The longer toenail fungus is present in the toenails the more damage the toenail fungus causes. In some cases the damage to the keratin in the toenail can be extensive enough that there is some permanent damage to the toenail. Permanent damage can take a couple of different forms.

1. If the toenail gets so thick that it stretches the root of the nail, called the "toenail matrix", then the toenail will be permanently thickened to some degree. The permanent toenail thickness cannot be changed even if the fungus is completely treated and removed. Although the fungus won't be growing in the toenail and causing the nail to expand and look much thicker, some portion of the toenail may just continue to grow out thicker than the original toenail. In this case, there can be some improvement, but maybe not 100% improvement in the thickness of the toenails.

2.. Often the toenail fungus infection leads to a portion of the toenail separating from the underlying nail bed. This can create a light colored or white area where there is space between the toenail and the nail bed. Although the toenail fungus can be treated, the toenail is not likely to completely re-attached to the nailbed underneath even after successful laser treatment. So in this case, the toenail does look a little different just because it has this light colored area.

Keeping theses possibilities in mind, it is important to realize that laser treatment can help. Given the condition of the toenails I would expect that laser treatment would help improve the condition of the nails by removing the fungus making the nails less brittle, less friable and thinner. However it would be important to recognize that some of the toenails may still be discolored or slightly thicker even if the fungus is completely removed.

Without treatment, toenail fungus generally just continues to get worse over time. But don't be fooled by doctors who threaten that it's going to get significantly worse quickly. It gets worse consistently, but very, very slowly.

If you would like to talk about the condition of your mother's toenails, you can simply send a photograph of the toenails to us and then call to talk with Dr. Segler so you can get all of the details about how much laser treatment of the toenail fungus might help the condition and appearance of the toenails.

If you have additional questions or would like to schedule a laser treatment, please feel free to call Dr. Segler directly at 415-308-0833.

Toenail fungus can be a recurring problem. It is an infection. Just like it is possible to get a cold or a flu even if you had it before, the toes can become infected with toenail fungus again at anytime in the future.

It is possible to cure toenail fungus with laser treatment, oral medications, topical medications or home remedies. There are many reports of success with all of these treatment methods to remove the toenail fungus and get the toenails to become clear again. The key to making sure that your toenails stay clear and fungus free is to make sure that you decrease your exposure to the toenail fungus spores.

The toenail fungus spores are basically the seeds that cause the toenail fungus infection. If you don't get exposed to them, you will not get toenail fungus again.

Here are the common sources of exposure to toenail fungus spores:

Skin
When you have athlete's foot, you basically have an infection of the skin that is caused by the same organism that causes toenail fungus. If you cure the infection in the toenails but you do not cure the infection in the skin, the toenail fungus can spread from the skin back to the toenails and cause another infection. In that case the end result is that your toenails become yellow, crumbly, the formed and thicker because they become reinfected. 

If you have any areas of peeling skin on the toes or bottom of the feet it is important to make sure that you treat the skin infection at the same time you are treating the toenail fungus. Otherwise you are at high risk of getting a reinfection in the toenails.

Socks
The spores that caused toenail fungus are often shed as the nails crumble, crack and fall apart. Little bits of infected toenails and the spores that cause the toenail fungus infection can accumulate in your socks. You have to either replace your socks with new ones or wash your socks and hot water to remove the toenail fungus and fungal spores.  

Shoes
Fungus thrives in three conditions: when it is warm, dark and moist. The inside of your shoes, with your sweaty feet stuffed in them, provides the perfect environment for fungus to grow. Shoes are like little incubators for fungus. If you effectively treat the toenail fungus and the scan at the same time you're remove any active infection. However if you do not treat your shoes you may have large quantities of toenail fungus spores in the shoes waiting to cause a reinfection. It is important to disinfect your shoes completely to make sure that you don't leave any spores in the shoes that can infect the toenails again later.

