Fungal Nail Treatment

Fungal infection of the nail – known as onychomycosis – is the most difficult of the superficial fungal infections to treat. This is because most treatments available are topical agents (nail paints, ointments, and sprays) and are unable to penetrate the nail plate to reach the infected, which is usually in the skin beneath the nail (nail bed), rather than the nail itself. Getting anti-fungal treatment to this area in sufficient concentration is very difficult making this a challenging problem to treat.

Following consultation, your podiatrist may recommend medicated nail paints or oral medication, and will discuss anti-fungal foot health advice with you. Your podiatrist may recommend the Lacuna Method, which offers an effective solution for fungal nail conditions.

What is the Lacuna Method?

The Lacuna Method can be used by trained podiatrists to treat fungal nail infections. Several rows of tiny holes are drilled through the nail plate to the nail bed – the number of holes depends on the size of the nail being treated and the extent of the infection. Anti-fungal spray (Terbinafine 1% known as Lamisil) is applied over the nail and passes through these holes spreading under the nail to reach the infected area. It can then treat the infection more effectively than simply being applied to the impenetrable surface of the nail. This spray is then applied daily at home, until the infection is clear.


Toe nails grow slowly, and the treatment may need to be applied for 6 months and in some cases even longer. During the treatment period, the affected nails should not be cut at home. You will need to see your chiropodist for this and to monitor the progress of the treatment (approximately every 6 weeks). More holes may need to be added as the nail grows forward.  Any fungal infection of the skin must also be treated, and socks should be ‘hot-washed’ or soaked in Napisan/Milton prior to washing to reduce risk of re-infection.


This treatment is not suitable for everyone – we would like to make you aware of the following:

There are some contra-indications which will be discussed in your initial assessment along with identifying whether the infection is in-fact fungal.

• Making holes in the nail is not painless. Most patients liken it to having their eyebrows plucked or waxing treatment. Any pain is short-lived.

• There is sometimes bleeding from beneath the nail, where some of the holes are made. This is to be expected and a dressing will be applied if required. Treatment with the spray can still be started but there may be some stinging on the first few applications.

• This is not a short treatment – there is no quick fix for fungal nail infections. You need to commit to applying the spray daily for at least 6 months, or the treatment is likely to fail.