Often, parents bring their children to our office with a condition that looks like toenail fungus. But some patients have visited their primary care physicians and taken a course of oral antifungal medication before arriving at our NYC podiatry office—only to find that the reason the antifungal didn’t work was that they did not suffer from fungus at all! Here’s how to tell if your child really has toenail fungus and what other conditions may be occurring.
Hispanics and Latinos make up 27.5% of New York City’s population. This group suffers from foot pain and health issues like any other, yet they tend to be more reluctant to seek professional help. The first step toward wellness is asking your primary doctor to check your feet and give you a referral to a foot and ankle specialist who can offer state-of-the-art care. Dr. Mariola Rivera, DPM is a friend to Hispanics and Latinos in the New York City area who are looking for a Spanish-speaking, board-certified podiatrist to add to their healthcare team.
Though the weather is barely breaking 60 degrees, we are getting close to at least imagining those warm, sunny days where it seems most prudent to wear sandals. Ingrown toenails are one foot-related issue that can really dampen your springtime fun. Not only do they look unsightly in sandals, but they are also downright painful! When the corners of the nails bite into the skin, redness, inflammation and purulence ensue. No one wants to kick off spring with an infection like that! Worse yet, ingrown toenails can quickly spiral into a limb-threatening condition for those with vascular disease, neuropathy or diabetes. The board-certified podiatrists from The Center for Podiatric Care and Sports Medicine in NYC discuss how to treat and prevent this common foot affliction.
Any avid runner knows that the sport is not always so glamorous. There are some days where we’re drowning in tears when one of our black toenails finally prepares to fall off. The average person may call this a “black and blue toenail” or “runner’s toe,” whereas a geek (or your non-geeky podiatrist!) might call it a “subungual hematoma” — which is a fancy way of saying “bruised toenail.” No matter what you call the condition, it ain’t pretty! The good news is: we know how to fix it!
Ingrown toenails are an impossible situation to tackle on your own. You will need to see a licensed and trained podiatrist to help you get your feet to a healthy state again. “Ingrown nails are not only painful, but they can also cause an infection in the toe,” says Dr. Katherine M. Lai of The Center for Podiatric Care and Sports Medicine in New York City. “Often, we will treat nails that repeatedly become ingrown with an in-office procedure that can remove the ingrown nail permanently.”
Dr. Lai explains that there are several procedures a patient might have, depending on the severity of the condition and the way the nail is growing. “Some of the ingrown nail procedures are: P&A (phenol and alcohol) procedure, where the ingrown nail is removed back to the nail root and phenol is applied to the root to stop the ingrown nail from growing back in; or Winograd procedure, where the ingrown nail, adjacent swollen skin, and the nail root are surgically cut out. The skin and rest of the nail are then stitched together.”
These procedures, done in a clinical setting, are the best way to prevent ingrown toenails from occurring. In addition to ingrown toenail surgery, there are several other steps you can take to keep your toenails growing properly and protect your toes from infection…
Ingrown toenails are one of the many common issues treated at our NYC Center for Podiatric Care and Sports Medicine. We see people of all age groups come in with this type of injury. Often, the problem seems to occur for no real reason at all, but we find risk factors include: tight shoes, improper nail trimming, or foot injury. Sometimes the nail becomes infected and you’ll need to soak them in warm water with Epsom salts, apply antibiotic ointment, and stop in to see us for treatment. Generally, treatment is a quick outpatient procedure that allows you to return to work the same day.
This past November, manufacturers of the PinPointe FootLaser celebrated a big milestone as the 100,000th procedure was performed. While there are several competitors on the market now, PinPointe was the very first light-based device given FDA clearance to treat the appearance of onychomycosis nail fungus. This nail fungus solution was presented as a safer, more effective alternative to oral medications.
The cost of treatment ranges from $600 to $1,000 — which is deemed a “cosmetic procedure” that is not covered by insurance; so the decision to seek laser therapy is one to seriously consider. You’re probably wondering, “Does the PinPointe FootLaser work to cure toenail fungus for good?” We have the answer for you, here at the Center for Podiatric Care and Sports Medicine.
How Do Lasers Work To Eliminate Toenail Fungus?