The key here is to understand that the goal is not just to remove the infection from the toenails but also to make sure that you remove all sources of reinfection so that your toenails remain clear and healthy appearing.

Today we got a common question from someone who thinks she may have toenail fungus, but isn't sure.

"My toe nail is discolored now has dark black spots, I have two young children and the likelihood of them stepping on them is high.... But I am uncertain if they are bruised or if it fungus.... What do I do and how do I distinguish the two apart?"

Bruising of the toenail can resemble toenail fungus. If you have traumatized the toenail in anyway, whether it means children have stepped on the toe, you dropped something on the toe, you tripped on a door jamb or you simply have banged your toes on the inside of your running shoes repeatedly, you can get bruising under the toenail. The bruise usually looks like a dark black spot.

If the spot is black and shiny, it is likely a bruise and less likely toenail fungus. If the discoloration is yellow, grayish, greenish, it is more likely caused by a toenail fungus infection. 

Discoloration of the toenail is one of the signs of toenail fungus. Of course the toenails can become discolored because there is a bruise under the toenail. Toenails can also become discolored if there is dark colored toenail polish applied to the toenail, and only partially removed.

One of the keys in distinguishing toenail fungus infection from other causes of discoloration is the separation of the toenail from the underlying toenail bed. In most cases this leads to opaque appearance of the toenail in the area of dark discoloration. If there is no opacity and no apparent separation of toenail from the skin underneath,, it is less likely that the discoloration is caused by a toenail fungus infection.

If it looks like there is space between the toenail and the skin underneath the toenail, then it is more probable that there is a toenail fungus infection brewing in there. If the dark discoloration on tyne toenail appears to be firmly adhered without any separation from the toenail itself, it may be less likely caused by a toenail fungus infection.

If you have a question about discoloration of the toenail that you may think is caused by a toenail fungus infection, you can arrange a free consultation here.

Dr. Christopher Segler is a toenail fungus specialist who does house calls to provide patients with rapid access to treatment of unsightly toenail fungus infections. He performs laser procedures in order to kill the fungus in the toenail. He actually brings the toenail fungus laser directly to you so that you can have the procedure in the privacy of your own home.

Today I received a great question from a patient.  with toenail fungus on the big toenail. He wanted to know whether or not it would be prudent to remove the entire toenail plate. The thinking behind this question is that if the toenail itself is infected with fungus, then removing the entire nail plate could effectively cure the infection.

A podiatrist could certainly remove the entire nail plate. 

Removal of a fungal infected toenail has advantages and disadvantages. Removing the entire nail plate removes a great deal of the infection. After all, most of the fungus is in and on the toenail itself. 

When the plate is removed, most of the fungus is removed. There can still be some fungus in the nailbed, underneath the toenail. This must also be treated in order to have a successful care of toenail fungus.

Studies have shown that removing the nail plate, as a stand-alone treatment, has about a 50% success rate. Those are not great odds.

But there is a bigger risk with removing a fungal toenail. It takes many months for the toenail to grow back. During the time you are waiting for the nail to grow back the skin folds tha make up the nail grooves at the side of the toe can contract. If the skin contracts or shrinks, there may be less space available at the end of the toe for the toenail plate. If the toenail grooves are restricted, this can lead to an increased risk of ingrown toenails in the future.

A better option may be to actually aggressively debride the fungal toenail prior to laser treatment. In that case, the podiatrist would simply trim back and grind down/file away the vast majority of the nail, but retain enough of the nail plate to keep the skin folds intact without contracting. This should increase the chances of success, without adding the increased risk of deformity of the toe that could lead to ingrown toenails.

In either case, it is important to make sure that all of the other sources of fungus (including shoes, socks and any fungal infection in the skin) are treated simultaneously. If not, your chances of success may be lower.

Toenail fungus can cause an embarrassing discoloration of the toenails. Toenail fungus infections can make toenails change in color becoming whitish, yellow, or even brown. So, it is possible that the brown discoloration is caused by toenail fungus. 

