Frequently Asked Questions About Toenail Fungus and Laser Treatment

Q. How do I know if I have toenail fungus?

A. The most common signs of toenail fungus are:

  • Discoloration, such as yellowish, brown and or grayish changes in portions of the nail or the entire nail plate.
  • Thickness and deforming of the nail plate.
  • Either a crumbling nail or a very firm and rigid nail plate.
  • Unpleasant odor.
  • Debris under the toenail.
  • Pain that is usually caused by foot gear due to the thickness of the nail. In some cases, there can be pain even without shoes.
  • An elevated and loose toenail that permits moisture to infiltrate under the nail allowing bacteria to enter between the nail and the skin.

Q. What exactly is nail fungus and where does it come from?

A. The medical terminology for nail fungus is onychomycosis. A nail fungus is a microorganism that could be one of several invading parasites in the nail and nail bed (the tissue in which the nail plate rests). The invading parasites contaminate all layers of the nail anatomy, including the nail itself, the nail bed, the cuticle and the nail growth center or "root."

Q. How do you get toenail fungus? Is it contagious?

A. There are several sources of fungal and bacterial nail infections and, yes, it can be contagious. A fungus is a living organism that can be transmitted from one person to another. It can be transmitted in places like shower stalls, locker rooms, dirty floors and old shoes or by wearing someone else's shoes that has the infection. The fungus also can be spread from one of your toenails to your another one of your toenails. It is possible for the infection to be spread from pedicures at nail salons as the fungus can be transmitted through nail polish and instruments that are not properly sterilized.

Q. Are there any other causes of toenail fungus?

A. Injury is another cause of nail fungus. If your toenail has been injured by stubbing it or by accidentally dropping an object on it or even by consistently wearing tight-fitting shoes, the natural barrier of the skin around the nail becomes compromised and the fungus can easily penetrate under the nail. Examples of activities that can contribute to subliminal trauma are:

  • Tennis
  • Jogging
  • Power walking
  • Bowling
  • Racket ball

These types of activities can cause "trauma" to the nail, allowing fluid to collect under the nail, which then causes the nail to loosen and/or fall off.

Q. What are the most common types of organisms that can infect my toenails?

A. The most common types of organisms are:

  • Fungus- (dermatophytes) mold and yeast
  • Bacteria - e coli, staph, pseudomonas
  • Bacteroids- B. fra'gilis

All of these organisms are tissue parasites and, if left untreated, can cause other problems. In each category of organism there are multiple types of invaders. Sometimes we will recommend a pathological culture to identify the organism or combination of organisms. While this is an additional cost, the test is usually covered by insurance and is only recommended when our physician feels he needs to refine his diagnosis. If this is his recommendation, he will take a trimming from the nail plate and send it to the lab for a culture and examination by a pathologist. Our physician may make a recommendation for a lab test any time prior to, during or following treatment.

Q. Is toenail fungus more common in men or women?

A. We tend to see more men affected because men wear more closed-toe shoes than women and usually have sweatier feet. Wearing the same infected shoes also increases the chance of constantly re-infecting your skin and nails. This is one of the reasons why it is important to disinfect your shoes following laser treatment, especially for men.

Q. How does the laser work?

A. The laser produces multiple light wave lengths that seek out the fungal cells. The laser only targets the fungal cells and does not harm or destroy the skin or tissue surrounding nail. The laser light penetrates through the nail to the diseased cells on the nail bed and roots where the fungal infection resides.

Q. Does the laser treatment procedure hurt?

A. There is no pain during laser treatment. The type of laser utilized is called cold laser. Since the treatment is not painful, no local anesthesia or injections are necessary. If the nail plate is loose, sometimes during debridement of the nail prior to the treatment you may have minimal discomfort. Most patients describe the laser treatment procedure as being comfortable with a quick, small pinch at the end. Immediately following the procedure, your nails may feel warm for a few minutes.

Q. How long does the laser treatment take?

A. The actual laser treatment process takes about 20 to 30 minutes if treating all ten toes. Prior to the treatment, you will complete a medical history form and our physician will perform a four-point medical examination that includes the following assessments:

  • Vascular
  • Dermatological
  • Neurological
  • Musculoskeletal

To prepare your nails for the procedure, our medical assistant will perform a professional medical pedicure utilizing sterilized equipment. This process is painless and includes thinning the toenails to allow the laser to more effectively penetrate the nails during the treatment.

