Over 20 percent of U.S. adults, or approximately 23 million people, suffer from toenail fungus infection.
Unfortunately, those treatments that have been around a while — toxic oral medications and expensive topical creams or nail polish — often don’t really work. Topical treatments are less than 5% effective. Yes, that's correct - only 5% effective and only when the fungus is caught very early and only treats the surface of the nail. Not to mention, oral medications are very toxic to the liver, have significant side effects, require regular blood testing so your liver doesn’t fail. As a matter of fact, they can adverse reactaions by interacting with other medications you may already be taking. Furthermore, pills are only 60% or so effective, and then the fungus usually comes back within 12 months. That can be extremely frustrating and discouraging.
Fortunately, there is a newer, better, safer treatment available, and laser therapy works over 90% of the time. Since around 2010, more than a handful of laser devices have been FDA approved and are used with success by podiatrists as a safe, quick, effective, pain-free form of treatment. Good to know there's a solution and effective treatment available - right?
To help guide you through the murky world of toenail fungus, I have put together some basic information to make things easy for you. Below you will find out more about this unsightly condition, how its treated, and what you can expect if you decide laser therapy is the right choice for you.
What Is Toenail Fungus?
Toenail fungus is an infection of the toenails with fungus, also called onychomycosis (oh-nick-oh-my-koh-sis). There are many different kinds of fungus that can cause this problem, and just about all are susceptible to laser therapy.
Onychomycosis, the growth of fungi onto the toenails. These fungi are often found on your body and usually do not cause any problems. However, in your feet, the fungus can become an huge problem. These fungi use a component of your toenails, called keratin, for its food. It is literally - feasting on your toenail tissue. Did you know, you can contract fungus from someone else too?! Just like at a nail salon or from your spouse, if you are repeatedly exposed over a period of time. This fungus infection is also the same organism that can cause jock itch or athlete’s foot and even feminine yeast infections. It can be very uncomfortable.
The fungus infection happens when the fungi get in through the cracks in your toenails and start to invade on the toenail tissue that is in, on, or under the nail. Fungi love a warm, dark, moist environment and often finds that in your toenail. Fungi also thrive, particularly when you are active and when you sweat inside your shoes.
How Do I Know If I Have Toenail Fungus?
A toenail fungal infection has a slow, eroding effect on your toenail but usually takes a while to develop and spread so you might not notice it at first.
Here are some of the toenail symptoms you may encounter:
- Change in color — often the toenail turns yellow, brown, white, or eve green
- Nails become thick…sometimes so thick you can’t get a toenail clipper to work
- Toenail shape becomes curved, twisted, or ingrown on the sides
- Initially, a white dot may show itself which then slowly grows larger
- Toenails become brittle and break easily, sometimes they seem to crumble or get chalky
- Toenails become flaky and break off
- Sometimes the toenail has a "cottage-cheese" type substance especially under the hard-outer shell
- Toenails may loosen and separate off the nail bed – occasionally they may even fall of entirely
- You get pain around the toenail as the hard, curved nail digs down into the sides
- There is a bad-cheese smell coming from your toenails
- Eventually, the fungus spreads to your other toes and even out onto the skin on your feet
If left untreated, you can develop a secondary bacterial infection and even get ulcerations, which are extremely dangerous if you are diabetic or have poor circulation. For some people, toenail fungus has even ultimately led to the surgical amputation of toes or even leg amputations.
Toenail fungus is also very unsightly (dare I say ugly?), and if you care about the look of your toes then this can make you very self-conscious. Many of my patients come in saying, "I just hate showing my feet. Especially at the beach." They are embarrassed about their toenails and chose to do something about it.
How did I get toenail fungus to begin with?
Fungus is everywhere (aka there’s fungus among us) and most of the time that’s not a problem. Our immune system is pretty good at fighting off any infections. However, when the immune system is weakened, such as with diabetes, chronic illness, and other diseases, then fungus has the ability to easily set up shop. So, a weakened immune system is often the culprit and increases your risk of getting a fungal toenail infection. In diabetes or vascular disease, where blood flow is not that ideal going down to the toes, the fungus will often become a problem.
Furthermore, a good percentage of the population is simply more susceptible to fungus infections. This is something you may inherit from your parents and have no control over. So if your mom, dad, or aunt Edna have always had those awful, thick, yellow toenails, then there is a good chance you may eventually get them too (if you haven’t already).
Guys may tend to get toenail fungus more than ladies, and older people tend to get toenail fungus simply because there has been more time on this planet for those toenails to be exposed to the fungus
How Can I Be Sure I Have Toenail Fungus?