If the brown discoloration is in fact caused by toenail fungus, then yes, the laser treatment may help. But if the discoloration is caused by bruising under the toenail or is the result of surface staining of the nail plate, then no, laser treatment would not help.  

A couple of questions may help determine how likely it is that the discoloration is caused by a fungal infection. 

1. How long ago did the discoloration begin.
2. Have you ever had athlete's foot?
3. Have ever had any trauma to the toenails where they became bruised under the toenail?
 
How Long Have You Had The Discoloration
Generally speaking, the longer the toenails have been infected, the more difficult it is to get rid of the fungus and return the toenails to a normal appearance. Some of this has to do with how much the matrix or root of the toenail has been stretched and or damaged by the thickening of the toenail. In some cases the thickening can become permanent. However the color will typically change significantly and improve after being successfully treated to remove the toenail fungus that is infecting the toenails. But, the toenail may remain thicker, if there has been damage to the matrix or root of the toenail. 

Athletes Foot
Athlete's foot is sometimes caused by the exact same fungus that infects the toenails. Toenail fungus is an infection of fungus in then toenails. Athletes foot is just a toenail fungus infection in the skin on the feet. If you have had athletes foot it s possible that you could have the fungus in your shoes that could lead to a toenail fungus infection.

Toenail Trauma
If you have repeatedly traumatized the nails by stubbing your type, or beating them up in running shoes, you may have bruising under the toenail. If there is bruising under the toenails, it may change the treatment options available to you. For example, if there is a large amount of dried blood underneath the toenail, the dried blood is dark in color and may absorb heat and burn the nail bed underneath the toenail if you were to have the laser toenail fungus removal procedure. In addition, a bruised toenail may look like a fungal toenail, but not actually be infected with toenail fungus. 

If you aren't sure whether or not the brown discoloration in the toenail is caused by a toenail fungus infection you can visit a podiatrist specializing in the treatment of toenail fungus. Another quicker option is to take a picture of the toenails and arrange a free remote email or phone consultation so you can get a better idea of the extent of the problem.

Dr. Christopher Segler is a podiatrist who specializes in the treatment of toenail fungus infections in San Francisco, Oakland, San Rafael and San Jose. He is board certified, American Board of Podiatric Medicine.  If you have a question about discoloration of the toenails that may be caused by toenail fungus you can call him directly at 415-308-0833.

This is a typical question from patients with mild cases of toenail fungus:

"Hi Doc...

I have a mild case of toenail fungus. Only the big toenails have the white spots and thicker nail that suggests a toenail fungal infection. However my dad’s toes are a different story. 

We recently had a house call podiatrist come to the home to check his feet. When I saw my dad’s toes, I was horrified at the sight of his toenails!  All of his toenails are yellow, thick and curving in odd directions. The big toenails are incredibly thick...nearly as thick as the toes themselves. They are crusty and flaking as well. Dad said that his toenails are so thick he hasn’t been able to cut them himself for years.

The podiatrist told us that super-thick fungal toenails are really not that rare in elderly people. He said that the appearance of dad’s fungal toenails is characteristic of a longstanding toenail fungus infection. 

My question is, “How long will it take for my mildly infected fungal toenails to get as thick as my father’s fungal toenails?”

The rate at which toenail fungus gets worse depends upon the type of fungus that has infected the toenail and your body’s ability to fight and slow the infection. 

Fortunately the most common forms of toenail fungus are not caused by overly aggressive organisms. Trychophyton rubrum and Trychophyton mentagrophytes are responsible for most of the toenail fungus infections. There are some less common fungal organisms that progress rapidly, but again, those are rare.

If you are young, healthy, have good blood circulation in your feet and have a strong immune system, you should expect the common forms of toenail fungus to get worse very slowly...almost unnoticeably slowly. You won’t notice any change from day-to-day. In fact, you may not see a change from month-to-month. 

