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The Lacuna Method®

What is The Lacuna Method® ?

The Lacuna Method® is a treatment method for fungal nails which involves drilling multiple micro holes (0.4mm) through the nail plate. This is known a fenestration*. The Lacuna Method® is only available from suitable qualified Podiatrists. This is relatively new treatment and although short term studies have been encouraging no treatment can be guaranteed to be 100% successful.

How Does it work?

It is now understood that the active part of the fungal nail infection is actually on the nail bed (the skin beneath the nail) and not the nail itself. The nail plate acts as a barrier between the application of antifungal solutions purchased over the counter accessing this active portion of the infection.

By drilling the micro holes in the nail plate this allows an antifungal solution, normally Lamisil® AT 1%(Terbinafine)** spray to be transported to the area of infection (the nail bed) directly. The pressure from footwear on the nail helps redistribute the treatment under the surface of the nail. This stops the fungus spreading and encourages the healthy nail to grow out, along with the holes. As with any antifungal treatment, this takes time, as the infection will clear only as fast as your toenails grow, which can take up to 18 months. Review appointments are recommended on average every 6 weeks and this will include the redrilling of the holes as required. However, this may vary, and your podiatrist will advise you.

Who can benefit from the Lacuna Method®?

People with a mild-moderate fungal nail infection. This is any infection that doesn’t reach past the cuticle, as antifungal solutions cannot access this portion of the nail.

Symptoms of a fungal nail infection include:


  • Nail thickening
  • Nail discolouration – usually either white/dark/yellow
  • Brittle nail texture
  • Build-up of debris under the nail
  • White patches on the nail plate
  • Lifting of the nail

There are some contra indications but your podiatrist will discuss this with you during your assessment.

What does The Lacuna Method® involve?


  • A thorough podiatric assessment to examine the nail, this may include testing to confirm the presence of a fungal. We will also provide advice regarding foot hygiene, and how to prevent future recurrence.
  • A photo is taken of the nail, so the progress can be monitored.
  • The nail is cleaned.
  • Micro-holes are drills across the infected portion of nail(s).
  • Home care advice is given.
  • A review appointment is booked. This is repeated until the infection has cleared.

Other fungal nail treatment options include:


How much does it cost?

We have a scale of fees based on the number of toes that need to be treated, as well package of treatments.


Single treatments:

  • One nail £50
  • Two to Five nails £75
  • Six or more £100

Package of 4 treatments

  • One nail £150
  • Two to Five £225
  • Six or more £300

New patients to the practice or returning patients that haven’t been seen in over a year will require an initial assessment.

*Fenestration is a technique that can be traced back to ancient Egypt.

**other products are available.