Health experts have confirmed that fungi is present in and on the body and therefore fungal infections can affect any part of the body. Toenail fungal infections are unfortunately one of the more common infections people can contract. How can you detect whether or not you have a toenail fungal infection? Here are the top five clues to look for to determine if you have one:

1. Toenail color changes 
One of the common changes will be development of yellow streaks under the nails. Health experts consider this the initial sign that an infection is developing. If the nail in question turns green, there is definitely an infection and it is likely bacterial. White and yellow nails indicate fungal and yeast infections. Yellow nails indicate fungus. In some cases, however, the color change is more subtle. The shininess of the nail simply fades. Other times the nails turn a darker color than normal. If you regularly paint your toenails, it's a good idea to take off the polish completely once in a while to check on your nail bed’s color. 

2. Toenail texture changes
If your toenails become exceptionally brittle or have begun to thicken you could be suffering from an infection. In some cases the toenails will break, or the shape will become distorted by the growing fungus.
 
3. Toenail separation
In some cases of toenail fungal infection, the nail can completely separate from the nail bed. If you have not recently stubbed your toe or endured any similar injuries, this could be an indication of trouble. The unfortunate thing is sometimes when you have a fungus-related infection you won't even feel the separation. Therefore, it's even more critical to regularly examine your feet.

4. Pain
As the infection advances, pain may be felt on the affected part. Furthermore, the surrounding tissues may get inflamed. Pain is attributed to the thickening nails. If you gently press the nail and find the area is tender or sore, you could have an infection. It is also important to clarify that the pain is not a result of tight footwear or other toe conditions, however.

5. Odor
A bad smell is another reliable indication that you have a toenail fungal infection. As the fungus causes the toe tissues to die, an odor will be given off. This option is relatively tricky because bad smell can be caused by other factors apart from fungal infection. For example, wearing shoes for a long time can lead to the development of unpleasant odors. This is common in people whose feet sweat. Because of this many people will go undiagnosed, simply assuming they have stinky feet. If this is the case and you're not quite ready to seek medical confirmation, wear open footwear such as sandals for a couple of days. If you still have an odor, it's a pretty clear indication there is trouble afoot. 
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Other indications include a discharge of pus, running a fever and red streaks around the area. If you suspect you have a toenail fungal infection, visiting a doctor isn't a bad idea. Your case may or may not warrant prescription medication, but it's better to know what you're dealing with than play the wait and see if it gets better game.

Dr. Christopher Segler is Board Certified, American Board of Pediatric Medicine. He see patients at home in San Francisco, Palo Alto, Menlo Park, and San Jose so that they can get cutting edge diagnosis and treatment of toenail fungus infections right in the comfort and convenience of their own homes. If you think you may have toenail fungus and have a question about it, you can reach him directly at 415-308-0833. 

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.

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. 

I recently had a doctor as a fungal toenail patient who asked me this question. He wasn’t a podiatrist, so infected toenails are not his specialty. 

The question is an interesting one and speaks to the conception that many people have about lasers. Many think that a laser is a laser.

All lasers are not the same. 

Some lasers cut steel, others kill toenail fungus and some only highlight presentations. 

Laser pointers are not medical lasers and cannot treat toenail fungus. 

Here is why:

The medical laser we use to treat kill toenail fungus is 1064nm wavelength YAG laser. This is the wavelength that has been shown in clinical trials to remove the toenail fungus that infects the toenail plate causing a toenail infection (known as onychomycosis). 

Laser pointers are all a much shorter wavelength than the toenail laser:
       Red laser pointers are 635nm wavelength
       Green laser pointers are 532nm wavelength
       Blue laser pointers are 445nm wavelength 

All three varieties of laser pointers are within the visible light spectrum  (380 nm – 700 nm).  A medical laser used to remove toenail fungus and treat a fungal toenail infection is an infrared laser (1064nm) and the light energy from it behaves much differently. 

The nail fungus treatment laser beam has the ability to directly damage components of the toenail fungus cell membranes and kill the fungus. Laser pointers that are used to highlight a powerpoint presentation simply can’t remove the toenail fungus from the infected toenail. 

Dr. Christopher Segler is a San Francisco based podiatrist and is board certified, American Board of Podiatric Medicine.  He sees patients all over the Bay Area in order to help them treat their toenail fungal infections with one of the newest lasers available. We offer house calls all to treat toenail fungus in San Francisco, Oakland, Berkeley, Corte Madera, Mill Valley, Palo Alto, and San Jose. If you have a question about toenail fungus and wonder whether or not the laser fungus removal treatment will cure your thick, yellow, toenail that has a fungus infection, you can call and speak directly with a toenail expert by calling 415-308-0833.  And yes, you will actually get to speak with the doctor.