Fungal infection of the nail (onychomycosis) is the most difficult of the superficial fungal infections to treat. The active infection is usually on the skin beneath the nail (nail bed), rather than in the nail itself. Getting sufficient amounts of an anti-fungal treatment to this area is very difficult. The nail plate acts as a barrier to the active infection on the skin underneath and most treatments available are topical agents (nail paints, ointments, and sprays), which are unable to penetrate the nail plate and reach the infected skin.
What is the Lacuna Method?
The Lacuna Method is only available from suitably qualified individuals. Several rows of very small 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 then applied over the nail and passes through these holes spreading under the nail to reach the infected area. The contours of the underneath of the nail allow the treatment to spread along the nail bed, stopping the fungus spreading and encouraging the healthy nail to grow out. The anti-fungal spray is then applied daily at home, until the infection is clear.
Who can benefit from the Lacuna Method?
People with a moderate to severe fungal nail infection - Symptoms of fungal nail infections include:
Nail discolouration - usually either white/dark/yellow
Brittle nail texture
Build up of debris under the nail
Lifting of the nail
Introductory Treatment Prices
All patients must have a New Patient Appointment before booking a Lacuna treatment appointment. During your New Patient Appointment we will:
assess the nails and infection to ensure as accurate a diagnosis as possible. For certainty in diagnosis, we can perform a fungal nail test (see below) that can be done during the appointment. Results for the fungal nail test take just 5 minutes.
have a detailed discussion about your treatment options, including reasons why some treatments may be more or less suitable for you.
discuss the intended benefits and risks associated with different treatment options.
give advice to help prevent future re-infection.
Treatment: (price includes first bottle of Lamisil) 1-2 nails (30 minutes) £65.00 3-5 nails (60 minutes) £95.00 6 nails + (90 minutes) £145.00 Fungal nail test: £40.00
In order to improve treatment outcomes and prevent recurrence, follow the advice below:
We strongly advise against cutting your own toenails during the treatment period. Instead please return to the podiatrist every 6-8 weeks to have the progress assessed, the nails trimmed and further holes drilled as necessary.
Foot hygiene is essential, wash your feet well at least once a day and dry carefully especially between the toes.
Keep the feet cool and dry as far as possible.
Avoid sharing towels, socks and shoes.
Consider replacing old footwear as this could be contaminated with fungal spores.
Wear footwear in public places, such as communal showers.
Wear mixed / blended socks and change them every day, replace often.
Rotate footwear and wear properly fitted shoes with a wide toe box to prevent injury to the nail.
The intended benefit of this treatment is to resolve fungal nail infection. However, this treatment is not suitable for everyone – we would like to make you aware of the following known risks for treatment using the Lacuna method: • Making holes in the nail may not be painless. The thinner the nail, the more likely that the burr will come into contact with the nail bed, which may cause bleeding. There may also be some pain or discomfort, which should be short-lived. • There is sometimes bleeding from beneath the nail, where some of the holes are made. Should this happen, a small dressing will be applied if required. If bleeding occurs, do not use the antifungal spray until 4 days after. Be aware, that there may be some stinging on the first few applications.
Lamisil spray is a treatment for fungal infection of the skin not the nail. Anti-fungal skin treatments are much more effective than fungal nail treatments. The majority of fungal nail infections are under the nail, on the nail bed and fungal nail treatments struggle to make it through to the affected skin underneath. The holes in the nail made during this appointment will allow the medication to get to the infected area much more quickly.
The Lacuna Method 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.
No nail varnish may be worn during the duration of the treatment.
It is likely that you will need to return to the chiropodist to have your affected nails trimmed and further holes drilled at the base of the nail, as the nail grows forward. It is likely to be about 8 weeks before more holes need to be made at the base of the nail, this is because infected toenails grow slowly and it is important to assess how well the treatment is working before having further treatments.
Any fungal infection of the skin must also be treated.