"For people with toenail fungus there is no good time to wear sandals. Not even at the beach in July. Toenail fungus causes nails to become thick yellow and brittle in a way that looks pretty ugly and can be painful. Sufferers can spend years and hundreds of dollars trying to clear the infection with drugs topical treatments and home remedies sometimes to no avail. It tends to be a cosmetic issue for the younger set and a pain issue for older folks.  The problem is huge. It is bigger than you can imagine says Washington podiatrist Stephen J. Kominsky. I would say  percent of the patients who come into my office have fungal infections on their toenails.  There may be hope. Podiatrists have begun using a laser treatment that combats the infection  or wastes their patients money because it doesnt work depending on whom you ask.  The treatment in which the podiatrist aims a laser beam at the patients toenails to kill the organisms that cause the fungus costs about  and is not covered by insurance because it is considered an aesthetic procedure. The nails arent immediately clear after the treatment which takes up to an hour the patient must wait for the fungusfree nails to grow out. Last year the Food and Drug Administration cleared the first laser http_docspdfK.pdf PinPointe for temporary increase of clear nail in patients with onychomycosis the medical term for a fungal infection of the nail. The FDA cleared a second one GenesisPlus in April. Practitioners have been using other lasers on toenail fungus since about .  No side effects  Kominsky has treated  to  patients with the PinPointe laser. Compared with oral medication he says the odds of success are better with the laser plus theres no side effects.  The most common oral treatment Lamisil works for about two out of three patients according to Lamisils FDAapproved prescribing information http but it has been associated with rare cases of serious liver problems. Other potential side effects include diarrhea headache rashes and changes in taste. According to Lamisils manufacturer Novartis the relapse rate is  percent one year after completing treatment.  In one small study http about laser treatment for toenail fungus which appeared last year in the Journal of the American Podiatric Medical Association  eligible toes ten mild seven moderate and nine severe were treated with a laser produced by Nomir Medical Technologies which is still seeking FDA approval. After six months  percent of the toenails had improved.  I never use the term cured with toenail fungus Kominsky says. With a cure people think theres no chance for a recurrence. In this case there is a chance.  Even John Strisower the founder of PinPointe USA says patients should expect at least a minimal reinfection within five years after laser treatment. Routes of infection  Research done by PinPointe which is based in Chico Calif. identified more than  organisms including fungi yeast mold and bacteria that work together to cause toenail fungus. Theres no one route of infection but sources include pedicures and locker room showers. Fungi love moist dark environments such as wet shoes Kominsky says so people such as lifeguards landscapers and fishermen are particularly susceptible. Shoes are the reason why toenail fungus is much more common than fingernail fungus which can also occur.  The elderly are more likely to have toenail fungus than younger people because they have had more years to be exposed to the infection and their immune systems cant always fight it off according to Washington podiatrist Lee Firestone. He estimates that about half of people over  have toenail fungus. Last year Americans spent  million on prescription and overthecounter treatments for toenail fungus according to IMS Health a healthcare information company. Firestone typically recommends oral medication for patients with toenail fungus.  I think the laser can improve the appearance of the nail but its only temporary and it needs to be used again and again to maintain that improvement says Firestone who doesnt use the lasers in his practice. Ive had patients come in who have had laser procedures and not seen longterm success.http_docspdfK.pdf Vinegar wont work  Firestone also says that overthecounter antifungal nail creams and ointments rarely work because they cant penetrate the nail root. Home remedies such as tea tree oil bleach and vinegar also dont work he says. Yet even a superficial improvement would be an improvement for many. Richard a retiree in Fairfax who did not want his full name associated with toenail fungus got a laser treatment on all  toes in April  and he says his nails were fully cleared of the yellowed thickened look after a year. To prevent reinfection he has purchased all new socks and a SteriShoe a  device that uses ultraviolet light to sanitize shoes at his podiatrists recommendation. He has also turned to what he calls an old wives tale that he read about in a newspaper column slathering Vicks VapoRub on his toes.  My doctor said Listen its not a prescribed treatment but if it works for you for heavens sake do it."