Frequently Asked Questions
How do I treat fungus on my toenails?
There are 4 possible treatments for treating fungal toenails, Topical medications (Tolcylen), Laser treatment, Oral medications (Lamisil), and permanent removal of the toenail.
What anti-fungal treatment is right for me?
All treatments have different degrees of success, invasiveness, and cost. It can also depend on the severity of the toenail. Most patients will start with a topical medication and see how they look after 3 months. You can purchase the topical Tolcylen in our store.
How long is it going to take for my toenails to look better after starting treatment?
It takes as long as it takes for your new healthy toenail to grow out. Normally it takes a toenail at least 9 months to completely grow out and even up to 18 months on rare occasions.
Will my toenail fungus spread to other toes?
It will most likely spread to all toenails in time and the ones that are already infected will get worse if untreated.
How did I get toenail fungus?
A lot of toenail fungal cases come from untreated athletes foot infections. Any crack or portal of entry into the toenail can result in an infection of the toenail when the fungus is already on the surrounding skin. Decreased immunity and lack of blood flow to the feet can also contribute.
Are thick toenails always fungus?
Thick toenails are not always fungus. The thickening of the toenail can be caused by repetitive microtrauma to the toenail and toenail bed, usually from ill-fitting shoes, and also one traumatic event to the nail bed. It is usually wise to get a biopsy to see if the toenail thickening is from fungus or another cause. This is a simple, pain-free procedure done in the office.
Do over the counter topical medications at the pharmacy work?
Not normally. I have had patients over the years use Vicks vapor rub, apple cider vinegar soaks along with other home remedies that really have not been proven to work. The key to success is the penetration of the medication. That is what makes Tolcylen the best topical that we have used.
Why does it feel like I am walking on a rock in the balls of my foot?
That is most likely a neuroma, which is a pinched nerve in the forefoot. Most patients can experience pain, numbness, and tingling in the area usually between the 3rd and 4th toes. The irritation of the nerve can feel like you are walking on a rock or pebble, or that your sock is wrinkled in your shoe.
Does my neuroma need surgery?
Why do tight shoes and high heels bother my neuroma?
Compression and pressure on the forefoot from tight shoes and heels can compress the area and pinch the nerve causing more pain and irritation.
Do orthotics help neuromas?
Orthotics can offload the area and create relief from the neuroma. Over time, the inflammation of the nerve and surrounding tissue will decrease and help the pain.
Why does my heel hurt in the morning?
The most common cause of heel pain is Plantar Fasciitis. The plantar fascia is a thick band of tissue on the bottom of your foot that goes from the heel to the balls of the feet. Plantar fasciitis is inflammation (swelling) of the tissue and over-stretching of the band. When you sleep, your foot is relaxed and the plantar fascia tightens, but when you apply pressure in the morning it pulls tight and tears at the insertion (the heel). As you walk a bit, it starts to stretch out and feel better, but if you sit and let the plantar fascia tighten when you get up the pain will return.
What can I do to help my heel pain?
Proper shoe gear, anti-inflammatories, icing, and stretching are things that may help. Over the counter inserts may be helpful too but will wear down quickly. We have many options at our offices including, custom orthotics, night splints, cortisone injections, regenerative tissue injections, Shockwave treatments (EPAT), Aquaroll therapy, and laser treatments. These all can be done before surgery is considered.
Are custom orthotics worth the cost?
Custom orthotics are digitally cast to your foot precisely and prescribed for your exact condition. They will correct the biomechanical instability in your feet that was causing the heel pain. Over the counter inserts will only last for a couple of months, at best, while custom orthotics will last for many years. Some patients will bring in orthotics they still wear from 20 years ago! Custom orthotics are a solid investment compared to buying $50-60 inserts every couple of months.
Does my heel spur have to be surgically removed?
Not normally. Less than 5% of all heel pain patients need surgery and even less actually need the spur removed. It is very, very rare that the spur needs to be addressed with surgery. The spur itself does not usually cause the pain, it the tight plantar fascia that is normally painful.
My heel pain is in the back of the heel, is that plantar fasciitis?
I think I need a cortisone shot in my heel, does that hurt?
The injection does hurt for about 10 seconds, but most patients leave the office with no pain in the heel. We use ultrasound to guide the injection to get it in the exact location needed and use a cold spray to minimize pain associated with the injection site.
How long will a cortisone injection last?
It really depends on a number of factors such as location, the severity of the condition, and the body’s response to the medication. It is possible that the injection may not work at all or it could heal certain conditions. Most patients experience months of relief after a cortisone injection.
How many cortisone injections can I have?
In one area the most allowed is 3 in one year. Doing more injections may have certain undesired side effects such as weakening of the tissue and cartilage along with demineralizing of the bone.
What new treatments are available for my heel pain?
Other Foot and Ankle Questions
What is the bump on the top of my foot?
It could be a few different things such as bone spurs due to arthritis or a ganglion cyst. This can cause pain and rub against your shoe. X-rays would be needed to assess the condition and get a treatment plan to resolve the issue.