Even celebrities aren't immune from foot-related issues such as the dreaded thickened toenail. Actor Danny DeVito , former basketball player Shaquille O'Neal and Guardians of the Galaxy star Chris Pratt have all posted photos of their poorly pinkies online over the past couple of years.
Author
- Craig Gwynne
Senior Lecturer in Podiatry, Cardiff Metropolitan University
Thickened and discoloured toenails can be caused by a variety of issues, from ill-fitting shoes or trauma from stubbing your toe, to ageing and psoriasis (a chronic skin condition). Often, though, they're caused by a fungal infection.
Fungal nail infections may seem embarrassing, but they're actually very common. Also known by the scientific name onychomycosis , fungal nails affect around 10% of people worldwide, climbing to 50% in older adults .
These infections most often affect the toes, causing nails to thicken, crumble and become discoloured. The effect isn't just cosmetic, though. Fungal nails can cause paronychia - pain and inflammation of the skin around the nail - making everyday activities more challenging.
Fungal nail infections are most often caused by dermatophytes - the fungi that feed on keratin, the protein that gives nails their strength. Yeasts and moulds can also cause the condition.
Sharing communal spaces like gyms , hot tubs , swimming pools and changing rooms increases your exposure to fungal spores . Then, tiny cracks or injuries from everyday wear or poor footcare can allow these organisms to invade the nail - typically through gaps between the hard nail plate and the underlying nail bed.
Older age, weakened immune systems, diabetes and poor circulation make nails more brittle and less resilient to infection. Closed shoes and sweaty feet create ideal growth conditions.
However, a few simple daily habits can help prevent fungal nail infections:
1) Dry your feet thoroughly after each shower or swim - this makes your toenails less inviting to fungi.
2) Choose shoes made from breathable materials and wear moisture-wicking socks to help keep your feet dry.
3) Ensure a good shoe fit and protect your nails during activities to maintain nail health.
4) Wear flip-flops in public areas like pools, gyms and communal showers to limit exposure to fungal spores.
But even if you follow all these measures, a fungal nail infection can still happen. If you develop a crumbly, discoloured nail, how should you treat it?
Home remedies and medication
Applying Vicks VapoRub to the affected nail is a popular home remedy. But while there may be lots of personal success stories on social media, there's scant scientific evidence to support these claims.
As far as I can see, only two small clinical trials have tested the product's effectiveness on fungal nails. One pilot study found that 83% of people showed some improvement, with nearly 28% achieving both a laboratory-confirmed cure and visibly clearer nails after 48 weeks. And another study in people living with HIV reported similar improvements after 24 weeks.
Vicks VapoRub contains ingredients with antifungal properties, including eucalyptus oil, camphor and menthol. The product may also oxidise when exposed to air and sunlight, producing a mild bleaching effect that brightens the nail.
However, it's important to note this product is licensed as a cough suppressant and topical analgesic (a medication applied directly to the skin to relieve pain in muscles and joints), not as a treatment for fungal nail infections. So, while the research findings may sound promising, larger, more rigorous studies are needed to confirm its effectiveness as a standalone therapy.
Alternatively, oral medications are available by prescription and can clear the infection in 50-80% of cases over several months. But they require regular monitoring for side-effects and potential drug interactions, so may not be suitable for everyone.
Topical treatments like paint-on nail lacquers are another option for mild cases affecting one or two nails. These treatments tend to have fewer side effects compared with oral medications, but often struggle to penetrate the nail bed . As a result, it can take six-to-12 months to see improvement as the nail grows out.
Laser therapy is an emerging treatment that uses high-energy light to heat the nail and kill the fungus, while leaving surrounding tissue unharmed. Early studies suggest several laser therapy sessions may lead to clearer nails, but the long-term benefits remain uncertain - and this treatment can be costly due to the need for repeated sessions.
A combined approach that pairs oral medication with topical treatments and regular nail cutting tackles the problem from multiple angles. This method has shown promising results in clearing infections more effectively, particularly when several nails are affected.
Simple lifestyle changes
Fungal nail infections are a widespread condition, influenced by factors like moisture, age, immune status and nail trauma. Simple lifestyle changes can greatly reduce the risk. Advances in treatments, from oral and topical medications to laser and combined approaches, offer hope for healthier nails.
Bear in mind, though, it can be a challenge to tell the difference between thickened nails caused by trauma from footwear, and those caused by a fungal nail infection. So, someone with thick, discoloured nails might home-treat with topical products, mistakenly thinking they have a fungal toe infection. But in fact, they will only see improvement once they remove the cause of the trauma - a podiatrist can diagnose this condition accurately.
In all cases, if you continue to struggle with fungal nail infections, consider seeking medical advice from a specialist. This should ensure you can step confidently into each new day.
Craig Gwynne does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
