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.

If you have toenail fungus, you probably have fungal spores in your shoes. This is not a cleanliness issue. It is just a fact of life with a fungal toenail infection.

The longer you have had the toenail fungal infection, the more likely it becomes that shedding spores (that have the potential to sprout a new fungus infection) are collecting inside your shoes.

Some patients are so afraid of getting a re-infection from the toenail fungus,that they will get rid of the old shoes and buy all new shoes. This isn't really necessary.

Another strategy is to wash the shoes in hot water. Washing your shoes in hot water is not really a great idea as this would obviously ruin most shoes. There are other ways you can get the fungus out of your shoes. 

One way to get rid of the fungus in your shoes is to spray the inside of your shoes thoroughly with a disinfectant spray like Lysol. Be prepared for the shoes to smell like Lysol. Make sure you dry the shoes completely before wearing. 

Another less noxious option is to kill of of the fungus and fungal spores with an in-shoe ultraviolet sanitizing light, like the Steri-Shoe ultraviolet sanitizer. UV light is toxic to fungus, killing live fungus and spores that collect inside your shoes. Using a Steri-Shoe ultraviolet sanitizer will reduce the risk of becoming re-infected with toe fungus after you have cured the fungus infection with the laser nail fungus treatment. 

Dr. Christopher Segler, DPM is Board Certified, American Board of Podiatric Medicine.  He believes the best podiatry practice combines cutting edge technology with the old-school convenience of house calls. He makes podiatry house calls for young active adults who want to get rid of their funky toenails as quickly as possibly. He brings the laser to homes and offices in San Bruno, Emeryville and San Francisco.  If you have a question about fungal toenail laser treatment, you can reach him directly at 415-308-0833.

Toenail polish has been cited as a contributing factor to the development of toenail fungus. The reason for this is that ultraviolet light (in the form of natural sunlight) inhibits the growth of the fungus that causes the toenails to become thick, brittle and yellow.

Part of the reason that toenails become infected with fungus more than fingernails is that toes are enclosed in a warm, dark, moist environment (the inside of your shoes). This environment contains all of the essential ingredients for fungal growth. 

The fungus loves to grow in the dark. It’s not such a fan of the sunlight.

When you paint your toenails with toenail polish, this creates a barrier to sunlight and ultraviolet light. It basically creates some shade in which the fungus is more likely to grow. This is the thinking when podiatrists recommend that you should not paint your toenails if you’re prone to developing toenail fungus.

But it takes much more than just darkness for fungus to grow. You also have to have some sort of trauma or damage to the nail plate that allows the fungal spores to actually get between the nail plate and nail bed to start to grow.

Once you have the laser toenail fungus removal treatment and you have effectively killed all of the fungus that is attacking the nail plate and the nail bed. It is then okay to paint your toenails. 

Rather than becoming obsessed about a minor additional risk, such as painting your toenails. It is much more important to treat your shoes and get rid of all of the fungal spores that have been deposited in your shoes as a result of the fungal toenail infection. 

The key to healthier toenails is not eliminating toenail polish but eliminating the fungus that causes the infection.

Dr. Christopher Segler is board-certified, American Board of Podiatric Medicine.  he performs housecalls for patients with toenail fungus in San Francisco, Emeryville, Orinda and Burlingame.  If you have a toenail fungus infection he can bring the laser right to your home or office so you can have the laser  toenail fungus removal treatment without wasting time traveling to a doctor’s office. If you have a question about toenail fungus, you can call him directly at 415–308–0833.

If you have only one toe nail that has become infected with a fungal infection you may choose to only perform the laser treatment on that single funky toenail. The laser treatment can successfully kill and remove the fungus from a single thick, yellowing, discolored toenail, and you do not have to treat all of the clear toenails. The problem with this approach is that there is a high recurrence of fungal infections after the fungus has been killed. When you get reinfected, the previously infected, clearing, healthy appearing toenail may start to become yellow and thicker if it starts to get infected again.

There are three primary reasons you might get another toenail infection after successful laser treatment.
1. You have an early fungal toenail infection in one of the other toes on the same foot. If the fungus has just started to invade one of the other toenails on your foot, you might have fungus growing there, even though it hasn’t yet caused the yellow, thick and ugly appearance expected with a fungal toe nail. 

If you only treat the thick yellow nail that is obviously infected, but not the other nails on the same foot, you run the risk of leaving live fungus behind that can restart a fungal toenail infection and spread to the other toes. 

2. You have fungal spores in your shoes that can start a re-infection of toe fungus after the toenail laser has removed the fungus in the toenail. The spores are essentially microscopic seeds that sprout fungus. When you have toenail fungus, the crusty white debris that accumulates under the end of the toenail is loaded with fungal spores. As you walk around, the fungal spores are shed and land in your shoes. The warmth from you feet, moisture from sweaty feet and darkness inside the shoe creates the ideal environment to sprout a now fungus infection from the old spores sitting in your shoes. You can help prevent a re-infection of toe fungus by spraying you shoes with Lysol disinfectant (if you don’t mind the smell) or you can simply kill the fungus in your shoes with a Steri-Shoe ultraviolet sterilizer. that will use ultraviolet light (which kills fungus) to kill all of the spores and fungus in your shoes. 

3. You are simply susceptible to toenail fungus and fungal infections like athletes foot.
Just like some people are more prone to allergies or catching a cold, some feet are more prone to picking up fungal infections in the skin of the feet and toenails. Athlete’s foot is a fungal infection of the skin. Onychomycosis is a fungal infection of the nail. The same fungal organism that causes athlete’s foot is the same fungal organism that causes toenail fungus. If you have had many cases of athlete’s foot, you will want to stay alert for athlete’s foot. When you start noticing an athlete’s foot infection after your toenail infection has cleared with the laser treatment, you will want to aggressively treat the athlete’s foot before the fungus in the skin spreads to the toenails. You should also kill the fungus in your shoes with a Steri-Shoe ultraviolet sterilizer. 

Dr. Christopher Segler is a podiatrist who is is Board Certified, American Board of Podiatric Medicine.  He believes the best podiatry practice combines cutting edge technology with the old-school convenience of house calls. He makes podiatry house calls for runners, athletes and busy professionals in San Francisco, Millbrae, Belvedere, San Rafael and Berkeley.  If you have a question about toenail fungus, you can call him directly at 415-308-0833. 

When you have a toenail infection, the fungus is growing under, and within the toe nail. As the fungus grows, the fungus sheds spores which are basically toe fungus seeds. These spores can end up in your socks. If you don’t get rid of the spores you will be at a higher risk of getting the toenail fungus again even after you have successfully rid your toenails of the nail fungus with the laser fungus removal treatment. 

On strategy is to simply throw out all of your old socks and buy new ones. But this is usually not necessary. If you wash your socks in hot water, it should get rid of the fungus in your socks. 

Dr. Christopher Segler, DPM is Board Certified, American Board of Podiatric Medicine.  He offers laser toenail fungus treatment to patients who prefer the convenience of house calls. He makes podiatry housecalls to treat nail fungus for patients in San Francisco, Oakland, Alameda, Menlo Park, Burlingame, San Carlos, and San Rafael. If you have a question about a fungal toe nail infection, call him directly at 415-308-0833.