Nail Trepination

Treatment advancements in the battle against fungal toenail infection.

The presence of fungal infection in the toenails continues to be a battle for the podiatrist, until now that is…

The two treatments commonly offered for fungal nail infection are ; oral antifungal medication (Terbinafine), or topical antifungal nail lacquer (curanail).

The evidence on the effectiveness of topical antifungal nail lacquers is relatively poor and it requires continual application for up to 18 months.

The use of oral terbinafine is certainly more successful with one study showing complete resolution of toenail fungus in 74% of the patients included in the study.

However some individuals are not suitable candidates to receive oral terbinafine due to the risk of drug interactions and possible side effects. These include patients on anti-depressants, beta blockers and even some cold and flu remedies.

Other treatment modalities on the market have a poor evidence base. These include laser therapy, photo dynamic therapy, tea tree oil, cider vinegar and Vicks’ vapour rub.

We have been using a new treatment at the clinic that has been providing surprisingly good results to even chronically affected nails.

The treatment is called nail trephination and involves the drilling of micro holes in the area of the nail plate that is infected by the fungus.

By introducing micro holes in the nail plate it allows the transfer of the topical antifungal solution to target the source of infection.

We suggest a daily application of topical terbinafine (antifungal preparation) for a period of 2 months and then a review in 2 months to assess the progress of healthy nail tissue.

We also suggest that the footwear and skin is treated with an antifungal spray. This will minimise the likely cross contamination to the nail by the presence of fungal infection on the surrounding skin or in the footwear.

The process is pain-free and takes a total of 45 minutes to perform.

We feel this is an exciting addition to our list of treatments at the clinic and welcome anyone struggling with fungal nail infection to try this new concept.

Appointments can be made by phoning reception on 01224 643803 or booking online at

Our Staff

Meet Our experts

Podiatrist specialising in specialist verruca treatment ( needling) and shockwave therapy for heel pain and Achilles pain.
Beauty therapist and pedicure specialist. Kelly works with our team of podiatrist to offer the pedi-pod treatment.
Clinical Director
Scott Shand
Scott Shand
Podiatrist specialising in foot and ankle sport injuries using manual therapy and orthotic therapy.

what people say about us

I booked an appointment with the podiatrist as I picked up a bad ankle injury playing football and was unable to walk. This turned out to be a torn tendon of my ankle.

Scott was very clear and concise as he explained my treatment over several sessions of mobilisation ,massage and functional exercises and I began to see improvement as each week went by. I'm very happy to say after 3 months of treatment I am now able to walk and participate in sport again.


Absolutely top notch service, a friendlier practice you will not find! Everyone is so pleasant and patient, they really listen to you and address your concerns like the true professionals they are. Very knowledgable and the results were fantastic. Highly recommend The Shand Practice!

Central location with on street parking outside. Great service and flexible appointments. I have been to the practice for various injuries and pains such as 'shin splints' and plantar plate issues. Treatment included; massage, acupuncture, review on how I was running (treadmill) and I was also given exercises to do at home and lots information and tips to stop the problem reoccurring. I would like to thank Scott as it never has!
A family run business who care bout their clients and the results.

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