A fungal nail infection, or onychomycosis as it is known in the clinic, often begins so subtly that patients only notice when the damage is already done. Singapore’s year-round warmth, combined with heavy monsoon downpours, creates the exact conditions fungus loves: damp shoes and sweaty feet, which have little chance to dry out properly. Studies suggest that about one in seven adults in Singapore will experience a fungal nail infection at some point. This common nail infection, among the most prevalent, primarily affects toenails.
Whether you’re pounding the paths at East Coast Park, spending long hours in air-conditioned offices along Orchard Road, or changing in shared gym facilities in the CBD, the risk is real. Over the years at The Foot Practice, we’ve treated hundreds of cases of fungal nail infection, giving us the experience to guide people back to fungus-free feet and provide comprehensive foot care.
What Is a Fungal Nail Infection?
Onychomycosis, also known as tinea unguium, develops when dermatophyte fungi, most often Trichophyton rubrum, and specific yeasts or moulds invade the nail bed or plate. These nail infections occur when organisms love the warm, dark confines of a shoe, where feet remain constantly warm. That’s why toenails suffer far more than fingernails, roughly tenfold, from the constant compression, heat, and restricted airflow. Toenail fungus infection is particularly stubborn once established.
Anyone who spends the day in trainers, whether pounding the pavement or standing in an office, ends up in the perfect environment for fungus to thrive and keep feet hot. Left unchecked, the affected nail gradually thickens, edges start to crumble, and a faint, unpleasant odour can appear. From there, the infection can spread to other nails or the surrounding skin, leading to additional skin conditions.
What Causes Fungal Nail Infections?
Getting a handle on what causes nail infections and fungus under the toenail is the real key to keeping them at bay. Nail fungus doesn’t just appear; it waits for an opening in the nail’s natural barrier. The usual suspects in the clinic include:
- Microtrauma: Little splits from shoes with narrow toes that pinch at the toes, a dropped dumbbell, or the steady pounding of runs. Even a minor nail injury can create an entry point.
- Moist environments: Socks that stay damp after the morning MRT ride, or the slick floors of public showers where feet remain constantly warm and moist.
- Poor hygiene: Sharing clippers at the salon or skipping thorough drying between the toes. Never share nail clippers with others.
- Compromised immunity: Diabetes, years of smoking, those with a weakened immune system, chemotherapy treatment, or organ transplant all slow the body’s fight-back. Those with underlying health conditions need extra vigilance.
- Athlete’s foot crossover: Untreated tinea pedis, also called athlete’s foot, is the entry point in roughly a third of cases; the same fungi hitch a ride on fingers or a towel, then travel straight to the nail. This skin fungus spreads easily.
Singapore’s heat, paired with the hard, unforgiving floors of offices and malls, sets the stage for a fungal nail infection. Even a minor infection can flare up quickly if you keep slipping into the same old shoes, since spores can remain active for months. Be aware of the causes of fungal nail infections, as these can make a difference in your long-term foot health and help prevent fungal nail infections.
Risk Factors for Fungal Nail Infection
While fungal nail infections can happen to anyone, some are more prone than others. Those with a weakened immune system, undergoing chemotherapy treatment or living with chronic illnesses, are more at risk as their bodies can’t fight off the fungal infection. Poor blood circulation, common in older adults or those with diabetes, also increases the risk of fungal nail infection by slowing the delivery of infection-fighting cells to the affected toenail and toenails.
As we age, nails grow more slowly, and toenails become more vulnerable to fungal nail infection and fungal invasion by toenail fungus. A history of athlete’s foot or other skin fungus can also pave the way for nail infections, as the same fungi can spread from skin to nail bed and infect the whole nail. These nail infections can be stubborn.
Lifestyle habits also play a part. Those who wear shoes that are too tight or made of non-breathable materials create a moist environment that favours the growth of fungal nail infections and toenail fungus. Sharing nail clippers or other personal grooming tools can transfer fungal spores from one person to another, increasing the risk. Walking barefoot in communal areas like locker rooms or swimming pools exposes feet to fungus that lingers on damp surfaces, increasing the risk of nail infections and other foot problems.
Being aware of these risk factors is the first step toward preventing fungal nail infections. Simple changes like keeping nails short, wearing flip flops in public showers, and never sharing nail clippers can make a big difference in protecting your foot health. You should also wear cotton socks to keep your feet dry and prevent sweaty feet.
Recognising Symptoms Early
The changes creep in slowly, often over several weeks or even months, which is why many patients seek help only when the nail looks unmistakably off. Keep an eye out for toenail fungus symptoms affecting your toenails:
- White or yellow streaks appearing just under the nail tip of the affected nail
- Toenails that thicken or warp out of shape
- Edges that flake away or split without warning
- The beginning of lifting from its bed (known as onycholysis)
- A general loss of gloss, occasionally with a faint green cast from bacteria that tag along
- Thick nails that are difficult to trim
A fungal infection under the nail can begin as nothing more than a tiny blemish on the affected nail, yet without attention, it will spread until the entire nail plate is involved. Toenail fungus pain usually stays quiet until the nail loosens enough to catch on socks or press against the toe when you walk. Don’t wait for it to get that far. Keep a close eye on your toenails and seek help if you see something is off. Tinea unguium requires prompt attention.
