that you paint onto your nails to treat nail fungus have actually been shown in studies to have success rates as low as between 5.5% and 17.8%.⁴ Yep, it’s a pretty grim reality and often not what is advertised.

So why is the effectiveness of these products so low, even if you follow the instructions and use them daily? Because fungus is an organism, it has a life of its own, and it spreads. That’s what makes it different from other injuries we treat like heel pain or Achilles pain where we support the tissues and tendons through the repair process using gold standard principles. In order to beat toenail fungus, you need the right effective treatment and the right person on your team to teach you what you should be doing at home to address the fungus still present in your environment - like your socks and shoes. 

The good news is that’s exactly what our podiatrists do at our Brisbane clinics. 

What Kills Nail Fungus?

There are a few options available on the market, so we’ll explain a little about each one so you know what you’d be in for - and what to avoid.

Hot laser treatment

Like the name suggests, hot lasers produce a heating effect on the nail and any surface that the laser light comes into contact with. The nails are heated to approximately 46-48 degrees - high enough to damage the fungal cells. Your practitioner applies the laser to your nails themselves, typically heating the nail until you reach your capacity for heat discomfort and let them know to stop. This is actually one of the reasons that hot lasers are contraindicated in those with diabetes, as with diabetes, you tend to lose sensation in your feet, which risks the laser getting to the point of ‘burning’ you without your body registering that sensation. Not until it’s too late, anyway. This can create burns which can turn into ulcers.

Hot laser has a mixed bag of results when you look at the studies. These range from cure rates of 33%, to “good treatment outcomes” in 72% of nails treated, where the actual cure rate was only 9.3%. The largest efficacy review of hot lasers included 4278 infected nails, and produced a total cure rate of 63%. Other studies have reported a 0% mycological cure after 12 months, which may be attributed to a high rate of re-infection during this time.

The bottom line? Hot lasers have some studies that show promising results, although at the cost of treatment discomfort and a risk of nasty side effects like burns.

Nail fenestration treatment

Nail fenestration is an interesting one, with several devices currently on the market that can carry out the procedure. Nail fenestration involves drilling very small holes all through the nail. This allows the ointments that you put on your nails to reach deeper into the nail, better reach all the fungal spores, and so have better results for successfully treating nail fungus.

There have thankfully been major advances with nail fenestration in recent years which means that it no longer needs to be a manual procedure vulnerable to user error when knowing how deep to drill the holes (ouch). Now, there are machines that intuitively know when to stop by being able to detect when it reaches the end of the nail layer. Phew! 

Studies show that nail fenestration can improve the delivery of the anti-fungal ointments by up to three or four times. It still does, however, largely rely on the ointment, and being careful with consistent regular application. You also can’t wear any nail polish or do anything that may close the holes as this can invalidate the treatment.

PACT: Photodynamic Antimicrobial Therapy

PACT is the treatment we choose to offer our patients, because we believe that it has the best of everything - it’s easy for our patients, it doesn’t have any discomfort or risks, and it’s shown to be much more effective. 

PACT uses the power of light paired with a special blue dye painted on the nails that magnifies the sensitivity of all the fungus in the area. This interaction creates photochemical reactions that then destroy the fungal cells, eliminating the fungus. The light is not hot, and in the studies, no adverse (negative) events have been reported. Yay!

Our results in the clinic speak volumes, with so many people achieving healthy and clear nails, even if they’ve previously tried other treatments with no luck. In terms of studies:

• Baltazar et al. 2015 reported that patients who were unresponsive to other standard treatments, including oral antifungals responded to PACT.
  
• Figueiredo Souza et al. 2014 reported that PACT had a 100% success rate for mild to moderate and a 63.5% success rate for severe onychomycosis infections.
  

It’s safe to say that we are big fans of PACT treatment, and it quickly became our #1 leading (and preferred) treatment for fungal nail infections by our patients. You can read more about PACT and how it works here, including what a typical appointment looks like. If you have any questions about PACT or any other antifungal treatment, please feel free to contact our team. We’re here to help!

FAQs

Can you get rid of toenail fungus permanently?

Yes - when you treat toenail fungus effectively, then you can permanently get rid of that nail fungus. The caveat is that your nails can become reinfected in the future. Maintaining good foot hygiene and preventive measures can help reduce the chances of recurrence. 

Think of it like breaking a window by throwing a ball at it. You can repair the window (and throw out the ball) so that it’s as good as new. But that doesn’t stop someone throwing a new ball at the window and breaking it again in the future.

Can you just remove a toenail with fungus?

While this isn’t our go-to as a first treatment, in severe cases or as a last resort, your podiatrist may discuss removing the affected nail, either partially or completely. Removing the nail allows direct treatment of all the fungal spores (including those beneath the nail) and gives a new, healthy nail the chance to grow back. Other precautions will also need to be taken that your podiatrist will discuss with you to help prevent reinfection in the future.

What worsens toenail fungus?

Several factors can worsen toenail fungus, including:

• Damp, sweaty environments as they promote fungal growth.
  
• Tight or non-breathable shoes that trap moisture and restrict airflow, creating an ideal environment for fungus
  
• Stopping antifungal treatment too soon or using it inconsistently can allow the fungus to thrive.
  
• Not washing and drying feet properly, especially after exposure to moist environments.
  
• Injuries to the nail can create entry points for the fungus.
  
• Sharing shoes or nail instruments can spread the fungus from one person to another. Always use personal, sterilised nail care tools.
  

Can toenail fungus cause permanent damage to the nail?

If left untreated, toenail fungus can cause thickening, distortion, and permanent damage to the nail. It may also cause the nail to separate from the nail bed. While these effects can’t be reversed, if you treat the infection then your nail can grow out healthy and clear.

Why do some people get toenail fungus more easily than others?

Nail fungus thrives in warm, moist environments, and some people naturally have sweatier feet or spend more time in environments where the fungus can spread (like gyms or pools). Factors like age, weakened immune system, diabetes, or previous nail injuries also increase susceptibility.

Can nail fungus affect my overall health?

For most people, toenail fungus is a cosmetic issue. If the nail thickens significantly, it can also start to become quite uncomfortable in shoes that have a smaller toe box.