The patient below had laser procedures done at another clinic, our intense fungal eradication program is proving to be no match for the fungus.
- We use the Genesis Plus laser system specifically designed for podiatry, including laser nail fungus treatments. The Genesis Plus has the best results of any other laser system on the market. The settings we use are specifically designed for the treatment of nail fungus. We do NOT use a hair removal laser.
- Dr. Oehler is a podiatrist with 15 years of experience in nail fungus treatment.
- Proper preparation of the nail is critical for optimal results. Whoever, is treating your nails should know how to optimize the treatments, it begins with proper nail preparation.
- We are all about long term care and preventing reinfection, we work with each of our patients to develop a plan. Our plans are unique to each of our patients.
- At totally feet podiatry and laser center we are committed to offering the most effective care and treatments to our patients. We know not everyone will respond to the laser or the oral medication, this has been demonstrated in studies. We are starting a trial in our office that we believe will significantly improve the results for a larger percentage of the people. This is why we have started the Premium Plus package.
Lasers and Laser Nail Fungus Treatment
At this point it is not clear what is killing the fungus under the nails. There are different theories on the mechanism of action (MOA) but we are still not able to definitively identify a particular action, we just know it works better than anything else. Lasers are absorbed by different components in our cells called chromophores. The most common chromophores are hemoglobin, melanin, and water. The lasers most effective for onychomycosis are highly absorbed by hemoglobin and melanin. Parameters that have been studied and proven to reduce the nail fungus are available in a few lasers. Currently, it appears Nd:yag 1064nm with a spot sizes of 5mm, is going to be the most effective and able to treat the toenails in 15-30 minutes..
Realistic outcomes and treatment protocol depend on the severity of the infection and the individual. For a more detailed description of onychomycosis and levels of severity take a look at our onychomycosis page. A resent study suggests 81% of patients had complete or moderate clearance of the nails.
I believe that adequate debridement prior to laser treatment will improve the outcome. It is critical, potential patients do their homework and be sure the individual providing the service is capable of medically debriding the nails to no more than 2mm in thickness, so the laser can be most effective. Most studies suggest 1 treatment for mild cases and 3 treatments for moderate to severe cases.
It is important patients proceed with preventative care program. Preventation should include treating shoes with the SteriShoe, skin with antifungal cream, and the nails with Formula 3. This will help to prevent reinfection of the nails in those who are genetically more susceptible to the nail fungus. The best method of disinfecting shoes is with the SteriShoe, though less effective some patients opt to try a foot powder (Desenex or Tinactin) or Mycomist spray.
The number of treatments an individual needs will depend on the severity of the infection and the genetic makeup of the person being treated. Because the infection is usually progressive it often depends on the amount of time a person has had the infection.
Mild cases where discoloring is isolated to the tip of the toenail and thickening is minimal, 1 treatment may be enough. People with more than half of the nail infected and thickening of the nails, I recommend our 3 treatment package. This will offer the best results for these more moderate to severe cases. Patients with complete nail involvement and severe thickening of the nails may have limited improvement in their nails. If the root of the nail has been damaged by the fungus or an injury, permanent damage may have occurred. There is no real easy way to know if damage to the root of the nail has taken place. I recommend a treat and see approach.
Totally Feet Podiatry and Laser Center is now offering the Premium Plus Nail Fungus Treatment Package. Our Premium Plus Package is available for those who want to try everything out of the shoot or those that have gone through laser treatments without achieving desired results. The treatment includes 4 laser treatments, 4 weeks of terbinafine, topical terbinafine, and 3 follow up appointments. The terbinafine was is given in a pulse dosing regimen to minimize the risk of side effects. I am expecting better efficacy and better long term results. For more details take a look at Trial Study to Evaluate Oral Terbinafine in Conjunction with Laser Therapy
The bottom line: No treatment is 100% effective for nail fungus treatment, our laser is the most effective and more effective than any other treatment on the market and has no side effects. At totally feet podiatry and laser center we are committed to offering the most effective care and treatments to our patients.
There are many important factors when considering the right laser for a specific treatment. NOT all lasers are created equally. There are 4 main technical capabilities of a laser that need to be assessed to establish the efficacy for a particular type of treatment. Unless a laser is specifically designed for a treatment, it is not likely capable of the most effective treatment parameters.
- Fluence– Power over a set time to a set amount of area. Measured in Joules/cm2; Joules = Watts x Time
- Pulse Width– Measures the length of time a laser is exposing the target tissue. This with the fluence determines how much energy is delivered to the target tissues.
- Spot Size– Refers to the diameter of the laser beam and helps control the depth the laser will travel through the tissues
- Wavelength- is generated by the materials used to generate the laser beam. This is one of the most important characteristics of the laser because it determines how much energy is absorbed by particular targets in the tissue and how deep the laser will travel through the tissues.
Many companies will claim a high maximum amount of power without stating a spot size or pulse width. Potential patients should make sure they select the right doctor for their treatment. A spot size and wavelength are the most important factors in determining the penetration of the laser in to the tissues. The 1064nm wavelength has the best penetration of any laser on the market, making it very versatile and the choice of many. If the laser is capable of meeting the effective parameters, it can be used to treat hair removal, onychomycosis, spider veins, reticular veins, erythema, skin rejuvenation, scar reduction, and many problems. Laser Treatment of Nail Fungus (Onychomycosis) Rounded Rectangle: Pre and Post Laser Treatment care for Onychomycosis
Anti-fungal Treatments Worth Considering
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