“The laser creates a thermal effect,” says Steve Duddy, president and CEO of NuvoLase, Inc., the manufacturers of PinPointe FootLaser. “Temperatures are raised to levels high enough to impact the growth of the fungus without causing discomfort to the patient,” he tells Nails Magazine. During the 30 minute treatment, patients may sense a little bit of warmth, but that’s about it. The laser is able to penetrate the nail plate to essentially cook the fungi to death. Patients can keep their toenails, simply waiting for the fungus nail to grow out — as with most other treatments. A full recovery generally takes anywhere from four to six months, up to a year.
How Well Does the PinPointe FootLaser Work?
Clinical trials of the PinPointe FootLaser have been very encouraging. A multi-site retrospective study of 265 patients conducted by five private parties in the UK and United States reported “continuous improvement” for 71.8 percent of participants.
The success of one’s treatment depends upon the severity of the infection. “With mild-moderate cases, patients have an excellent chance of success,” explains Michael Bilinsky, D.P.M. of Beverly Hills, California. “With severe cases, clients have seen dramatic improvement, but when they expect to end up with a normal nail, they can be disappointed.”
Here at our NYC podiatrist’s office, we prefer to under-promise and over-deliver. We let patients know that success rates depend on a myriad of factors, including:
Adherence to a post-treatment plan.
Follow-up care is very important, as re-infection rates are high. “The life-cycle of fungus includes a dormant stage,” says Daniel Waldman, D.P.M. of North Carolina. He adds, “Many doctors schedule a follow-up visit not only to monitor the growth of the fungus, but also to make sure patients are performing home care.”
This home care may include a change in footwear, the use of topical treatments, disinfecting one’s shoes, and maintaining dry feet.
Are There Any Drawbacks To Laser Treatment For Fungal Nails?
Topical medications are generally considered to be ineffective for fungal nail treatment, as they cannot penetrate deep into the nail bed where infections lie. Oral medications are more effective, but side effects run the gamut from headaches to gastrointestinal upset — and require liver enzyme tests to be sure the internal organs are not overtaxed by the treatment. So, from that standpoint, the PinPointe laser (with its zero side effects) appears to be the obvious choice for treatment.
Keep in mind that there is no true way to “cure toenail fungus fast.” Laser treatment for fungal nails is not a cure, but it can temporarily improve the appearance of thickened, yellow toenails over time. We feel that laser foot fungus removal can be incredibly advantageous, but patients must be willing to comply with our recommendations for remaining fungus-free down the road.
“Just as in laser-whitening treatment of fading teeth, with laser nail treatment the fungus can come back over time,” according to Ben Pearl, DPM. He adds, “It is also important to disinfect the areas in which the fungal spores reside, so the nail does not get reinfected. There are now ultraviolet lights to do this, which are safer than many disinfectant chemical sprays.”
Toenail fungus is not life-threatening, but this unsightly infection of the nail affects about 10 percent of the U.S. population, according to Boni E. Elewski, a researcher at Case Western Reserve University in Cleveland, Ohio. “The disease can have certain negative consequences for patients, such as pain, and can potentially undermine work and social lives,” she wrote in an issue of the journal Clinical Microbial Review. While this may not sound like a huge number, it is when you consider that up to 90 percent of elderly Americans have what is called onychomycosis. Traditionally, the only treatment options were to remove the affected nails or treat with risky oral antifungal medication and wait for the nail to grow out. (Even though Americans shell out loads of cash on topical antifungal medications, these are considered ineffective.) Here’s what you need to know about PinPointe FootLaser for fungal nail treatment.
1. The PinPointe FootLaser has been in use since 2007.
The Pinpointe FootLaser was developed by scientists and medical professionals over a 20-year period, with funding provided by the National Institutes of Health. Clinical studies began in November 2007 and the device received F.D.A. clearance in October of 2010 to be used as an effective treatment for fungal nails. Since then, over 3,800 patients have been successfully treated.
2. It’s quick and painless.
People generally like that they can just come right in to their regular podiatrist’s office and have the procedure done quickly by appointment, rather than waiting at a hospital or unfamiliar clinic. Any subsequent treatment is done by your own podiatrist, so you can maintain the same standard of care you have been receiving.
