This is one of the most common questions posed to me in my neuropathy practice. Of course every case is different-but there are some broad generalizations that can be made with regards to different types and causes of peripheral neuropathy. For the sake of this discussion, I will address some of the more prevalent neuropathies.

Diabetic neuropathy

Diabetes is one of the more common causes of neuropathy. It is estimated that over 75% all people with diabetes will develop neuropathy to some degree. The outlook for those with diabetic neuropathy varies from mild discomfort and numbness to the other end of the spectrum-as some will develop castorophic complications such infections, ulcerations and amputations. Some of the factors to keep a person “out of the danger zone” include:

• Meticulous control of blood sugar
• Proper diet and regular exercise
• Following sensible foot care practices-This means wearing a comfortable walking/tennis shoe. A shoe that has a good arch support, well padded heel area and a deep, wide toe box to prevent corns and blisters. A person with diabetes should not self-treat. Problems such as ingrown toenails, calluses and plantar warts should be treated by a podiatrist.

Neuropathy caused by chemotherapy drugs

Chemotherapy can be life-saving however a common side effect is nerve damage resulting in neuropathy. Some chemotherapy agents do not cause neuropathy while others may result in transient neuropathy symptoms. In some cases the effects on the nerves are not reversible. On a positive note, I have noted that once chemotherapy has concluded neuropathy symptoms usually stabilize and does not worsen.

Neuropathy caused by alcoholism

The extent of nerve damage is time-related. The longer the nerves are exposed to alcohol-the greater damage to the peripheral nerves.

Neuropathy caused by back problems

The nerves that supply the feet originate in the spinal cord at the level of fifth lumbar-and first sacral vertebrae. Spinal problems that result in neuropathy include spinal stenosis (narrowing of the spinal column) and protruding discs. Spinal problems can cause pain, burning, tingling and electric shock sensations. Conservative care including physical therapy, a sensible exercise program and back- care 101 (avoid lifting heavy objects, lifting with knees bent and stretching before and after activities), can help reduce neuropathy symptoms. Back surgery should be the very absolute very last alternative!

Neuropathy cause by nutritional deficiencies

In today’s modern world a sensible diet including fruits, vegetables and fish can provide most of the essential vitamins and nutrients. Some conditions such as anemia can deplete certain mineral and supplements. In these cases reversing the medical condition and adding appropriate supplements can in many instances reduce or eliminate neuropathy symptoms.

So coming back to the question-how bad will my neuropathy get? I would like to close with the proverbial “good news-bad news:” The bad of course is that in most instances peripheral neuropathy is not curable or reversible. The good news (if there is in fact good news if you have this condition) is that in my observing and treating patients for over 35 years with neuropathy most people with neuropathy do not wind up “crippled” or in a wheel chair. Peripheral neuropathy can be painful, annoying and very uncomfortable but armed with knowledge, a commitment to good health and proper medical care-the condition can in most instances be manageable.

There is a recent buzz about the use of laser for curing fungus toenails-but does it actually work?  Before answering the question let’s talk about fungus toenails. Fungal toenails are caused by a number of organisms-the same ones that result in athlete’s foot. Fungal toenails have a variety of appearances. They can be thick with discoloration (usually black or yellow) and can be streaked as well. Usually there is dead skin build up under the toenail.  It is estimated that a staggering number of Americans are afflicted with fungus of the nails-over 23 million?

With the numbers so great, it is no wonder that companies are on the fast track to find a cure. Within the past five years claims are popping up in newspapers, on radio and on the internet by some doctors can cure fungus with laser treatments. A recent article in the New York Times has shed light on the subject. In the article entitled, False Start on a Laser Remedy for Fungus basically states that the claims for a cure are far too optimistic. One laser manufacturer basically jumped the gun and made claims about curing fungal toenails before it was approved by the FDA.

Treating fungal toenails with laser is highly questionable. The nail growth tissue is literally made of millions of cells and directing the laser beam in the vicinity of the nail cells does not guarantee that all the cells will be treated. Now let’s assume that the laser reaches the nail cells-what assurances are there that the laser beam will kill the offending fungal organisms-there are none. In addition no official settings or treatment protocols have been established by the FDA.

So what’s the rush for claiming that laser effectively treats fungal toenails?  Some companies and some doctors are eager to get a piece of the billion-dollar-plus market. If you suspect fungus toenails-here are some practical suggestions. First I suggest that you a see a podiatrist. There are simple tests that can be performed (toenails scrapings-called PAS tests) that accurately determine if you have fungal toenails and what organisms are involved. Certain conditions may mimic the appearance of fungus-injury to the nail yeast and bacterial infection is just a few.

The following are some treatment suggestions:

• Topical treatments-Penlac® is a FDA approved nail lacquer for treating fungal toenails-The treatment is relatively safe but the downsides are that it is costly and is effective in curing toenails-less than 30%.
• Over-the counter-topical treatments such as FFN®.  This is a new topical medication that contains the same ingredients as the oral medication. It is slower acting than the oral medications but it is much safer and less expensive.
• Home remedies-there many home remedies for treating fungal nails. As long as “they do no harm”-they can be tried. One popular treatment is the use of Vicks Vapor Rub®-applied to affected nails daily. I’m not sure that it works but it is inexpensive and safe.
• The most aggressive treatment is oral medication such as Lamisil tablets. Lamisil is by far the most effective agent for resolving fungal toenails. Lamisil is safe as long as the FDA guidelines are followed. Lamisil can exacerbate liver disorders so it is necessary to have liver screening done before being placed on the medication.

So to answer the question-does laser work for curing fungal toenails?-My input is that I would discourage this type of treatment. It is not FDA approved for this condition and it is expensive-and most insurances will not cover this procedure.