Hands down, the best way to determine if you have toenail fungus is to get a nail culture done by a podiatrist. If you see any of the signs I’ve mentioned, just make an appointment for an evaluation. Because the infection eventually spreads to every toe, it is better to get cracking and treat it early before bigger problems come around. With toenail fungus, its either treat it and fight it away, or don’t treat it and let it get worse. Sounds simple, right? Well, the choice is up to you…
Early detection also improves the chances for the treatment to work more effectively and quickly before the infection spreads. Also, this early nail culture will set a baseline so that, after treatment with the laser I often take another nail culture to determine the effectiveness of the laser. There are different components to the fungal culture, and your podiatrist is the best person to discuss the results with you. Most importantly, the laser is over 90% effective for just about every type of fungus out there.
What Types of Treatments Are Available for Toenail Fungus?
Until recently, toenail fungus treatment had been limited to topical anti-fungal creams/nail lacquer and oral medication. With limited success and many downsides, these treatments have become secondary to the more effective laser treatments.
The antifungal cream/lacquer has the lowest success rate, ranging from 5-12% (more like 5% or less in my experience). Unless you have extremely mild toenail fungus, topical treatments are very unlikely to effectively penetrate into, underneath, and around the affected toenail.
Prescribed oral medications work somewhat better (around 60%, though likely less). However…and this is big, however… oral antifungal medications have significant medical risks and often interreact with other prescription drugs. Oral medications should not be prescribed without consulting a primary care physician, in order to ensure safety and protection during the months you would be taking these pills.
Side effects might include liver failure, rash, loss of taste, or change of taste (patients tell me food tastes like metal or tinfoil for months on end), headaches, stomach discomfort, and lupus-like symptoms.
Topical medications require daily applications for at least a year, and often longer. Even then, a lifetime of application on some level is required to prevent a recurrence. Oral medications, similarly, require several months of pills and are usually associated with recurrence at some point afterward.
Another treatment option is to have your entire nail surgically removed. I strongly discourage this approach. Patients come in to my office after this had been done elsewhere, and the fungus is still there! Even worse, after you have a toenail yanked off the nail and nailbed (the smooth surface underneath the nail that needs to be smooth, flat, and without traumatic scarring) becomes roughened up so much that the nail is almost always forever changed. This shows up as a nail that is chronically thickened, misshapen, angled off to a side, curled, split in two, bent to grow upward, or worse bent to grow downward to become severely ingrown. This can hurt…a lot… and since toenails are a dirty, germ-infested area to begin with, bacterial infections requiring antibiotics are often needed in these cases.
Since oral and topical treatments are not ideal, doctors began looking for alternative toenail fungus treatments. With the initiation of laser therapy 15 years ago, patients are finding a treatment that is effective, safe, easy, pain-free, and without any side effects.
Studies show the success in clearing fungal infection through laser treatment was good enough for laser treatment to be FDA cleared and is now considered the ideal method to treat onychomycosis.
How Does Laser Therapy Work?
Simply stated, the laser machine shines a laser beam light into the toenail. Many thousands of laser pulses penetrate into, around, under, and onto the toenail to destroy the fungus. The energy from the laser beam shatters the structure of the fungus, thereby killing it permanently. The laser machine has a focal wavelength which only goes after the fungus, and nothing else. As a result, this laser light has no damaging results to the normal, healthy toenail areas or surrounding skin.
To be more technical, there are actually a few ways the laser light destroys fungus, depending on the laser. Most lasers use photo-thermolysis which causes mechanical or thermal (heat) damage. I prefer the non-thermal laser therapy, which does not use heat, and therefore is pain-free. There’s more to it, of course, depending on how much engineering you care to get into. But in a nutshell, the most important thing is that laser treatment for toenail fungus has been shown to be clinically effective, proven in clinical trials, and FDA-approved for treatment of toenail fungus.
How Long Does the Process Take and Is There Anything I Can Do at Home That Can Help?
As with every different type of treatment, you won’t see the results right away. It usually takes about three months for you to see a healthy nail start to grow in at the bottom, sometimes longer. After that, it will take a year or two for the nail to fully grown in all the way out to the tip. As slow as a glacier, this new nail can take a long time to grow in, so patients is key.
Home treatments do NOT treat the toenail fungus infection, however, home treatments are necessary to prevent the infection – and most importantly they prevent re-infection. Home treatment options range from treating shoes, soaking the feet, antifungal creams or lotions, antifungal soap or shampoo, topical urea gel, and other methods. I go into this in detail with my patients because the home side of treating toenail fungus is important. You see, the laser does a great job of getting the fungus to go away, but you are required to keep it away. So this is very important.
