A discoloured, thickened toenail is easy to spot. What’s less obvious is what to do about it, and why the treatments you’ve already tried may not have worked.
Fungal toenail treatment is rarely a one-and-done solution. The infection lives inside and under the nail, which makes it genuinely difficult to reach, and because toenails grow slowly, even a successful treatment takes months before you see a visibly healthy nail. Understanding what your options are — and how they work together — makes a significant difference to your outcome.
Before You Start: Get the Right Diagnosis
Not every discoloured or thickened nail is fungal toenail infection. Nail trauma, psoriasis, and bacterial infections can all produce similar-looking changes, and treating the wrong condition will get you nowhere.
Your podiatrist may take a nail sample and send it to pathology to confirm the diagnosis and identify the specific type of fungus present. This matters because different fungi respond to different treatments, dermatophytes, yeasts, and non-dermatophyte moulds each have their own most effective treatment pathway. Starting treatment before you have a confirmed diagnosis is one of the most common reasons people end up going in circles.
Fungal Toenail Treatment Options
Laser Therapy
Laser therapy is currently one of the most effective in-clinic fungal toenail treatments available, and it’s the primary treatment we use at Sole Podiatry.
It works through a process called photobiomodulation, the application of red and near-infrared light through the nail. The high-energy laser beam heats the fungus to the point of destruction while simultaneously stimulating new nail cell growth underneath. Most other nail laser machines can only do one or the other. Sole Podiatry uses a Class 4 K-Laser, which is one of the few machines capable of both actions in a single session, which is why results tend to be stronger.
Treatment is not painful, though you’ll feel a small amount of warmth during the session.
What a typical laser treatment course looks like:
- The nail is cut, filed, and thinned using specialised podiatry instruments before each session, this allows better laser penetration to the nail bed.
- 5 sessions are performed, usually weekly or twice weekly.
- After the 5th session, a 4–6 week growth period follows, with topical treatment recommended during this time.
- At the 4–6 week review, new nail growth from the base is assessed, and a top-up laser session may be advised for advanced infections.
- Subsequent reviews and top-ups are guided by your podiatrist based on how quickly your nail is growing and the degree of infection.
Because nail growth is slow, visible results can take a few months, but the aim of laser treatment is to destroy the fungus at the source so it stops reinfecting any new nail coming through.
Topical Antifungal Treatments
Topical treatments are applied directly to the nail and surrounding skin, and they play an important supporting role, both alongside laser therapy and as a standalone option for milder infections.
The right topical product depends on your pathology results:
- Dermatophyte infection (e.g. Trichophyton rubrum): Daktarin nail lacquer, applied daily
- Yeast infection: Canesten topical nail lacquer, applied daily
For the skin, a Terbinafine cream or spray (such as Lamisil) applied once or twice daily addresses any tinea pedis that may be fuelling the nail infection. This step is frequently overlooked, but if athlete’s foot is present and untreated, it will keep reinfecting the nail regardless of what you’re doing to the nail itself.
Apple cider vinegar foot soaks (5–15 minutes, 3–4 times per week) can also be a useful addition due to its antimicrobial properties.
Oral Antifungal Medication
For more severe or persistent infections, your GP may prescribe oral antifungal medication. Oral antifungals work systemically, reaching the nail bed through the bloodstream, which gives them a broader reach than topical treatments alone.
That said, oral medication isn’t suitable for everyone. It can interact with other medications and may cause side effects, so a conversation with your GP about suitability is essential before starting a course. Your podiatrist can work alongside your GP to coordinate this as part of an overall treatment plan.
Nail Debridement
Debridement, the professional cutting, filing, and thinning of the infected nail, is a core part of in-clinic fungal toenail treatment, not just a cosmetic step. Thinning the nail plate improves the penetration of both laser therapy and topical treatments to the nail bed, where the fungus actually lives.
It also reduces nail thickness and discomfort, particularly if the infected nail has become painful inside footwear.
