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Frequently Asked Questions Regarding Fungal  Toe nail Treatment 

Onymychosis At Deva Podiatry Foot Health Clinic Chester





























At Deva Podiatry Foot Health Clinic, Chester we offer a number of treatment options for fungal nail infection. Within an initial consultation we can assess your foot health condition and advise as to whether you have  fungal nail infection (onymychosis) and can develop, with you, a suitable plan of action to reduce its presence.


It is common for a patient to present at clinic with a belief that fungal nail infection is present. A specialist podiatrist can advise and most importantly offer a correct diagnosis of the condition, often and where the nail fungus is mild a suitable topical treatment can be supplied for the patient to administer and apply topically.


In some cases and dependent on factors such as age and underlying health conditions, as a podiatrist I am able to recommend that a GP prescribes an oral alternative. This option would be discussed with you during an initial consultation.

Online research can be extremely helpful but can also throw up added confusion. Images can be enhanced or photographed in poor light. The origin or age  of an image is not known and often the image does not relate to the stated condition.

If you have doubts as to whether you have fungal nail we are able to offer an in clinic diagnostic test. This test is an optional stage in helping you make decisions on how you wish to proceed.

A knowledgeable Podiatrist can address your concerns and set up a  pathway towards resolution.

Although we refer to the condition as fungal nail, modern Podiatric research has established that the fungus establishes itself below the nail and above the nail bed creating a cavity where it thrives on the underside of the nail in its own eco-system. Over the counter products have little effect on the eradication of the condition as they are unable to penetrate through the nail. At best some may " bleach" the outer nail to appear whiter.


If after your initial consultation it is determined that fenestration ( The Lacuna Method ® )  is a potential solution  we can discuss a suitable treatment plan.


About Fenestration ( Fungal Toenail Treatment) - The Lacuna Method ®


Lacuna Method® for fungal nails involves a specialised technique to safely and painlessly introduce multiple tiny holes across the fungal area of the affected nail. A topical anti-fungal agent is then applied to the nail which is then able to reach the affected area beneath the nail plate via the small holes which act as a portal.

In clinic we use an array of sterilized micro tools and techniques to ensure that the anti-fungal agent is assisted in directly reaching the affected areas. 


 No anaesthetic is required and the procedure is generally completely pain free.

As part of the treatment regime the patient administers a recommended anti-fungal agent  daily at home.  The patient returns to clinic on 4 further occasions for a 6 weekly progress session. Further micro holes are placed in the nail as the affected areas grow out during treatment. High levels of record keeping are maintained through photographic updates on changes and treatment notes to correspond with each session.


Additional advice on best evidence foot health hygiene is provided thoughout the process as a compliment to the treatment plan. Evidence has shown that where the treatment  plan is followed results are highly encouraging.

The initial treatment plan is tailored to a six month period which is equal to the growth cycle of  around 1/3 to 1/2 a full nail cycle. Patients have the option to continue with the treatment programme  with repeat cycles or withdraw to independently maintain their foot health.

The Lacuna Method® History

Fenestration was originally developed and patented in the USA in the late 1970's. At the time the ability to administer appropriate medicaments was not as well developed and research identified that the creams and potions of the day could not penetrate micro-holes and contra  the size of hole needed would be ineffective at retaining the creams and allow for an effective treatment action.

In recent years advances in nano-technology have allowed for gels and sprays to be developed that contain active ingredients at micro particle level. This has allowed for the fenestration method to return as the delivery method for such anti-fungal agents.

The Lacuna Method® has been developed as a process by leading Podiatrists and is now being used internationally by Podiatrists who recognise the benefits of the method in addressing fungal nail infections. The Lacuna Method® has become the preferred method of treatment at many of the UK's advanced Podiatry Clinics. At Deva Podiatry as advocates of Resolution Podiatry  we consider ourselves to be such a clinic and commit ourselves to best practice modern podiatry.


There are a number of contra-indications to treatments for fungal nails infections all of which will be discussed at your initial consultation.


