QUESTION:

Hi Doc!

My boyfriend has toenail fungus on both feet and he had a discount laser treatment from another clinic about 6 months ago. We were hoping that this would help, but his toenails still look like they are the same as before the laser treatment. The fungal toenails are still yellow, thick and crumbly. He hasn't had any improvement at all.  If laser treatment did't help, are there other options that he can try?

Thanks!
CJ.

ANSWER:

Hello CJ, 

I am sorry to hear your boyfriend has not made a full recovery. If he had a laser treatment and the toenails didn't get better, he still has several options:

Laser Re-Treatment
1. Re-treatment with the laser. This is the fastest way to kill the fungus. But if we do this, we should schedule more than an hour. I would recommend doing a double laser treatment in one setting. Basically, I would just make sure that the treatment is so thorough that there is no way the fungus could live through it. 

Prescription Anti-fungal Pills
2. Prescription terbinifine pills. If I give your boyfriend a prescription for the course of pills, he will need to have a blood test to make sure his liver is in good shape before beginning the course of medication. He would then need to have a blood test again in 6 weeks to make sure he isn't having liver damage. The prescription medication can cost more than laser treatment. And the pills can alter your taste (making some foods have a metallic taste) but it is usually transient and goes away once he stops taking the medication. Also, he CANNOT drink alcohol while taking the anti fungal pills. 

Prescription Strength Topicals
3. Prescription topical anti-fungal medications can also work, but they can tedious and very expensive. The advantage over the pills is that there is no risk of liver damage. I have seen one patient that had a bad reaction where he had to stop using it because the skin around the toenail became very red and inflamed. But this is not typical, and the redness and pain did resolve after he stopped using the topical anti-fungal on his toenail. The topical solution is applied to the toenails daily. They to be applied every day for almost a year. I have had patients tell me that they often need a few tubes of these medications since they have to apply it for almost a year. The cost can vary depending upon which pharmacy you use, but most patients have said they paid over $500 per tube in some cases. You would want to check with your pharmacy to inquire about cost before getting started, just to make sure it wouldn't be too expensive. 

No matter which treatment your boyfriend prefers, we have to make sure that he has NO Athlete's foot at all trying another treatment. If there is any peeling skin on the feet that looks like an athlete's foot infection, then I would suggest either a month of a topical anti fungal on the skin, or a 2 week course of the oral anti fungal prescription pills (instead of 3 months) just to clear the skin fungal infection. Once the fungus has been removed from the skin, we could do the laser treatment to clear the toenail infection.

Making sure there is no athlete's foot is critical to success. 

Please let me know if you have any questions.  You can also feel free to call me directly at 415-308-0833 if you have any other questions or would like more detail. 

Dr Christopher Segler is Board Certified, American Board of Pediatric Medicine. He brings the toenail laser directly to patients in San Francisco, Atherton, Palo Alto, Menlo Park and San Jose to so that they get have the laser toenail fungus removal treatment in the comfort and privacy of their own homes. If you think you have a toenail fungus infection that may need laser treatment, you can even arrange a complimentary web-consulation here.

​You can also call Dr Segler directly at 415-308-0833.

This question came from a patient who wants laser toenail fungus treatment, but inquired about getting only the worst of the infected toenails treated with the laser.

Question:
Hey Doc, 
Several of my toenails are thick and discolored.  But, the 1st toe on my right foot (my big toe) is the worst.  I'd like to get an estimate for getting that toe treated, and I'd like to know if there are complimentary or discount treatments if I don't see results in 3-6 months.  From my research, it sounds like 2 treatments are often needed.

Answer:
Hello,

Thank you for your inquiry. I am sorry to hear that you're having trouble with your toenails but I would be happy to help.

One thing that you have to understand is that treating toenail fungus is really an all or nothing proposition. Because the toenails become damaged when you have toenail fungus they're very easily reinfected...even from neighboring toenails. In fact, if you even have athletes foot where the same fungus is impacting the skin, then there's a good chance your infection won't completely clear and the toenails will still remain discolored...if you don't treat ALL or the toenails...or if you don't get rid of the athletes foot before we do the laser procedure.

