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Toenail Fungus Specialist

Mark Co, DPM -  - Podiatrist

Mark Co, DPM

Podiatrist located in Duboce Triangle, San Francisco, CA

Toenail fungus is painful and unsightly, and without professional treatment, it can soon spread to other toes. At his Duboce Triangle practice, Dr. Co uses the most advanced laser treatments for toenail fungal infections in patients throughout San Francisco, CA, destroying the fungus at the deeper layers where it's rooted.

Toenail Fungus Q & A

What causes toenail fungus?

Toenail fungus is caused by fungal organisms called dermatophytes that enter the nail bed through a tiny cut or another tiny opening in the skin. The dermatophytes become rooted in the deeper layers of skin under the nail which acts as a protective shield, making treatment much more difficult. Dermatophytes prefer to live in warm, damp environments, and walking barefoot in public lockers rooms or showers can increase the risk of developing an infection. Fungal infections can also be caught by wearing shoes or socks belonging to someone who's infected. They're also more common among people with compromised immune systems or circulation problems.

What symptoms does toenail fungus cause?

Toenail fungus usually starts out as a small area of discoloration under the nail that spreads to the rest of the nail over time. The nail itself generally becomes ragged and brittle, and eventually, the area under the nail will become tender, especially when pressure is applied. Without care, the nail can develop an unpleasant odor, and the infection can spread to other toenails. People with untreated toenail fungus can find wearing shoes an especially painful experience since the shoe will press against the tender and inflamed nail bed.

My nails have become discolored and are thickening. What can I do to prevent them from getting worse?

The main reason nails become discolored and thick is nail fungus. Nail fungus thrives in warm, dark, and moist environments, which describes the inside of a shoe. Keeping the feet cool, dry, and open to air and light is the way to prevent nail fungus from proliferating. Wearing moisture-wicking or wool socks will prevent moisture build-up in your feet. Cotton, though it is a natural fabric, is not recommended as it holds moisture close to your skin, especially in the enclosed environment your shoe creates. If you work out, removing your shoes and wearing open-toed shoes immediately after your workout will also reduce moisture build-up. There are over-the-counter products which you can use to combat athlete's foot and disinfect your shoes as well as ultraviolet shoe trees which kill fungus in your shoes. The bottom line with respect to foot hygiene for athlete's foot and nail fungus is to keep the feet as cool and dry as possible.

Once fungus infects under your nails it becomes much more difficult to treat. There are two effective treatments on the market today, oral anti-fungal medication and laser therapy. Most patients opt to treat with the laser, as it does not pose the same risks that oral medications present to the liver. Topical treatments, though much improved, are still not effective enough to be used as a primary treatment. 

For more information on how to treat your specific case of athletes foot and nail fungus, please make an appointment for an evaluation. 

How does laser treatment work?

Dr. Co's office uses the Pinpointe laser, the first FDA-approved laser for treatment of nail fungus. The Pinpointe laser uses heat to desiccate fungal spores, effectively killing fungal cells instantaneously. My protocol involves 3 separate treatments to all affected nails, each separated by 2 months. At each treatment the nails are debrided to remove as much fungal debris as possible, then laser treatment performed to all affected nails. Each visit takes about 10-15 minutes.

The laser is not initially hot, but when the nail absorbs the laser heat, it will feel like a match is over your toe. The heat dissipates quickly once the laser is removed. There are no limitations after a laser treatment and you can return to all your activities without limitation. 

How long will it take to see the results of laser treatment?

Nails grow at a snail's pace, at about 1 millimeter per month. It takes 9 months to a year for a nail to fully replace itself. You will see clearing at the base of the nail which will continue to push out month after month. After the initial laser treatment is done it will take approximately 9 to 12 months to see full effectiveness. Even after the first year though, the nails may continue to improve if proper hygiene is adhered to

Conversely, nail fungus can return if the nail is not adherent to the nail bed or if the feet are constantly subjected to a warm, dark, and moist environment. There are a variety of recommendations to safeguard your laser treatment, such as alternating your shoes, wearing moisture-wicking socks, keeping your nails trimmed short, use of antifungals, and such. 

Dr. Co makes it a point to continue to follow up with his Pinpointe laser patients to make sure they get the best results possible. 

How is toenail fungus treated?

The most effective treatment for toenail fungus is presently oral medication or laser therapy for fungal nails. Toenail fungus can sometimes be treated with prescription-strength topical medicines. More recently, the FDA has approved laser treatments for toenail fungus. In this treatment, highly-focused laser energy is directed through the skin and toenail to the deeper layers of tissue where the fungi are located. Laser treatment is painless and requires no anesthesia, plus it can be completed right in the office and there's no recovery time. During the treatment, most patients experience a warming sensation as the laser energy reaches its target tissues.

Insurance Providers

We accept Medicare and most PPO insurance plans. For questions about insurance, please contact the office.

Blue Cross Blue Shield
Brown & Toland
Hill Physicians Medical Group