If you takes pictures every few months and then compare over a long period of time, you may gradually notice that the areas of white and yellow discoloration are getting bigger. This may be your only indication that the toenail fungus is spreading and getting worse. If the fungus goes untreated for a long period, you may even notice that the toenail is getting thicker as well. 

But even if you are healthy and have a strong immune system that is fighting the toenail fungus infection, don’t expect your immune system to win. Toenail fungus is not something that you “get over” the way you might get over a cold or a case of the flu. When toenail fungus gets inside the toenail and starts to grow it is there to stay...unless you treat it. If you don’t treat the fungus it will simply continue to grow. 

Over time the fungus spreads throughout the toenail. As the toenail fungus grows, it begins to separate the keratin that forms the toenail. The cracks and splits in the keratin change the way light refracts through the toenail. Once that happens you notice white or yellow areas of the toenail where the keratin has been infiltrated and damaged by the thriving fungus. 

If the toenail fungus does enough damage, the nail plate may become misshapen enough to actually separate from the underlying nail bed. This usually creates large opaque white spot because the pink skin of the nail bed is no longer flush against the undersurface of the toenail. When this happens, it is usually at the end of the toenail in one of the corners.

As the fungal infection continues to get worse, the fungus bores its way through the toenail, moving closer to the root of the nail or “matrix.”  The toenails grows directly outward from the matrix. The matrix is the same size, same thickness and same curvature as a cross section of the toenail. 

If the fungus thickens the toenail and stretches out the matrix, the damage is permanent. At that point, even after you remove the fungus from the toenail, the matrix is permanently deformed and the toenail will always grow out thicker. 

If your immune system has been weakened by chronic disease, malnutrition, HIV infection or over-training, the fungus can grow and spread at a much faster rate. 

So, back to the real question. How long does it take for toenail fungus to become irreparably damaged and terribly thickened?

In many young healthy adults toenail fungus will worsen over the course of a year before the problem seems noticeable. In five years the common forms of toenail fungus can form substantial thickening and possibly permanent damage to the nail plate. But it may take ten years of more to develop the kind of grossly deformed thickened toenails like your father. The fact is, given what you describe, your father has likely had toenail fungus for decades. 

Dr. Christopher Segler offers concierge laser toenail fungus treatment services in San Francisco, Marin and Silicon Valley. If you have toenail fungus he will bring the laser directly to you.  If you have a question about laser treatment of toenail fungus, you can reach him directly at 415-308-0833.

Yes!  We firmly believe that if you pay for a doctor’s visit, you ought to see a doctor.  And the doctor ought to be the one delivering the care. 

We never, ever allow non-doctors to perform the laser toenail treatments. 

We have had patients tell us that some medical offices offer laser toenail fungus removal treatment, but that a nurse or “medical assistant” of some type is the person actually performing the laser toenail fungus removal treatment. Granted, there may be a doctor in the office, but the doctor isn’t the one doing the laser procedure.

All of our laser procedures are performed by Dr. Christopher Segler, a podiatrist who is Board Certified, American Board of Podiatric Medicine. 

When you call our office, you will speak directly to Dr. Segler.  He will explain the options for toenail fungus treatment. If you are a candidate for laser toenail fungus treatment, he will bring the toenail laser to your home or office. You will not speak to a nurse or an assistant, but you will speak to a real doctor. A real doctor will perform your laser toenail treatment. 

If you think you have ugly, thick, white and yellow toenails you might have a toenail fungus infection. If so, you can call Dr. Segler directly at 415-308-0833. And yes, you will actually get to speak with a real doctor. We bring the toenail laser to you. Laser toenail fungus removal treatment is available in San Francisco, Oakland, Berkeley, Mill Valley, Tiburon, San Rafael and Palo Alto.

With most technology-based equipment time affords remarkable increases in size and power. This is especially true of computers and other electronic devices. Today smart phones have more computing power than a laptop computer from just a few years ago.  All in much more compact design.