You can actually watch a short video that I created to help explain this....

The total cost of the laser toenail treatment is $949. But we would treat ALL of the toenails. 

The cost includes the house call, evaluation, laser treatment, topical antifungal medication to help prevent reinfection of the toenails and physician dispensed decontaminant to kill the fungus in your shoes.

In the last several years I've had very few patients who have had to have a second treatment. We simply do an extremely thorough job on the first treatment... And we make sure that patients don't have cases of athletes foot or other sources of reinfection that could re-infect the toenails.

The entire appointment takes about an hour to an hour and a half depending upon the extent of the infection. But you will want to make sure that you block out enough time so that we can do an extended laser treatment session and make sure we wipe out the toenail fungus in one long session, rather than two or three short laser treatments.

With this approach, as long as you don't have any athletes foot, (and understand that you have to actually do a lot on your own) we will be happy to come back and do a re-treatment if necessary, in 3 to 6 months...at NO CHARGE.

You just have to confirm that you don't have any athletes foot before scheduling your laser treatment. But, as long as you don't have any athletes foot, just let me know what dates and times work for you and I'll be happy to schedule your laser procedure to remove the fungal infection in the toenails and get you moving back to clear toenails.  

Thanks!
Dr. Christopher Segler

Dr. Christopher Segler, is Board Certified, American Board of Pediatric Medicine. He specializes in the treatment of you healthy patients who lead active, busy lives. He actually brings the laser to patient's homes to perform toenail fungus treatments during a house call appointment. That way there is no missed work. In fact, he can even see you before work if you like. He treats patients in San Francisco, Palo Alto, San Jose and the rest of Silicon Valley. If you have a question about your toes and whether or not Laser Toenail Fungus Treatment is right for you, call him directly at 415-308-0833.

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.

Barefoot running has increased in popularity in recent years. In fact, Dr. Segler recently lectured at a medical conference on the topic of barefoot running trends. Part of the appeal in barefoot running technique is to increase your efficiency by using more natural running biomechanics in order to hone your running form.

The American Podiatric Medical Association has a position statement declaring that barefoot running is an unsafe activity and is not recommended by podiatrists. Of course not all podiatrist agree with this position. I happen to be one of those dissenting physicians.

Toenail fungus is common among runners. In fact all fungal infections are common among runners. Particularly athlete's foot. Athlete's foot is nothing more than a fungus infection of the skin on the foot. A toenail fungus infection is actually caused by the same organism that causes athlete’s foot.

When you run your feet sweat, moisture collects in your shoes and the ideal environment for fungal growth is created. If you run on back-to-back days the problem is compounded because your running shoes never completely dry out.

If you happen to develop a case of athlete's foot, the fungus is growing between the layers of the skin. As the skin peels it sheds fungal spores into your shoes. These spores of course are the seeds from which fungus grows.

If you are running, doing hill repeats or some other strenuous workout, and you repeatedly bumped the toes and the end of of the toenail on the inside of the running shoe, the fungal spores can get between the toenail and the underlying nail bed. The fungal spores begin to grow and develop into a fungal toenail infection.

However when you run barefoot, you not have any risk of bumping the toenails repeatedly against an inside of a running shoe that is ripe with fungus. So in that respect, running barefoot is actually much lower risk for developing a toenail fungus infection as compared to running with running shoes.

The risk is mainly related to the potential for fungal spores to collect in your shoes and then have trauma where those spores are actually in contact with the toenail in such a way that they can become embedded in or underneath the toenail and start to grow. If you are wearing minimalist running shoes such as the Vibram Five Fingers without socks the risk of developing one of these toenail infections actually increases significantly. 