Nail Removal
In cases where the infection is severe and hasn’t responded to other treatments, surgical nail removal may be considered. This allows direct treatment of the nail bed and removes the infected nail plate entirely. It’s typically a last resort, and your podiatrist will discuss whether it’s appropriate for your situation.
If the nail has been severely damaged by infection, KeryFlex may be the best treatment for fungal toenail restoration while a healthy nail grows back. Read more about the treatment here.
Why a Multi-Level Approach Gets Better Results
No single treatment works in isolation, and this is the key reason so many people struggle to clear a fungal toenail infection despite trying multiple products.
The most effective fungal toenail treatment combines:
- In-clinic laser therapy to destroy the fungus within the nail.
- Topical antifungals applied to both the nail and the skin.
- Oral antifungals where indicated and prescribed by a GP.
- Footwear hygiene to remove the reservoir of fungal spores living in your shoes.
At Sole Podiatry, we also offer UV shoe sanitising in clinic. Bringing your shoes in for sanitising is something we actively encourage, spores can survive in footwear long after treatment begins, and reinfection through shoes is a common reason treatment fails.
Treating the Skin, Not Just the Nail
This is worth its own mention because it’s so commonly missed. A fungal skin infection (tinea pedis) and a fungal nail infection act as reservoirs for each other. If the skin between your toes or on the soles of your feet is infected, it will continue to reintroduce the fungus to your nail even while you’re treating it.
A complete fungal toenail treatment plan always addresses both. Your podiatrist will assess the skin as part of your initial consultation and factor any skin infection into your treatment plan.
Understanding the full picture of what causes a fungal toenail infection can help you make sense of why treating both skin and nail is so important. Read more about it here.
How Long Does Fungal Toenail Treatment Take?
This is usually the first thing people want to know, and the answer requires honesty. Toenails grow slowly, typically 1–2mm per month, so even once the fungus is destroyed, it takes time for a visibly clear nail to grow through.
For most people, treatment involves:
- 5–6 laser sessions over 5–6 weeks.
- A 4–6 week review to assess new growth.
- Several months before the nail looks visibly healthy, depending on the degree of infection and individual nail growth rate.
Sticking with the full treatment course, including the at-home topical component, is what makes the difference between a partial result and a lasting one.
What to Expect at Your First Appointment
Your initial consultation at Sole Podiatry runs for 45 minutes. During this time, your podiatrist will examine the affected nail, assess the surrounding skin, discuss your history, and develop a comprehensive treatment plan. If a nail sample is needed for pathology, this will be arranged through your GP.
You don’t need a referral to see a podiatrist, and Medicare CDM rebates are available with a valid referral from your doctor.
Frequently Asked Questions
Does fungal toenail treatment hurt?
Laser therapy is not painful, most people feel a mild warmth during the session, nothing more. Nail debridement uses specialised podiatry instruments and is generally well tolerated. If your nail has become painful due to thickening, treatment often brings relief rather than discomfort.
Can I paint my nails during fungal toenail treatment?
It’s best to avoid nail polish on infected nails during active treatment as it can trap moisture and interfere with topical treatments. Once the infection has cleared, nail polish is fine, and if appearance is a concern in the meantime, ask your podiatrist about KeryFlex, a nail restoration option that can be painted over.
Will the fungal infection come back after treatment?
It can, particularly if the underlying conditions that allowed it to develop haven’t changed, such as footwear habits, skin infections, or exposure to communal areas. Completing the full treatment course, maintaining good foot hygiene, and sanitising your footwear significantly reduces the risk of reinfection.
Do I need a referral to see a podiatrist for a fungal toenail?
No referral is needed to book an appointment at Sole Podiatry. If you have a valid Medicare CDM referral from your GP, a rebate can be applied, but you can book directly without one.
The Right Treatment Makes All the Difference
Fungal toenail treatment works best when it’s targeted, consistent, and addresses the full picture, not just what’s visible on the nail. If you’ve been dealing with a stubborn nail that hasn’t responded to over-the-counter products, a professional assessment is the most efficient next step.
Our team at Sole Podiatry can diagnose, treat, and support you through the full process. Book an appointment online or call us on (03) 9939 1012.