Identifying whether there is a fungal nail infection may require some additional tests.

There are no 'quick fixes' to any treatments offered of any nature for fungal nail infections due to the nature and complexity of the condition. You will need to adhere to any treatment regimes as directed by your podiatrist.

Further  treatment sessions will be required to be completed at approx 5-6 weekly intervals. Within these sessions progress is monitored and recorded and your podiatrist will discuss progress and developments with you.


Terbinafine liquid is used for the purposes of the Lacuna method for fungal nails. The spray is used "off licence" as it is intended for use on the skin. However, the Lacuna method® introduces small holes allowing the liquid to penetrate to the skin beneath the nail  plate to be effective on the organisms responsible for fungal infections.

Where it is deemed that Terbinafine is not a suitable treatment liquid we have alternative liquid medicaments available.These alternatives are approved and regulated by the relevant UK and EU guidance and suitability will be discussed with you.

In addition to the course of fungal nail treatment it may be necessary to self-administer a complimentary  regime to your feet with a suitable antifungal treatment.

There may be some slight discomfort during or after treatment and/or minor bleeding. If this occurs a sterile dressing will be applied and it will not affect your being able to proceed with your treatment.

Strict hygeine methods will need to be adhered to in order for any treatment to work effectively, all this will be discussed with you in detail at all appointments. At Deva Podiatry we have produced a detailed information sheet that will be provided to assist you.

Fee Structure For Lacuna Method® -Fungal Nail Fenestration

Fungal Nail Treatment Initial Consultation Fee £65.00 - advice with recommendations of suitable treatment specific to each persons needs.

If you are to proceed, preparatory work is carried out within the initial consultation.

The Lacuna Method® Fungal Nail Treatment course consists of 4 further appointments at 6 weekly intervals over the following 6 months.

Payment for the course is offered by one of two options:-

Option 1 - Full course of Lacuna® treatment - price is inclusive of all medicaments, advice and instruction sheet, payable in full following initial consultation and prior to commencement of treatment programme.

 1 nail           =   £300.00  

 2+ nails     =   £325.00

Option 2 - Pay as you go  Lacuna® Treatments  starting from £65 for the initial consultation and then £65 per treatment  for 1 nail or £70 per treatment for 2+ nails.

1 nail            =   £325.00

2+ nails      =   £350.00

OPTIONAL EXTRA within initial consultation is the fee for the in-clinic fungal test at £49.

An introductory bottle of active product is included within the treatment package. Additional product is available to purchase from Clinic at £8 to £16.

The pricing structure is a reflection of most common fungal nail patient presentations. For example most patients require treatment for 1 or both large toes. Additional treatments for other toes if required are included in the treatment plan as the fee structure is capped at those listed above.

The Lacuna Method® fee pricing structure is reflective of the condition treated and compares favourably to alternative therapies.

Please Note: Lacuna Method® Fungal Nail Treatment.  Although it has a high success rate, it is NOT 100% guaranteed in every single case, as is no treatment. In order to get the best outcome you must be fully committed to following all the advice provided.


Fungal infections are treatable, and the best results are seen when treatment advice is followed stringently.




 Toe Fact: Your toenails grow at a rate of approximately 1.5 mm to 1.7 mm a month which is a far slower rate than fingernails that typically grow at a rate of 3 mm to 4 mm a month. The loss of a toenail may feel drastic and is compounded by the fact that the slow growth rate equates to full replacement with healthy nail taking 12 to 18 months. Sometimes trauma to the nail bed can hamper this regeneration process still further.


For Reassurance the Deva Podiatry Foot Health Clinic COVID-19 Policy is reprinted in full. You can be further reassured that the clinic and all equipment will be prepared to the highest standards prior to your designated surgery time.


The health and safety of both patients and podiatrists is paramount. Deva Podiatry have always focussed on exceptional Infection control; however COVID-19 has brought to the fore the need to introduce additional measures. This document is to be used in combination with documents from other organisations such as Public Health England and The College of Podiatry.