Laser technology has also had similar advancements and improvements. The A.R.C. Laser is one of the newest medical lasers on the market which can be used to remove toenail fungus. The A.R.C. Laser is significantly smaller, lighter and more compact than many of the previously introduced medical lasers. The laser fits in a briefcase and only weighs 4 pounds.

The small size and portability of this laser makes it possible for us to bring the laser to the homes of patients all over the San Francisco Bay area in order to perform laser toenail fungus removal treatments at home.

The Pinpointe laser for example is so much larger and heavier that it would be virtually impossible for our podiatrist to bring the Pinpointe laser into your home or office to perform your laser toenail fungus treatment. 

Toenail fungus can be an embarrassing condition. Although it is extremely common, many people do not feel comfortable exposing their yellow cracking toenails in public. For this reason house calls to treat toenail fungus can help to alleviate this anxiety and discomfort. 

Dr. Christopher Segler is Board Certified, American Board of Podiatric Medicine.  He makes podiatry house calls to perform laser treatment to treat toenail fungus in San Francisco, Mill Valley, San Rafael, Oakland, Berkeley, San Jose and Palo Alto. If you have toenail fungus and wonder if laser treatment at home can help remove the toenail fungus so you can develop clear toenails again, you can call and speak directly to our podiatrist to ask questions. Call 415-308-0833 to reach Dr. Segler directly. 

Yes!  When you have the laser toenail fungus removal procedure the fungus is dead. But the actually appearance of the toenail is no different at the conclusion of the laser treatment. 

You have to wait for the healthy non-deformed toenail to grow out.  This will take several months. 

If you have been using fake nails to cover the ugly, yellow, and white fungal toenail, you can go back to the nail salon to reapply the artificial nails. Eventually you may not need the artificial nails any longer if your toenails clear after the laser treatment. 

Dr. Christopher Segler is a podiatrist Board Certified, American Board of Podiatric Medicine. He performs laser treatments to remove toenail fungus in San Francisco, Oakland and San Jose. He even does House Calls!  That way we bring the toenail laser to you so that you can get rid of your toenail fungus without taking time off work to get laser treatment at a podiatry office. If you have a question about toenail fungus, you can call Dr. Segler directly at 415-308-0833.  You can also click here to get a HUGE DISCOUNT on laser toenail fungus treatment.  

A normal toenail is clear and healthy. It is smooth and uniform in color. But the toenail changes when it gets infected with fungus. All it takes is for your toenail to bump up against the inside of the shoe and get some of the fungal spores up under the toenail where they start to grow.  The growing fungus separates the layers of the keratin within the toenail making the toenail thicker. This causes the ugly discoloration that you see.

During the laser toenail fungus removal treatment, the doctor moves the laser in a grid pattern over the surface of the toenail to make sure that the laser kills ALL of the fungus infecting the toenail. All you will see during the procedure is an aiming light that tells the doctor where the laser is penetrating the toenail. But the laser is actually going all the way through the toenail to destroy the fungus.

In this video you can see the aiming light passing over the surface of the nail while the doctor is treating the toenail to remove the fungus during an actual treatment. The only thing you feel during the procedure is a little bit of heat that is generated by the laser light energy. 

Although the laser completely kills the fungus, the appearance of the toenail does not actually change at all during the laser procedure. Even though the fungus is dead, you have to wait for the toenail to grow out and become clear again. As the toenail grows you will trim off the thick discolored unhealthy toenail that was damaged by the toenail fungus and your nails gradually become clear.

If you have a toenail that you think might be infected with fungus you can call our doctor or even send a picture of the toenail to us so that we can discuss whether or not laser treatment might help you have clear toenails again. 

Dr. Christopher Segler is Board Certified, American Board of Podiatric Medicine. He can actually bring the laser out to your home or office to perform the laser fungus removal treatment in the morning before you leave for  work, during the day, in the evenings or on weekends. Call him directly to schedule your laser treatment at 415-308-0833. We perform podiatry house calls in San Francisco, Berkeley, Oakland, San Mateo and Mill Valley.