Why Is Laser Therapy the Best Option to Treat Toenail Fungus, and Why Would I Not Choose Laser Therapy to Begin With?
Laser therapy is the better treatment for toenail fungus for many reasons, though I will tell you there is one main reason why it is sometimes not used – money. Insurance carriers do not like paying for anything new and/or expensive unless they have to. For whatever reason, insurance companies have so far declined reimbursement for laser treatment, and as a result, you will have to fork out the money to cover the cost. And it can be expensive – sometimes I have seen places charge over $1,000 for EACH treatment, or I’ve seen places nickel-and-dime you to pay several hundred PER TOE! In my humble opinion, that is ridiculous. I would rather more people get the treatment and tell someone they know how great it works. Remember, 1 out of 5 people you know have toenail fungus just like you, and often they have no idea they can affordably get treated. With this philosophy, I get plenty of people getting the treatment who otherwise could not, or would not, pay for this safe, effective service. Please call our office at (301) 515 – FEET (3338) or send us a message through our website at www.GWAPodiatry.com so we can fill you in on the latest affordable special offer we have. We run them all the time, and do our best to make sure you can pay for this otherwise expensive treatment, however possible.
Getting back to why this laser treatment is ideal, here are a few of the reasons why you might consider giving it a try:
- It's SAFE. Laser treatment of toenail fungus doesn’t have any of the side effects that come with oral medications. It also doesn’t interact with any of your medications. It is safe in pregnancy. It is safe with diabetes, high blood pressure, vascular disease – In fact, it is so safe there are NO CONTRAINDICATIONS documented for laser treatment of toenail fungus.
- There are NO SIDE EFFECTS. Zero. None. You walk in, have the treatment, you walk out. Nothing changes.
- There is NO PAIN. Some older laser models work off heat which may tingle and be uncomfortable, sometimes even painful. But the newer laser available (Lunula) does not have this effect and you don’t feel a thing during or after the treatment. It’s the first and only available non-thermal (aka pain-free) device that is FDA cleared to treat onychomycosis, and we have one here for you.
- IT WORKS. Studies show about 85% efficacy for the older lasers and up to 93% cure rate for the new lasers. Multiple clinical trials have proven the safety and cure rate of Lunula laser treatment for toenail fungus.
- NO DOWN TIME. After treatment, you can go straight back to work or for a run.
- NO INTERACTIONS. No pills means no interactions at all with other medications. No radiation either.
- IT’S FAST. Plan on about 12 minutes for each foot, regardless of how may nails are affected. That’s it… you’re in and out.
- There’s NO CONTACT. The Lunula laser requires no office person to perform the treatment, so there is no unnecessary COVID-19 exposure to you during your treatment. Give us a call at (301) 515 – FEET (3338) or send us a message through our website at www.GWAPodiatry.com so we let you know how to take advantage of our unique NO CONTACT LASER VISIT options.
- It’s MADE IN THE USA. Erchonia makes the Lunula laser right here in the good old USA.
What Is the Treatment Like for Laser Therapy? Does it hurt?
When you come to Greater Washington Advanced Podiatry for Lunula laser treatment we like to make things easy. First, we have a NO CONTACT laser visit option, where you stay 6 feet away from anyone the whole time. We also have a full-service option, while stills adhering to social distancing and CDC guidelines. With this approach, you get a nail fungus evaluation including nail culture. A consultation with one of our podiatry specialists will allow you to decide which approach is best for you and have all your questions answered. Your doctor can even smooth down those ugly thick toenails to make you more comfortable and happy with your toes.
The laser treatment itself is fast and painless. You will go straight back to work or your day with no downtime. The laser does not remove the toenail whatsoever. In fact, the laser does not remove the fungus, rather it kills the fungus, leaves it there, then you come back again and repeat the process. You leave wondering if anything has even happened – but it has – and results follow. After a few months, you usually start to see the new toenail growing in at the bottom. Patience is key. Nothing happens fast in this world of toenail fungus. Homework is important i.e. treating your shoes and/or applying urea gel to the nails so that you don’t get re-infected from your environment. Trust me, you will get the fungus again and again if you don’t do your homework. This is the key to the ongoing success we have with so many of our patients here at Greater Washington Advanced Podiatry.
I Suspect I Have Toenail Fungus, What Now?
Well, now that you know the basics on toenail fungus and how Lunula laser therapy can help you get rid of it, maybe you’re ready to give it a try. Please call our office at (301) 515 – FEET (3338) or submit a form online so we can go through options to make this process safe, easy, affordable, and worthwhile for you on your journey to happy, healthy toenails!