The PinPointe FootLaser works by using a laser light to penetrate the nail and kill the fungus, without injuring the surrounding skin. Over a period of several weeks, you should notice the nail begin to clear. However, the nail will only be fully healed once the fungus nail completely grows out. Best of all, the treatment is done in just 30 minutes as a walk in/ walk out procedure — and it’s completely painless! Some people report “warmth” and a couple individuals have reported a “slight pinprick sensation,” but most people feel nothing at all.
3. Side effects are extremely rare.
Compared to oral medication for toenail fungus, the PinPointe FootLaser is a dream come true. The Mayo Clinic says that, while Lamisil and Sporanax are considered the “most effective” oral medications for treating toenail fungus, these drugs “may cause side effects ranging from skin rashes to liver damage.” For this reason, many people do not want to take an oral antifungal at all. Patient Joanne Grant told NBC Channel 10 Newsthat she “didn’t want to take medication.” She added, “I didn’t want to have my liver checked.” By comparison, the PinPointe FootLaser has no regularly reported side effects. The Village Podiatry Centers in Atlanta report that “rare side effects” may include: nail discoloration, mild pain (during treatment), redness around the nail (lasting 24-72 hours), and slight swelling (lasting 24-72 hours).
4. Your insurance company won’t pay for it, but there are options.
Insurance companies consider nail fungus to be a “cosmetic procedure,” so they do not cover the cost. We understand that it’s so much more than that. No one wants to have fungus living on their feet! Even though your insurance won’t pay for PinPointe FootLaser therapy, you can still use your HSA, Medical IRA, or Flexible Spending Account.
5. Foot fungus can grow back, even after laser treatment.
While clinical studies conducted by NuvoLase found that more than 71.4% of patients experience sustained improvement after a single treatment, it is always possible for the fungus to grow back if you are not careful. Fungus is everywhere in our environment, so if you walk around barefoot on an affected surface, you are putting yourself at risk of re-infection. Furthermore, it’s important to keep your feet cool and dry to discourage fungal proliferation. So, if you are going to make the investment to have healthy, attractive feet, then you will need to commit to preventative measures too.
Jenn F. on
Thursday, November 22nd, 2012
Hey, what are you eating today? Any toenail-friendly foods?
Now I know what you’re thinking: “Whaaaat? I’m not eating any food with toenails in it!” I completely understand your horror and am happy to inform you that I am not suggesting that you eat food with toenails mixed in (excuse me, need to step away and regroup and erase that image from my mind, don’t be afraid to join me; okay, I’m better now!). No, I mean foods that will make your toenails healthy and strong.
Did you know that fingernails grow faster than toenails? According to a study published in the Journal of the Academy of European Dermatology, fingernails grow about 3.47 mm per month, while toenails grow 1.62 mm per month (millimeters! that’s how we know it’s a European journal). I bet I don’t need to tell you, though, that the big toenail grows faster than the other toenails; you probably know that just from living with your own toenails.
These are normal things for toenails. Do you know what’s not normal? Deep grooves that run horizontally across your nails, otherwise known as Beau’s Lines.
“I am so grateful for having had Dr. Geldwert perform bunion surgery on both of my feet. I have complete confidence in him and continue to see him for other sports related injuries. I was cautious about having surgery for the first time, but his knowledge, patience, and skill made me completely comfortable in trusting him. And I couldn’t be any happier with the results!! When anything else feels wrong with my feet, I love that I now know to go immediately to him. He is my top choice for anyone searching for the best foot fixer/surgeon/sports doctor in NYC! Thank you, Dr. Geldwert!!!”
– J. M., Manhattan, NY
Manhattan Office 111 East 88th Street New York, NY 10128 (212) 996-1900 See map here
Westchester Office 10 Mitchell Place Suite 105 White Plains, NY 10601 (914) 328-3400 See map here
Manhattan Orthopedic and Sports Medicine 57 West 57th Street New York, NY 10019 (212) 996-1900 See map here
Dr. Josef J. Geldwert DPM, Dr. Katherine Lai DPM, Dr. Ryan Minara, DPM, and Dr. Mariola Rivera DPM serving Westchester County, White Plains, Ardsley, Bronxville, Harrison NY, Larchmont, Mamaroneck, New Rochelle, Rye, Scarsdale, Rye Brook, Chappaqua, and the surrounding area.
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