How We Diagnose Onychomycosis at The Foot Practice
At The Foot Practice, we begin with a thorough history, followed by:
- Clinical examination: This is done under bright light to assess the nail texture and colour of the affected nail.
- Clipping analysis: A sample is treated with potassium hydroxide (KOH) and viewed under a microscope to confirm fungal elements, which are positive in around 70% of cases.
- Fungal culture (if needed): This is performed to identify the exact species, such as T. rubrum or T. interdigitale, which will guide the choice of intervention for toenail fungus.
- Blood tests: These may also be performed to monitor liver function before and during systemic antifungal treatment, ensuring patient safety.
It’s important to distinguish a fungal nail infection from a bacterial infection, as each requires different diagnostic and management approaches. This rules out mimics such as psoriasis, trauma, or lichen planus, ensuring targeted care for toenails.
Management of Fungal Nail Infection
No single cure fits all. Success in curing a fungal nail infection hinges on the severity of the nail infection, the patient’s health, and compliance. Most fungal nail infections are caused by the dermatophyte fungi associated with athlete’s foot, which invade the infected nail and spread inward.
Antifungal nail medicine is a key part of management, requiring regular application and prolonged use until the infection clears. If topical medication is not practical, your healthcare provider may prescribe antifungal tablets. However, antifungal tablets are not suitable for those with kidney disease, and you should inform your doctor about other medications you are taking. Some patients experience an itchy rash and stomach ache as side effects. Here’s a snapshot of The Foot Practice’s evidence-based approach:
| Topical Fungal Nail Infection Treatments | For mild cases affecting less than 50% of the nail: Amorolfine lacquer (Loceryl): Applied weekly for 6–12 months; penetrates effectively Ciclopirox or fungal infection cream formulations: helpful for early distal involvement Suanfix Antifungal Cream: Our clinic’s botanical blend with tea tree and undecylenic acid, used alongside mechanical debridement Topical treatments work well when the fungus has not reached the whole nail. |
| Oral Antifungals | When the infection is widespread or topical access is limited, antifungal tablets offer the best approach: Terbinafine (Lamisil): 250 mg daily for 12 weeks; clears ~70% of cases but requires liver monitoring to avoid rare side effects like fatigue or nausea. Cure rates vary depending on severity. Itraconazole pulse dosing: Used for resistant yeasts or moulds |
| Adjunctive and Advanced Therapies | Medical pedicures: Safe thinning of thickened toenails under sterile conditions, improving topical penetration Laser treatment: Heat or photochemical action targets fungus without drugs; 3–5 sessions (~$200–400 each) yield 60–80% improvement with no downtime. Laser treatment offers an alternative to oral medication. Avulsion: Partial or full removal for severe, painful nail infection cases, followed by antifungal prophylaxis; a rare procedure for the infected nail. |
| Surgical Fungal Nail Treatment Options | For stubborn nail infections where standard fungal nail infection interventions fail, particularly in thick, painful nails, surgical removal is an option. In these cases, we simply take out the infected portion or the entire nail under local anaesthesia, clearing the way for healthy regrowth. This treats badly infected nails effectively. This step is reserved for when topicals, orals, or lasers haven’t worked, or when the nail hampers walking or daily tasks. Post-procedure, the site needs to be kept clean and feet dry. We often pair the procedure with laser sessions or ongoing antifungals to minimise recurrence of toenail fungus. |
If your infection persists despite months of effort, see a podiatrist promptly. They’ll evaluate whether surgery is a good fit for your management plan.
After Fungal Care
After your fungal care is over, the job isn’t done. The following steps are critical to addressing the cause and preventing the problem from arising again. Our podiatrists will offer the following to protect your feet from harmful toenail infections:
Footwear assessment
Switching to breathable mesh trainers or seamless cotton socks. Discard old shoes that may harbour fungus. Daywear flip-flops in communal or public areas, such as gyms, locker rooms, and swimming pools, to reduce the risk of infection and maintain foot hygiene.
Custom orthoses
Offloading pressure in high-arched or flat feet to prevent recurrence. RehaWalk® gait analysis: Identifying abnormal loading that stresses the toenails.
Prevention
Daily Habits To stop fungal nail infection before it starts, and prevent fungal nail infections, do the following:
- Dry feet thoroughly, especially between toes, after showers or pool visits. Keep feet dry at all times.
- Use antifungal powder in shoes during wet seasons to combat nail fungus.
- Rotate footwear and avoid vinyl materials that trap moisture.
- Always wear shoes that breathe.
- Disinfect nail clippers with alcohol, and never share them with anyone.
- Treat athlete’s foot promptly to prevent nail invasion and reduce the risk of early tinea pedis affecting toenails by 30%. Wear cotton socks and keep nails short to help avoid onychomycosis (toenail fungus).
Prevent toenail infections, including toenail fungus and tinea unguium, by maintaining good foot hygiene and monitoring for any changes in toenail appearance. Watch for early signs of nail fungus or fungal infection.
Take Control of Your Nail Health
A fungal nail infection doesn’t resolve on its own, but with early intervention, most patients achieve clear, healthy new nail growth. Whether you’re noticing the first yellow streak on an affected nail or battling years of thickening of toenails, The Foot Practice offers precise diagnosis and tailored fungal nail infection management in Singapore. Tinea unguium and toenail fungus respond well to proper management. Book a skin and nail care consultation today at our Orchard Road clinic.
