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.

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.

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.

Hi My Running Doc,


A couple of days ago I accidentally kicked the wall with my right foot. My foot still hurts and it is bruised.  I read on your website that bruising can be a sign of a metatarsal fracture. How can I tell if it is just bruised or if my foot is actually broken? I would love to have your expert opinion!


Thanks!
David, Houston, Texas.



Hi David, 

Bruising is a Bad Sign

It is true that bruising is a bad sign when it comes to foot and ankle injury. When you actually fracture a bone, the bone cracks and bleeds quite a lot. That blood diffuses throughout the soft tissue under the skin. What you see is a bruise. That is part of the reason that a bruise can be so concerning for a fracture in the foot. 

In fact the sort of bruising pattern that the picture of your foot shows is often indicative of a fracture or broken bone in the foot. Given your pattern of bruising it is more likely that you have a metatarsal fracture or a fracture in one of the bones in the little toe such as the proximal phalanx phone.


Myths about Foot Fractures

1.  If you can walk on the foot, it can’t be broken.  FALSE!

This may be one of the most widely perpetuated myths about foot injury on the Internet. I have seen many patients with serious fractures that are walking on the foot. Some patients are limping and obviously in a tremendous amount of pain while other patients with fractures or broken bones barely feel any discomfort at all. This is not a reliable indicator of whether or not you have a broken bone in your foot.

2.  There is nothing you can do for a broken toe.  FALSE!

This is also absolutely not true. While it is true that most fractures in the toe will heal uneventfully, there are things you can do to speed healing and decrease your risk of complications. Fractures of the bones in the toe can move if not properly stabilized. Certain shoes will speed healing. Taping the toes to provide stability and immobilize the fracture will also help. But some toes should never be taped together. 

Without the proper treatment of a broken toe, the fracture can fail to heal leading to what physicians refer to as a nonunion. A fracture that never heals correctly can lead to pain, disability and interfere with your ability to run or even walk without pain.  Occasionally patients that take the approach that “nothing can be done for fractured toe” just end up in surgery later.  For the most part this is avoidable if the toe treated correctly.

Diagnosis and Treatment Options

If you are suspicious that there might be a broken bone in your foot (or in one of your toes) it is best to figure out whether or not it is actually broken.  The best option is to have an in-person evaluation by a sports medicine specialist such as a sports podiatrist.  The second option is to have a remote consultation with a sports podiatrist via webcam. A third option is an attempt at self-diagnosis. This video on YouTube can show you how to perform self-diagnosis of metatarsal stress fractures. This same video would apply in your case if the pain is located where you’re bruising is in the foot.

If you see a physician in person or via webcam or you perform your own self-diagnosis and think that you probably have a fracture then you should get x-rays. X-rays will not only confirm (or rule out) a broken bone in the foot but it will also give you an idea of the severity of the problem. There are some fractures that absolutely must be treated surgically. Others simply need a fracture walking boot in order to stabilize the fracture and allow it to heal. And occasionally it is necessary to use crutches. 

But not all fractures are the same. So if you have pain and bruising after this sort of injury and suspect that you have a fracture in your foot it is important to determine whether or not there actually is a broken bone, and treat it appropriately. As long as you treat the fracture correctly you should be able to heal and then get back to running.

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. 

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. 

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.