Fungal toenails present as brittle, discoloured and thickened. They can often be difficult to cut, and occasionally cause pain. 

For minor toenail infections, often the offending portion of the nail can be cut away and a topical nail lacquer applied. However, for more severe infections where 3 or more of the nails are affected, a systemic medication is recommended. 

The National Institute for Clinical Excellence recommends that prior to prescription of systemic antifungal medication, a positive fungal culture should be proven via mycology testing. Often I see people in clinic who have had fungal testing carried out but received negative results, despite their nails appearing fungally infected. 

There is of course every possibility that the nail changes are not due to fungus but related to another cause. However, there is a chance that the sample was not collected properly initially which has led to a negative result. 

When collecting a fungal nail sample, it is really important to include debris from beneath the nail and not the actual nail itself. This is because the active infection is present in the nail bed, and is rarely in the nail. 

At Hackney Podiatry, I am more than happy to help patients with collecting nail samples for testing. I also offer two methods of testing in clinic: 

• Five Minute Dermatophyte Testing
• Detailed Mycology Testing through Viapath 

For more information on the fees for these tests, please head to my Fees page and do not hesitate to contact me here if you have any questions.