Welcome to the Website of

Dr. Michael Zapf, DPM, MPH, FACFAS

Call: (818) 707-3668

 Thank you for visiting my website. I have been placing information and articles on this site for many years and have received millions of  hits during that time (and not that many of them were mine). I have designed it for people who like to read about their foot and ankle problems. Since I started the web site, I have added two associates to my practice, Dr. Darren Payne and Dr. Stephen Benson.  Since my site is filled with just my thoughts and opinions they are not, necessarily, shared by my colleagues. To see our less controversial (and less windy) practice web site, I offer you: www.ConejoFeet.com, the practice site for The Agoura Los Robles Podiatry Centers (ALRPC). The ALRPC practice site has a lot of material about our office, many of our policies and the registration forms to be filled out before your visit. I suggest all prospective patients visit www.ConejoFeet.com.

 I made the web site to give my patients the extra depth information that I don’t always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. I am from a generation that likes to read in depth about all sorts of things, including our ailments. This site is dedicated to all those who want more information that what can be contained in a series of bullet points. If you like this philosophy then let me know when you see me or if you ask a question.

Remember, this site is in no way intended to tell you how your own ailment or problem should be treated, only the approach I use when confronted with certain situations. Your problem may well be different from what you think it is and should always be evaluated by the appropriate professional, whether podiatrist, orthopedist or other authority. Please understand that I, nor anyone else, can offer you a proper diagnosis or treatment plan without seeing and feeling the problem at hand (foot?) Happy reading.

 Sincerely, Michael Zapf, DPM, MPH, FACFAS, FACFAOM

 P.S. All the information in this web site is © by me and it is mine alone. No picture and none of the articles can be used by anyone without permission from me, personally.

P.P.S. Comments about this web site or questions about your feet can be directed to me at zfootdoc (at) doctor (dot) com.

P.P.P.S.  I was going to offer a nice prize to the person who could send me a screen shot of being the 3 Millionth person to visit this web site. I am sorry I missed that opportunity. But wait until you see what I offer the 4 Millionth visitor.

 


11/12/2013HomeNews+FAQ

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Options for Thick and Fungal Nails.

laser nail treatment for fungus nails

(revised 1-8-2012)

 

THERE ARE FOUR MAIN OPTIONS TO TREAT OUR FUNGUS NAILS:

 

1. DO NOTHING   Fungus in a nail rarely goes away without treatment. The normal course is for the nail to get fully involved with the fungus from the tip to the root and then get thicker and thicker. It is not unusual to see some of out senior patients with nails that can approach an inch thick.

 2. TOPICAL MEDICINES:  Most people start their treatment with the use of a topical medication or a home remedy. People have tried topical Lamisil, Lotrimin, Micatin, Vicks Vapo-Rub, tea tree oil, white vinegar, rubbing alcohol, bleach and the prescription product Penlac. All of these need to be used twice a day for up to a year to see results. Our current favorite is a topical Fungal Free Nails product that we sell for $38 a bottle (available from the internet at the same price). All three doctors have seen this remarkable product work on many (but not most) occasions. The probable effectiveness rate is less than 20% when used twice a day for a year.

 3. ORAL MEDICINE. Currently the only oral medicine is terbinafine, also called Lamisil. This medicine is taken one tablet a day for 90 days and achieves a 75% rate of improvement. There is a rare and slight but very real risk to the liver, kidney and blood cells. The people who have been seriously injured probably already had some organ damage and there is no proof that Lamisil did the damage all by itself. To check on potential damage we require a pre-treatment and during-treatment levels of your liver function and your blood cells (liver function tests and complete blood count). Because of the risks of Lamisil, we want laboratory proof that you have fungus in your nails before we prescribe this medication. This requires a laboratory examination of a sample of your nails. It takes us about 2 weeks to get results back from the laboratory.

 

4. LASER THERAPY This is a new treatment available for fungus nail treatment. The laser treatment is done at one visit where a laser light is passed over and through your nails to kill the fungus without damage to any of your skin or nails. The light literally passes right through your skin without any damage at all. It has been used thousands of times without any side effects. With the laser there are no injections, no pills, no lab tests and no risks of any kind. The effectiveness is running at 88% if repeated enough times (no fungus can be resistant to this wavelength of light). Success with only one treatment is probably more like 50-60%  Failures are likely due to damage to the nail plates, either through injury, severe long standing fungus infection, poor circulation or genetics. The first laser treatment with Dr. Zapf ranges from $400-600 with every 2 or 3 month re-treatments costing $100 each, plus the office visit, which can be billed to your insurance. You can pay for the laser portion of your treatment with a credit card, cash or check and you can also use your flexible spending account or health savings account. We have even made arrangements with an interest free health credit card for your convenience.

