A big-toe nail that thickens, yellows and crumbles at the edge. Skin that peels and itches between the fourth and fifth toes, especially in summer. Most people put off the appointment — "it's only a nail" — try a lacquer from the pharmacy, and a year later nothing has changed.
Here, very concretely, is what a podiatrist does with this problem — and where her job stops.
What the podiatrist does, step by step
She starts by looking at the whole foot, not just the nail that worries you. How long has it been like this? One nail or several? Was there a knock, a shoe that was too short, a running season? Do you swim, use a gym, walk on the beach? What shoes do you wear all day? Do you have diabetes, a treatment that lowers your immunity, circulation problems? This conversation is not small talk: it is where she works out what belongs to her — and what belongs to a doctor.
She then examines the skin as carefully as the nail. Between the toes, under the sole, along the edges of the foot. A fungal nail is very often preceded or accompanied by a skin infection — what people call athlete's foot. Treating the nail while ignoring the skin means leaving the reservoir in place.
Then she works on the nail. This is the core podiatric act: using a burr, she thins the nail down and mechanically removes the damaged, lifted, crumbling part. This has three very practical effects. It immediately reduces the thickness, and with it the pressure in the shoe and the pain when you walk. It removes a good deal of the diseased material. And above all, it allows a topical treatment to actually reach the affected zone instead of sliding across a thick, impermeable plate. That is precisely why a lacquer applied alone, to a badly thickened nail, so often disappoints.
She treats the skin and the neighbouring nails, removes hard skin, corrects the way the nails are cut, and clears the edges. Finally she tackles what keeps the problem going: closed shoes worn all day, synthetic socks, feet left damp after the shower or the pool, shared changing-room floors. None of this is glamorous, and yet it is what decides whether the infection comes back.
Israel: a climate the fungus enjoys
This is not just an impression. Heat and trapped moisture inside a closed shoe are exactly what a fungus needs. Here, the factors stack up: long hot summers, sweating, swimming pools, sand and the shared showers at the beach, gym changing rooms, sandals slipped on with bare feet.
That does not mean giving any of it up. It means that a few habits change a great deal:
- dry carefully between the toes after the shower, the pool or the sea — that is where moisture lingers;
- avoid walking barefoot in changing rooms, communal showers and around pools;
- rotate your shoes so each pair dries out completely between wears;
- choose socks that wick moisture away, and change them if your feet sweat heavily;
- do not share flip-flops, towels or nail clippers;
- treat the skin at the same time as the nail, or the problem simply reinstalls itself.
A nail that is thickening, skin peeling between the toes for weeks? Book an appointment with a podiatrist: a full assessment of the foot, the nail thinned down from the first session, and a clear plan — including, if needed, a referral to a doctor.
What a damaged nail is not always
Here is the point we wish were better known: a thick, yellow, lifted nail is not necessarily a fungus.
It can be repeated trauma — running, a shoe that is a size too short, a toe that hits the front of the shoe on every downhill — which thickens and deforms the nail with no fungus involved at all. It can be psoriasis, which readily affects the nails and produces a very similar appearance, or another skin condition. And more rarely, it can be a lesion that a doctor needs to see without delay.
In other words: treating "a fungus" without knowing risks spending months treating something that is not one. A definite diagnosis often requires a nail sample analysed in a laboratory — an investigation arranged through a doctor or dermatologist. It is especially worth doing before considering tablets, which are not a trivial treatment.
A podiatrist recognises a suggestive appearance, tells you so, works the nail and the skin — and sends you to the doctor when the diagnosis needs confirming.
The dark patch: worth saying, without drama
A dark mark appears under a nail. In the vast majority of cases it is a bruise: a knock, a tight shoe, a long descent on a hike. You can recognise it by one simple detail — it moves towards the end of the nail as the nail grows, and eventually disappears.
What should take you to a doctor promptly:
- a dark patch that does not move with nail growth, week after week;
- a brown or black band running lengthwise that is widening or changing;
- pigment that spreads onto the skin around the nail or onto the cuticle;
- a nail that deforms, bleeds or ulcerates with no obvious cause.
The point is to rule out a melanoma of the nail — rare, but one where the outcome depends directly on how early it is found. This is not a reason to panic. It is a reason to book a medical appointment in the coming days rather than in six months.
Treatments: who does what
The podiatrist: recognises the problem, thins and burrs the affected nail, removes the damaged material, treats the skin and hard skin, teaches you to apply topical care, corrects the way you cut your nails, advises on footwear and hygiene. She also follows you over time, session by session, as the healthy nail grows out.
The doctor or dermatologist: makes the definite diagnosis, arranges a nail sample if needed, and prescribes oral treatment. Tablets are mainly considered for extensive disease, several nails, or when the root of the nail is involved. They can interact with other medicines and sometimes require blood monitoring. Never self-medicate. The UK's NHS is clear that treating a fungal nail takes a long time and that a cure is never guaranteed.
The two roles complement each other: the podiatrist prepares the ground — a thinned nail, healthy skin — so that the prescribed treatment has something to work on.
What to know before you start
Let us be straightforward: treating a fungal nail takes a long time. You do not heal a nail; you wait for a new one to grow. A big-toe nail grows slowly. This is measured in seasons.
And recurrence is common. If the shoes, the moisture, the sweating and the changing-room habits stay the same, the fungus comes back. That is exactly why the "advice" part of a podiatry appointment is not filler: it is what decides the long-term outcome.
What you can expect from a good practitioner: that she tells you this from the start, that she shows you the new nail growing at the base so you can follow the progress yourself — and that she promises you nothing. Nobody can guarantee a perfect nail.
Diabetes, immunity, circulation: the rule that is not up for discussion
If you have diabetes, if you are immunosuppressed or on treatment that lowers your immunity, or if you have circulation problems in your legs, the rule changes completely: any foot problem justifies prompt medical advice. A crack between the toes, macerated skin, an ingrown nail, a small wound you cannot feel — what would be harmless in someone else can move fast in you.
Do not pick at it, do not cut it, do not apply harsh products, do not wait and see. Get it looked at.
Call 101 or go to the emergency department if the foot becomes red, hot or swollen, if there is discharge or an unusual smell, if you have a fever, if a wound is spreading quickly, or if a toe changes colour or loses sensation.
To finish
A damaged nail is never "just cosmetic". It is a nail that rubs in your shoe, that bothers you at the pool, and that can be a signal of something else. The podiatrist is the professional who will look at it closely, work it mechanically so that treatment can finally reach it, treat the surrounding skin, and tell you honestly if what she sees needs a doctor's eyes.
Book an appointment with a podiatrist near you: one session is enough to understand what you are dealing with, to take the weight off the nail and to leave with a realistic plan. And if something under that nail is out of the ordinary — a mark that does not move, a band that is widening — the first door is the doctor's. A good podiatrist will be the first to tell you so.
