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it can be performed in an office setting with minimal pain. Once the infection is re solved, many people will have a recurrence. Weekly application of topical antifungals can be an effective prophylactic. Recalci trant or non-responsive mycotic toenail infections may require permanent partial or total nail excision (surgical removal) or ad ditional doses of oral antifungals. In summary, fungal toenail infections are common. Many are treatable and significant improve ment can be made in appearance and related pain. Treatment be gins with debridement and topical antifungals. If the topical medica tion does not help, oral antifun gals are recommended, provided there are no contraindications. Š Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years and 50% of those older than 70 years.

Despite social media claims, topical treatment for fungal toenails is often unsuccessful. Oral antifungal prescriptions are generally safe and effective, provided you’re not taking other medications that interact with the antifungals. You should also not take oral antifungals if you have preexisting liver disease or drink excessive alcohol. Many of the oral antifungals have been on the market for over 20 years, have a proven safety profile, are inexpensive and are generally well tolerated. Typically, the oral meds are taken for 90 days; their efficacy ranges from 65-99% with the average being 80% effective. The mainstay of treatment for a fungal toenail is sharp

debridement. Debridement is the physical removal of much of the mycotic portion of the infected toenail, so the topical or oral an tifungals can be more effective by penetrating the deeper por tion of the nail. Debridement is considered a surgical procedure by Medicare and other private insurance companies; however,

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About the Author Dr. David T. Taylor earned his B.S. in Microbiology and Biological Sciences with honors from Colorado State University in Fort Col lins, CO. After his undergraduate work, he remained at Colorado State for a year of graduate school researching Tuberculosis. He attended the Scholl College of Podiatric Medicine in Chicago, where he graduated Summa Cum Laude in 1999. After gradu ation, he completed a three-year residency in Foot and Ankle Surgery at Hines Veteran’s Administration Hospital and Loyola

University Medical Center in suburban Chicago. During his residency, Dr. Taylor published several research papers regarding great toe joint arthritis. Board certified by the American Board of Foot and Ankle Surgery (ABFAS) in both Forefoot and Rearfoot/Ankle Surgery, he joined Community Podiatry Group in August 2002.

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