Posted by Brandon Nelson on Wed, Feb 23, 2011 @ 10:27 AM
Many patients from Issaquah, Bellevue and Seattle have recently inquired about laser treatment for fungal toenails. There currently are lasers being utilized to treat fungal toenail infections however, the results that we have seen are not outstanding.
Studies have shown only a 60-85% improvement in appearance of the nails after multiple treatments. The treatment seems to cost between $1,000-$1,400 per foot and most patients require a minimum of two treatments for each foot. The total out of pocket expenditure approaches $4,000-$5,600 dollars, which can be quite costly for a patient since it is not covered by insurance.
There are other modalities available to treat fungal nails that are more effective and much cheaper. They are as follows:
- Oral medication. Some patients prefer to stay away from the oral medications due to the length of time required to be on them. We have found success with other treatments that do not require an oral pill for those that prefer a different option.
- Topical treatment. We use an antifungal medication, which the patient applies daily to the entire affected nail area until the nail completely regrows.
- Steri Shoe. Steri Shoe uses germicidal ultraviolet light inside of the shoe to kill microorganisms essential to treating active infection and preventing future infection.
- Removal of the toenail, allowing regrowth of the new nail. The nail is removed, along with any soft tissue that is affected by the fungus. The nail growth center is left intact so the new nail can grow back.
- Permanent removal of the toenail. This is a definitive treatment to make sure the fungus will not grow back. This is not a common treatment, but is an option and can be done in our surgery center.
Issaquah Foot and Ankle Specialists
BestFootDoc.com
Did you know that we have developed a dedicated resource for heel pain sufferers?
SeattleHeelPain.com
Posted by Tim Young on Wed, Feb 09, 2011 @ 12:31 PM
New! Modification of dry needling for plantar fasciitis procedure. We are not aware of any other clinic or facility that is providing this treatment other than our clinic at this time.
One of our goals with dry needling has been to use the smallest dose of cortisone possible. This is because there is a small risk of rupture of the plantar fascia with any cortisone injection. The way that this risk has been reduced dramatically has been to inject between the plantar fascia and the fat pad (and avoid the plantar fascia itself). It is possible to do this procedure without using any cortisone at all. Some doctors have the theory that the use of cortisone with dry needling is counterproductive. This is because cortisone inherently decreases inflammation and the dry needling procedure itself is designed to actually allow for some inflammation and release of platelets with associated growth factor.
With this in mind, we are starting to do this procedure for some individuals using platelet-rich plasma instead of cortisone. The goal is to further augment the growth factor concentration after this procedure and allow the treated plantar fascia the maximum healing potential possible without adding cortisone which inherently decreases inflammation.
This procedure is very similar to typical dry needling protocol. A local anesthetic is used. We again use our electrical nerve stimulation to help minimize discomfort from the local anesthetic. Then there is no discomfort whatsoever. 20 cc of blood is drawn from the patient and put in a two-stage centrifuge. A high-speed centrifuge is able to separate out the component of blood that contains the platelets. So for the 20 cc of blood, we now have obtained 3 cc of platelets (with associated growth factor). This growth factor is then used instead of the cortisone. It is injected at the interface between the plantar fat pad in the plantar fascia. And we also inject some of this into the plantar fascia itself.
There are several different local biotech companies that help with the preparation of the platelet rich plasma. They typically charge the patient a direct fee for this service that is not covered by insurance. However, the doctor’s procedure for the ultrasound-guided injection is typically covered by insurance.
The post procedure protocol is essentially the same as typical dry needling. Some of the elements of this include the use of a cast boot and avoiding anti-inflammatory medication.
Issaquah Foot and Ankle Specialists
BestFootDoc.com
Did you know that we have developed a dedicated resource for heel pain sufferers?
SeattleHeelPain.com
Posted by Tim Young on Thu, Jan 20, 2011 @ 01:19 PM
Plantar fasciitis is one of the most common foot conditions that people suffer from and it's the number one condition that we see patients for in our office. Patients with plantar fasciitis will find that they experience many different symptoms, but the tell-tale sign of plantar fasciitis is heel pain first thing in the morning, which normally results in a limp.
There have been many effective treatments for plantar fasciitis. But, it can be recalcitrant to traditional treatments.
Mechanical treatments include:
Treatments addressing inflammation may include:
- icing
- cortisone injections
- oral anti-inflammatories
- physical therapy modalities such as therapeutic ultrasound and electrical stimulation
Recalcitrant cases may be treated with platelet rich plasma injections, shockwave therapy and surgery. Surgery is usually the last resort and can include plantar fascial release or a gastrocnemius recession.
In November of 2008, Dr. Lucia Sconfienza out of the University of Genoa in Italy gave his presentation on dry needling for plantar fasciitis at the radiological society of North America annual meeting in Chicago. He reported a 95% success rate for treatment of plantar fasciitis with this technique. Since this time, there has been more interest in this approach in the United States. At Issaquah Foot and Ankle Specialists, we have been providing this procedure since December 2008. Our clinic has developed a protocol to accompany this procedure. Ultrasound guidance is used to direct the procedure and ensure that it is safe. The procedure involves repeated probing during the injection that causes microtrauma and some internal bruising. This releases platelets that have associated growth factor and this in turn stimulates the body to heal itself. The procedure itself is actually quite low-cost compared to some of the other alternatives such as shockwave therapy and surgery.
Issaquah Foot and Ankle Specialists
BestFootDoc.com
Did you know that we have developed a dedicated resource for heel pain sufferers?
SeattleHeelPain.com