Toenail Fungus

"Onychomycosis"

Onychomycosis is a fungal infection of the toenails. This is very common condition in the feet, which may worsen over time. There can be pre disposing factors such as general health, hyperhidrosis (excessive perspiration), shoe type and materials, and poor hygiene. Just as you place your bread dough in a warm, dark, moist environment to have the yeast flourish; our feet undergo the same condition in shoes. Because of the very common presence of this fungus (usually tinea rubrum); getting this type of infection may be unfortunately inevitable. As such, this is a very common condition we treat at the Foot and Ankle Center. This condition may be very cosmetically unappealing and potentially painful.

While we encourage our patients to search the Internet for information on this topic; we will attempt to provide concise treatment options in an honest, forthright manner.

Before treatment is recommended, examination by one of our podiatric physicians is necessary. There are many conditions that may mimic nail fungus (lichen planus, psoriasis, trauma etc.) Definitive diagnosis is needed before treatment is started to avoid wasted time…and money. This is usually in the form of a nail culture. Once results are obtained, treatment options are then recommended after taking account the patients' goals and medical history.

Option 1: TOPICAL

There are many topical forms of treatment available. Examples are Penlac®, tea tree oil, Funginail® and Formula 3®. We find this works best in early fungal infections where there is minimal nail involvement, usually at the very end of the nail. As a rule, most topical treatments are effective only in 10-20%.

Option 2: ORAL MEDICATION

There have been many medications tried in past years in the US. These have included griseofulvin and sporanox. Presently, the most effective oral agent we prescribe is terbinafine (Lamisil®). This medication is effective in ~70% of the cases we treat and is taken once daily for three months. Before treatment we obtain a liver panel blood test and repeat this after one month of treatment. The liver metabolizes (breaks down) this medication and we monitor it during treatment. It is very rare that we need to discontinue treatment due to any potential side effects. The cost of this medication may be covered by your insurance.

Option 3: LASER

The Foot and Ankle Center offers the latest technology in treating nail fungus. While we feel this is still evolving, it has shown to be safe and effective in controlling nail fungus. We offer one of the most powerful lasers available to treat this stubborn condition. Our treatment guidelines follow the latest research in which optimal outcomes are achieved. This presently involves three treatments at 6 week intervals with follow up treatment as needed 2-3 times per year. While more costly, this treatment is safe and without any side effects with any current medications being taken. The effective rate is similar to oral medication at 70%.

Contact your doctor if any addition questions need to be answered before starting any treatment. Onychomycosis is a condition that may potentially recur over time. Periodic treatment may be needed. We will do our best to help advise and customize treatment options to meet your specific needs, health and goals.