 Additional treatment recommendations to avoid reinfection:

 q Use of a topical antifungal medicine daily or at least once or twice a week. Topical Lamisil is probably your best bet. We ask that you apply this to the tops of your toes, including the nails, between the nails and across the bottoms of your feet in the so-called moccasin distribution. Doing this right after your shower and before putting on your socks and shoes is a convenient and effective time to do this. You can purchase a very helpful topical antifungal medicine in our office or from the Footstore link on our website: www.conejofeet.com.

q Antifungal Foot Spray. We recommend that you spray the inside of your shoes with an antifungal foot Spray when you are finished wearing your shoes for the day. For real shoe sterilization we recommend the use of an ultraviolet shoes sterilizer. A good antifungal foot Spray is available in our office and many brands can be found from the Footstore link on our website: www.conejofeet.com

q SteriShoe. The sweat and dead skin cells from our feet accumulate on the inside of our shoes and it becomes the perfect breeding ground for athlete’s foot fungus, bacteria and other unpleasant critters. Spraying the inside of your shoes with an antifungal spray does achieve some good but it is nowhere near 100% effective. Ultraviolet light, however, is 100% effective in killing all pathogens from the inside of your shoes. We sell a set of two ultraviolet light containing shoe trees that will kill all organisms from the inside of your shoes in 45 minutes. They have an automatic shut off so all you have to do is place the shoe trees in your shoes, turn it on and forget about it. If you want to be free of fungus on your skin and nails we strongly recommend that you use the SteriShoe. You can purchase the pair of SteriShoe shoe trees from us for $130 or you can purchase it from the SteriShoe website: www.SteriShoe.com.

q If you want to get pedicures we ask that you take the proper precautions. Make sure that the pan in which you soak your feet has a disposable liner so that you don't soak your feet in the same water used by other clients. Make sure that the facility sterilizes any instruments used on your feet such as clippers, files, probes and scissors. Autoclaving (sterilizing under high pressure using hot steam) .is the only sure way to sterilize instruments. Typically these instruments are placed in an autoclave bag that has a colored marker that changes color when the autoclaving is successful. In our office our autoclave bags have a pink square that turns brown with successful autoclaving. Soaking instruments in a disinfectant is not a guaranteed way to kill nail fungus. You will notice that our office opens a sterile bag of instruments for every patient every time right in front of you, the patient. Your nail salon should do the same thing if they are interested in your foot health. Unfortunately, very few nail salons take this level of precaution. For this reason you should purchase your own reusable metal instruments and cleaned them yourself between visits. You can purchase these instruments from a beauty supply house or we sometimes have an extra supply of some instruments that you could purchase. Some instruments are also on sale from the Footstore link on our website www.conejofeet.com .From time to time we even have a pedicure kit for sale. Once you have your own metal stainless steel instruments, you can run them through your dishwasher as a reasonably effective way to keep them clean. If you are real serious about your foot health, we will offer to place your instruments in one of our autoclave bags and sterilize them for you. Ask about this service next time you are in our office.

q Fingernail and toenail polish: we have twenty colors of fingernail polish available for purchase in our office. They cost $17 a bottle and they have tea tree oil as an antifungal agent. These are not meant to treat fungus nails but they can help you keep your new beautiful nails fungal free. Please polishes also are free of two agents that tend to yell over the nails after the polish has been removed. You can apply this polish your self or you can ask your pedicurist or manicurist to use it when you receive your pedicure or manicure. These polishes are also available from the Footstore link on our website www.conejofeet.com.

q Fungus Free Nails-Rx.. If you want a topical that just might work, try Fungus Free Nails-Rx. Fungus Free Nails (without the -Rx) is a topical antifungal agent that was developed by two inventors; a podiatrist and a retired cardiologist. They mixed up a concoction of seven oils, literally in their kitchen sink, that each had a reputation for being effective against fungus nails. Tea tree oil is one of the seven oils. They bottled this concoction and sent it to a variety of podiatrists and dermatologist to get some feedback. I was one of the tester podiatrists and I gave a two sample of the product to two patients who both came back a few months later with dramatically improve nails. I immediately ordered more bottles of this product and used it on more people. My initial success rate was not duplicated, but I did have several people that noticed an improvement in their nails. With this original product I had about 30% significant improvement and another 30% with some improvement in their nails. Considering how poorly all of the other topical medications work, this was quite an improvement. I ordered many batches of this product and had many happy patients because of it. A few years after the introduction of Fungus Free Nails they introduced a new product which had the addition of three prescription strength, legitimate, antifungal agents: 2% Lamisil, 2%Ciclopirox (which is the active ingredient in Penlac) and 2% Fluconazole which is an ingredient specifically to target yeast which can sometimes creep into nails, especially when they are ready have a fungus. In my practice I substituted FFN-RX for the straight FFN. If somebody wants neither oral medication nor the laser I will often use debridement of the nails every two-months with the use of topical FFN-RX which I believe is the minimally legitimate way to try to treat fungus nails. Because of the effectiveness of the FFN-RX I tried to get all of my laser patients and even my oral medication patients to use this medication twice a day until the nails get as clear and clean as what makes them happy.. For some people this is merely a few months and for others it takes as long as two years. FFN-RX is only sold in physician offices and we have some in both of our offices for your use, if you so wish to have some. The price is $$49 a bottle plus shipping, of course.