Additional Infection Control

Between each appointment to wipe with diluted bleach or clinell wipes;-

•    Doorknobs
•    Entire treatment couch
•    Patients chair within clinic
•    Podiatrists Chair
•    Keyboard, screen, and housing of I-Pad
•    Square payment terminal
•    Pen
•    Treatment Trolley
•    Counter- top
•    Light
•    Sneeze shield
•    Drawer handles, drill, doppler, cardio machine, doppler and any other items touched in the course of treatment
•    Skirting to the clinic

Also, to mop floor with diluted bleach, clinell wipes or floor wipes.


Personal Protective Equipment ( PPE)

The College Of Podiatry currently directs podiatrists to use tables 2 and 4 when deciding which PPE to use:

•    Gloves
•    Apron
•    IIR fluid resistant masks
•    Eye or face mask, depending on risk. Risk factors to be considered are which procedure, likelihood of patient being contagious and risk factors of the contracting COVID-19.

The College Of Podiatry suggests that a FFP2 or FFP3 mask will provide superior protection, therefore a combined IIR and FFP3 mask is ideal. The College advises that a face visor would, if this combination is not available, provide additional protection.

Before booking the appointment

The podiatrist will question the patient and, if an existing patient, refer to previous notes to ensure the patient meets the current criteria for treatment listed in the “ Decision Tree for Independent Practitioners” and the  “Treatment Grid during COVID-19”.

Before the appointment

•    The COVID-19 triage form is completed
•    The patient consents to attending the appointment
•    It is explained to the patient that they must wait in the car until the allotted time
•    they may be required to wear a mask
•    they will need to wash their hands or use hand sanitiser upon attending 
•    that 2 metres distance will be maintained where possible (continued)

•    they will need to attend on their own (exception where it is previously identified that a carer or guardian will attend)
•    Payment will be taken via card

On Arrival for the appointment

•    Any pedestrian patient must not arrive before their allotted appointment time
•    A patient travelling by car is to stay within their car until the allotted appointment time
•    A patient will be encouraged to wear their own mask or scarf for their own personal protection
•    The patient will be directed to sanitise their hands prior to treatment or if a preference is made for washing hands      this facility is also available next to the treatment chair

Changes within the clinic

•    Worktop surfaces will be decluttered to allow for more efficient cleansing in between patients
•    All seating materials to be made of a wipeable material 
•    Sign at entrance to clinic highlighting COVID-19 guidelines
•    Tissues and hand sanitiser available to patients
•    Lavatory light to be left on
•    Patient appointments to be restructured to allow for adequate time to receive the patient, carry out the treatment and for the patient to exit the clinic without an overlap with previous or subsequent patient
•    An additional period of time to be allocated to the period post appointment to allow for satisfactory sanitising of the clinic
•    Patients who are known to be at higher risk from Covid-19 and fall within the vulnerable categories will be offered an appointment at the start of the session

Podiatrists Attire

•    Clean scrubs and socks to be put on in the clinic
•    Dedicated clinic shoes to be kept and used within the clinic
•    After session, scrubs and socks to be placed into a dedicated clinic laundry bag and put directly into washing machine upon bringing them into the house
•    After clinic session, podiatrist to go directly home and shower, laundering clothes that have been worn between clinic and house

VERSION 2:  Produced by Sarah Webber DATE: 5th June 2020
References and external links to governing legislation in relation to Covid-19. Click on the icons below to be taken to the relevant latest information on  coronavirus.

COP “PPE Clarification May 2020”
COP “ PPE inaccessibility guidance”
Public Health England “ Additional considerations, in addition to standard infection prevention and control precautions” table 4  “ Any setting. Direct patient / resident care assessing an individual that is not currently a possible or confirmed case ( within 2 metres)”


Lacuna Method Fungal Toenail Removal Chester Cheshire. Best Practice Podiatry Clinic
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