At the Arbor Foot Health Center, the laser we use on fungus toenails has a counter on the back which tracks the overall number of pulses that the laser has produced. This week we went over the 1 million mark. From that lofty vantage point I feel merited to make a few observations on the treatment of fungal toenails with the laser.
The use of the laser has followed a pattern I have seen before in the practice of medicine. A new treatment comes out and everyone is excited about it and it tends to be oversold. The laser is no different. The FDA approval noted that lasers are indicated for the temporary improvement of mildly infected fungal toenails. In everyone’s excitement, we start to use it for severely infected toenails that have been infected with fungus for 20 years or more.
The result of stretching the indications for the laser are predictable. Namely there is less success than the initial studies indicated. This does not mean that the laser does not work but it does mean that we must temper our initial enthusiasm and be realistic in what we can accomplish.
When someone has long standing fungus of many toenails and has had recurrent athlete’s foot, they have a stubborn fungus which has infected both the toenails and the skin. There is also an excellent chance that this fungus is residing in their shoes. Killing the fungus in the toenails with the laser alone will not solve their problem. When a fungus is pervasive in the environment it must be eradicated everywhere! A topical antifungal must be used on the skin and all closed in shoes must be disinfected. Fungus thrives in dark, warm, and moist areas. A multipronged approach is essential. We can cure severe fungus toenail cases but it is more complicated than just a laser treatment! (I will elaborate on this in a subsequent blog.)
The laser treatment of fungal toenails is in my mind one of the most exciting and satisfying innovations in the podiatry field. I have seen many people who were ashamed to wear open sandals because of their fungal infected toenails. In a climate like Austin where we have long, HOT summers, not being able to wear sandals is a real problem! Just today I had someone cancel a six-month follow-up on a laser fungal toenail procedure because she said her toenails were perfect. We were so happy for her that she can wear sandals this summer without embarrassment. I cannot think of a better reason to cancel an appointment!