Why focus on the lowly fungus nail in a lecture series for podiatric residents? That's simple. Patients with thickened, dystrophic, fungal nails make up a significant part of many podiatric practices across the country. For decades, Podiatrists has been the provider of choice for this medical condition, yet the majority of patients do not actually receive TREATMENT when they visit their Podiatrist!

In the average podiatry practice, 24% of patient encounters involve onychomycosis. It is for a podiatrist what an upper respiratory infection is for an Internist. It is estimated that 35 million Americans have fungal nails. 50% of people 70 years of age or greater have it. In a word, it is ubiquitous, and it will bring huge numbers of patients into your clinical practice. But Dr. Joseph points out that debridement alone does not actively address the underlying fungal nail infection. Millions of nail debridement services are performed each year by podiatrists. In fact, Medicare reports that nail debridement is the single most billed code by podiatrists. Debridement "reduces the infectious load" by removing parts of the diseased nail, and is actually, in infectious disease terms, the drainage of an abscess. But unlike the drainage of pus from an abscess, debridement of fungus nails never cures the infection. The body's immune system doesn't reach nail infections as well as abscesses more intimate with the vasculature. Curing onychomycosis requires medication...and the vast majority of those 35 million patients with onychomycosis never have their infection treated with effective medication.