q Nonyx-Nail Gel. This product is only modestly helpful in treating fungus nails but it has an excellent bleaching agent to lighten the color of a discolored nail. We sell Nonyx nail gel for $25 a bottle in our office. It is also available online at www.drugstore.com and other sources.

q Biotin is a vitamin pill that may help treat or prevent split and cracking nails. Biotin stimulates epidermal cells and affects the protein structure called keratin found in skin, nails and hair. Biotin is directly involved in the production of keratin cells and is believed to increase the quantity of keratin-matrix proteins in the nails. Thus, this B. vitamin is likely to improve nails strength, and dust resistance to fungus, by influencing keratin structure. One clinical trial of Biotin use in nails used a high tech scanning electron microscope to carefully measure fingernail thickness and splitting. The study used a daily dose of 2.5 mg of Biotin and found that fingernail thickness increased by 25% and splitting decreased after biotin supplementation. This study appeared in the respected dermatology journal, Cutis. (Hochman LG, Scher RK, Meyerson MS. Brittle nails: response to daily biotin supplementation. Cutis. 1993;51(4):303-305) Appearex is a commercial product recommended and sold by many dermatologists and contains 2.5 mg of Biotin per capsule and sells for $32 for 84 tablets at www.drugstore.com. We sell a more cost effective Biotin made by a high quality vitamin manufacturer at $8 for 60 8 mg tablets. Probably only two or three tablets a week are needed to improve the strength of your nails.

q Gelatin: gelatin capsules are available at your drugstore or health food store, Knoxx or other gelatin powder that you can mix in your fruit juice or even eating Jell-O can improve the thickness and strength of your nails and make them more resistant to attack by fungus.

q Moisture wicking and moisture repelling socks  athletes foot fungus , like any good mushroom , prefers dark , moist and warm environments to grow. The sweat from your feet can create a wonderfully hospitable environment for athletes’ foot fungus. Traditional cotton socks will absorb moisture until they are saturated and then maintain themselves as a wet layer of cotton against your skin for the rest of the day. There are two better alternatives for you then cotton socks. The first is exemplified by Thor-lo brand (www.thorlo.com) which readily transfers the sweat from your skin to the stock and allows for more rapid evaporation than cotton. Thor-lo socks are available at all sporting goods stores and athletic shoe stores for 31 different sports. A better alternative is exemplified by Drymax sports socks (www.drymaxsocks.com ) which is composed of two layers of material the inner layer of which quickly transfers moisture to the absorb an outer layer much like a disposable diaper. In both cases the skin, and in the Drymax case, the nails, stay extremely dry. Drymax socks were recently featured in Diabetes Educator Magazine as being very helpful for diabetics in preventing infection. In our area Drymax socks are Available at Road Runner Sports in Newbury Park. 

q Rotate your shoes – unless your shoes are made of all plastic, they will, undoubtedly, absorb a lot of the moisture that your feet produce each day. Unless you use the sterilizing shoe tree discussed above it will take about two full days for your shoes to completely dry out and be ready to absorb moisture again. If you wear your shoes in the rain, or get them wet some other way, it made take a full three or four days for them to fully dry out. Please place them in a well ventilated area so that air circulation can get to them.

q Avoid bare feet in public places.

q Treat athlete’s feet of all family members. One of the most common sources of reinfection are the athletes feet fungus spores left on the carpet, in the shower and in the bed sheets of family members who also have the condition. If you really want to be free of reinfection consider having your family members treated at the same time.

q Corynebacterium although it is not a fungus, there is a bacteria called corynebacteria that can grow on your feet and between your toes that can cause an athletes foot type itch, irritation and, especially, a pungent and disagreeable odor. This bacteria produces a coral red fluorescence which can be detected using a special wavelength of ultraviolet light. We have a special “Wood’s Lamp” in both offices that can detect the presence of this bacteria. If you are positive for coral red fluorescence this bacteria can easily be treated with topical erythromycin.

q Green nails: sometimes we will find a distinct color growth under the nail plate. This is often confused with a fungus but it is caused by a bacteria called Pseudomonas. Pseudomonas infections will are surprisingly common and are usually caused by foot soaking. The bacteria can sometimes be found in faucets used to fill a foot soak bowl. If we think you have a Pseudomonas infection under your nail we will treat it with either Ciprofloxacin ear drops placed under your toenail or with white vinegar. Pseudomonas is thought to be killed by acetic acid.

 

Random trivia about nails

·         The longer the toe or finger, the faster the fingernail grows

·         Nails grow faster in warm climates and fastest in the summer.

·         Nails grow 20 percent faster when a body is fighting off the flu

·         Extreme dieting slows nail growth

·         The nail on the pinkie finger and toes grows the slowest, followed by the thumb/big toe nail.

·         Fingernails grow twice as fast as toenails.

·         Men's nails grow faster than women's

·         Nails grow fastest between the ages of 10 and 14.

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Copyright © 2000 Michael A. Zapf, D.P.M., F.A.C.F.A.S., F.A.C.F.AOA.M.
Last modified: November 12, 2013