Not so happy feet
There’s nothing fun about nail fungus which plagues millions, but new laser treatments offer hope
First posted: Monday, December 05, 2011 02:00 AM EST
Called onychomycosis, nail fungus is estimated to affect up to 10% of the population worldwide.
"It's everywhere in our environment," says Toronto podiatrist Andrew Klayman. "Exposure to the gym, unsterile pedicure instruments at nail salons, swimming pools and public showers can spread the fungus. And it's contagious."
Klayman is one of a growing number of Canadian podiatrists who has found laser treatment to be effective against the stubborn infection.
Athlete's foot, another infection that plagues Canadians, can be easily treated with over-the-counter sprays and powders. But toenail fungus, if left alone, is much more persistent and can destroy the nail bed; in some people it can lead to serious secondary bacterial complications such as cellulitis.
Harvey Miltchin, director of Toronto's Accent on Feet clinic, says treating fungal nails has been one of the most frustrating challenges during his 30 years as a podiatrist. Fungus causes toenails to become discolored, thickened and separated from the nail bed.
"Patients who suffer from fungal nails are often too embarrassed to wear open-toed shoes or show their feet," Miltchin says.
When earlier this year Health Canada approved a laser for use on fungal nails, warts and scars, Miltchin and Klayman embraced the idea of offering patients yet another treatment modality. Up until now, toenail fungus has been treated with prescription medications. Getting rid of it can take weeks, months, even years.
Some of the oral antifungal medication prescribed can eliminate the infection and restore a nail to health when taken for six to 12 weeks. But side effects may include rashes and a risk of liver damage, and weekly blood tests are sometimes required to monitor the effects.
Topical drugs, though less effective than oral medication, can be effective if the infection is superficial. Though there are no significant side effects, the drug, which is in the form of an antifungal nail polish, has to be applied directly to the nails daily for up to a year. Every seven days, it has to be removed, then reapplied. Nail polish would be out of the question.
Surgery, though the most invasive of treatments, has also been a treatment option. When the severely infected nail is removed, a new nail eventually grows in its place - though it may take up to a year.
Miltchin says treatment options before the laser have been limited "because they didn't work very well and patients were concerned about side effects. I stopped prescribing oral medications years ago because the risks outweighed the benefits."
"This chronic condition has been very frustrating to treat in the past," adds Klayman, who runs Klayman Foot Laser Clinics (www.klaymanfootlaserclinics.com). "The infection gets under and inside the nail. People have felt a certain helplessness. They try the topical, some try the oral, and neither work. I am seeing results with the laser, though.
It clears it up."
Called GenesisPlus, its laser light works by passing through the nail where it is absorbed by the pigment in the fungi. The ensuing heat kills or damages the fungal organism.
About two or three treatments are usually needed for the procedure, which is painless – there is no downtime and no side effects.
But unlike the oral or topical drugs, which though expensive are covered by most provincial health plans, laser treatment is not. The cost, $200 to $300 for two to three treatments per foot, is pricey if it's not partially covered by your private health plan.
The Internet is filled with instant fixes for toenail fungus, but consulting a podiatrist or your family doctor will give you more success than a white vinegar soak (one of many suggestions), bleach, mouthwash, tea tree oil, even Vicks VapoRub!
These home remedies are often tried, says Klayman, "but there is no scientific evidence to support them as cures."
On Your Toes
Andrew Klayman says you can prevent nail fungus by:
- Catching and treating athlete's foot early and effectively
- Taking care around public changing rooms and swimming pools: Wear flip-flops, dry your feet well
- Let your feet breathe. Air out shoes and don't wear the same shoes on consecutive days
- Only attend nail salons that have adequate levels of hygiene. Make sure all instruments and files are sterilized and foot baths have removable liners
- Keep toenails trimmed and clean, and don't share your scissors and files
What and Where?
According to www.mayoclinic.com, nail fungal infections are caused by fungi called dermatophytes. These microscopic organisms don't need sunlight to survive. They live in warm, moist environments and can invade your skin and nail through small separations between the two or tiny cuts. They love toenails because toes are confined to dark, warm places inside your shoes