If you start to notice discoloration such as white or yellowish spots where the toenail seems to be changing and getting thicker it could be a fungal toenail infection. Treating these infections is not really a big deal. Our podiatrist can actually bring a laser to your home or office in order to directly kill the fungus and help your toenails returned to their normal clear and healthy state.  For more information on discount toenail fungus laser treatment andlas er toenail fungus removal treatment visit http://www.lasertoenailsanfrancisco.com/

The laser treatment will kill the fungus in your toenails. But to keep your toenail clear after the laser toenail fungus treatment you have to make sure you don’t get re-infected with toenail fungus. Up to 50% of patients who effectively treat the toenail fungus infection will get the nasty infection again within a few years. 

The key is to keep the fungal spores under control.

Spores are basically the seeds from which toenail fungus grows. They are very durable. In fact, fungal spores can lay dormant for many years and still remain viable. Just place the spores in a warm, moist, dark environment and they will start to grow sprouting a new toe fungus infection. 

The laser will effectively remove the fungus from your toenails, but that is only the first step.

The whole time you have had a fungal infection, you have been shedding fungal spores into your shoes and socks. Getting free of the spores is the best way to prevent the fungus from infecting your toenails again. 

1. Wash all of your socks in hot water. This will get rid of the fungus and spores in your socks. Some people throw out all of their socks and replace them. But this isn’t really necessary. 

2. Kill the fungus in your shoes. Use an antiseptic spray or an ultraviolet sanitizer to kill the spores and live fungus in your shoes. Bowling alleys have been doing this forever. They simply spray some toxic chemicals in the bowling shoes to kill all of the germs between rentals. Sprays like Lysol will work, but frankly they make your shoes smell like Lysol. So if you are going to try this, make sure you test it out on a pair of shoes you aren’t crazy about before you spray all of your shoes. The Steri-Shoe is a much nicer alternative. It uses ultraviolet light to destroy the live fungus and spores in your shoes. No smell, no toxic chemicals and no waiting to dry the shoes out. You can order one online at a discount here.

3. Watch out for and aggressively treat any athlete’s foot. The fungus that causes athlete’s foot is the same one that causes toenail fungus infections. Those little spots of peeling skin are the classic sign of athlete’s foot. Many people think that if the skin doesn’t itch, it isn’t athlete’s foot. This is false. 

Every time I see a patient who wants the toenail fungus laser removal treatment I ask them if they ever get athlete’s foot. Less than 10% say yes. But about half of all the laser toenail patients actually have signs of an active case of athlete’s foot that they haven’t even noticed. 

So it is possible that you could pick up a case of athlete’s foot and not realize it. You should check your feet every day. Look for peeling skin around the edge of the sole and between the toes. 

If you get athletes foot, you are actually growing fungus between the layers of skin. As the skin peels, fungal spores are shed into your socks and shoes. Then all it takes is to bump your toenails on the inside of the shoe and those spores can get in again start another toenail fungus infection.

If you notice some athlete’s foot don’t panic. You can simply apply an over-the-counter cream for a couple of weeks to cure the skin infection. Of course you will want to use the Steri-shoe ultraviolet sanitizer in your shoes again and wash your socks in hot water, just like you did after the laser procedure.

Taking these simple precautions you will help ensure that your toes stay clear, healthy and fungus free!  If you have a question about a toenail fungus infection, call the toenail fungus expert directly at 415-308-0833.

Dr. Christopher Segler is a San Francisco based podiatrist and is board certified, American Board of Podiatric Medicine.  His practice provides house calls to people who are just too busy to sit in traffic or a doctor's office. He sees patients in their own homes to treat their toenail fungal infections with one of the newest lasers available. We do house calls in San Francisco, Oakland, Berkeley, San Rafael, Mill Valley, San Mateo and San Jose. If you have a question about toenail fungus and wonder whether or not the laser fungus removal treatment will help you have clear toenails again, you can call and ask a toenail expert by calling 415-308-0833.  And yes, you will actually get to speak with the doctor.