Q. Who performs the laser treatment?

A. Village Podiatry advises that an experienced, board-certified and laser-certified physician perform this treatment. Non-physicians may make a misdiagnosis of your nail condition. There are many factors that can change the appearance of a nail plate other than a fungal infection including medications, chemotherapy, chronic lung disease, pigmented nail plates, psoriasis, melanoma and other conditions. Treating a toenail with a melanoma is a serious misdiagnosis and only a physician who can perform a biopsy prior to a laser nail treatment can provide this service. A non-physician is not capable of making a diagnosis since he or she has not been medically trained, and you may have an unnecessary treatment from a medically uneducated individual or, even worse, have treatment with the presence of a serious underlying medical condition.

Q. Are there any side effects from the laser treatment?

A. Countless studies have been performed for more than 20 years and there are no side effects from the treatment. There are no post-treatment complications or adverse reactions from the laser nail treatment. In addition, the majority of patients can resume normal activities immediately.

Q. May I continue to get pedicures and polish my nails during the recovery period?

A. Yes. You can apply nail polish but we do advise a polish that contains an antifungal medication. If you choose to use antifungal nail polish, we can offer those products for sale upon request.

Q. How long will it take for me to see results?

A. Most individuals begin to see results after approximately two to three months depending on the severity and amount of nail that is involved. Not all nails grow at the same rate so clearing varies from patient to patient and nail to nail depending upon the depth of the fungal infection.

During the growth period following the treatment, the new nail grows from the cuticle and pushes the infected nail out toward the end of the toe. Normal trimming and nail filing should occur during this standard nail-growth phase so that the old, diseased nail is trimmed off. At each follow-up laser treatment, the doctor or medical assistant will trim and mechanically thin the nail plate for faster results. We do know that patients who have had the disease for many years may require additional laser treatments. No two patients act identically in how long the overall treatment will take to show results. The results also may vary due to previous injury or underlying disease that may have influenced the nail infection and deformity. Some patients may require a biannual maintenance program that includes a sterile medical debridement and an additional laser treatment. Our doctor will advise you as you progress throughout the treatment cycle.

Q. What is the chance of the infection returning?

A. There is always a chance of reinfection if you are exposed to a new fungal infection; however, we have seen very few re-infections. We will provide you with important information on care and prevention for a lifetime of fungus-free feet. As stated earlier, chronic long-term nail infections may take longer to resolve. The Village Podiatry Laser Center also offers an ultraviolet shoe sanitizer available for purchase. This device is placed inside your existing shoes to kill bacteria and fungus.

Q. Can I have this procedure preformed if I am a diabetic?

A. With every diabetic there is the possibility of vascular disease or nerve disease called peripheral neuropathy. Diabetics are in danger of infections due to either advanced vascular disease or nerve disease due to thick and contaminated nail plates from the presence of a fungal infection. When the nails become thick due to the fungus, the thick nail plate can cause excessive pressure under the nail plate on the nail bed. The constant pressure of the shoe breaks down the tissue and either an ulcer can form or a collection of blood called a subungual hematoma or "blood blister" can form. Both of these are dangerous for a diabetic and can cause an infection if untreated. In the case of a diabetic with neuropathy, which is a reduction in feeling in the toes and feet, this infection may worsen and create an abscess that can then infiltrate the bone. Once this occurs, the doctor would need to remove the nail, identify the infection and take X-rays to rule out a bone infection. Sometimes it also is necessary to perform a blood culture to determine if the infection has entered the blood. If any of these unfortunate situations occurs, possible hospitalization and/or amputation of a toe, foot or leg may be necessary. This is one of the primary reasons why our physician performs an examination.

We encourage diabetics who are capable of having this procedure to either have the laser decontamination of the nails or routine foot care by a podiatrist for manual debridement to protect themselves from complications. In summary, we encourage diabetic patients to have this procedure if all of their medical findings are within the normal treatable parameters.

Q. Is this treatment covered by insurance?

A. Unfortunately, no. At this time, health insurance plans consider this treatment as cosmetic and thus do not cover this type of procedure. If you have a flexible spending account (FSA), we will provide you a procedure report to validate the treatment for reimbursement.

Q. What payment options do you offer?

A. We accept all major credit cards, cash, debit cards and money orders. Treatment pricing information.