toenail fungus

What can we do for you? 

There is no accepted medical classification system for the severity of nail fungus beyond mild, moderate and severe. The Journal of the American Medical Association’s Dermatology edition published an article in 2011 that lists a classification system based on a point scale from 1-35, with 1-5 considered mild, 6-15 considered moderate, and 16-35 severe. To determine severity, health professionals use the percent of the nail surface involved, the proximity of the infection to the nail matrix (cuticle area), along with other associated signs and symptoms like thickening of the nail, discoloration, brittleness, and distortions in shape and nail growth patterns. Flaky skin surrounding the nail, or a rash along the bottom of your foot, indicates a concurrent fungal infection of the skin.

With more mild infections the patient may not realize they have nail fungus. By the time the infection becomes apparent it has likely already progressed to a more serious condition requiring more focused treatment than the common at-home remedies, and over-the-counter medications, can provide. This is the reason why it is estimated that as many as 10% or more of healthy adults suffer from toenail fungus. For people over the age of 60 the prevalence jumps to over 50%.

  • It’s impossible to drastically change the way the nails appear immediately, aside from thinning and reshaping them.
  • The goal of treatment is to help the new nail growth to come in healthy, thin, and clear of any discoloration.
  • Full resolution is generally achieved through a 12-month regimen including the application of topical medications along with laser treatment.
  • The number of laser treatments will depend on the severity of your particular infection.


Here at the Golden Gate Foot and Ankle we provide a treatment protocol specific to each patient and the degree of infection present. Often, topical medications along with laser treatment are enough to cure all but the more stubborn infections. The topical medications we prescribe are the latest, most effective options available, and we have pharmacies that work with us to offer them at an affordable price.

Topical Medications:

  • Jublia (efinaconazole)
  • Kerydin (tavaborole)
  • Formula 7 (tolnaftate)


MildMild infections can often be resolved with topical medications alone, but by adding one to three laser treatment sessions over the recommended 12-month period of topical medication use we can help ensure you achieve the results you desire.



ModarateModerate infections are rarely resolved with the use of topical medications alone. The addition of monthly laser sessions will greatly increase the odds of successful treatment. The number of laser sessions required will vary for each person depending on the severity of infection, their age, overall health, and how quickly their nails respond to treatment.

Our laser is painless, and any warmth or slight discomfort you may feel is over the moment we’re done. As part of the laser treatment process, your nails will also be smoothed down to a more normal appearance, providing not only an immediate cosmetic improvement, but also more effective results from the topical medication by allowing the medication to penetrate down deeper into the nails, where it’s needed most.


SevereIn severe cases, where the infection has gone untreated for years, Dr. Dupont may suggest a more proactive approach, which can include the complete, but temporary, removal of the most severely infected nails. By removing the nail we are able to remove the majority of the infection, thereby making complete eradication substantially easier to achieve. Temporarily removing the nail is usually not enough on its own to cure the infection. However, when combined with the application of the newest, most effective topical medications while the new nail regrows, you will be left with feet that you no longer want to hide. Nail removal is also the fastest way to a cosmetic improvement, with the nail beginning to appear normal in as little as two to three months.

Having a severely infected nail removed may sound like a painful process, but with eighteen years of experience and thousands of nail procedures performed, Dr. Dupont will make it a fast and nearly painless process.

The use of oral antifungal medications, like Lamisil (terbinafine), are generally avoided when possible. This is reserved only for the most severe fungal infections due to the potential side effects of the oral medications, including liver damage. Topical medications and laser treatment are a much safer option and do not require the liver function testing commonly recommended with the use of oral antifungal medications.

“5 months after removal of the large toenail it’s growing back completely free of fungus”


John Addeo

One of a very few of Medical Offices I go to where my Appointment time is when the Doctor SEES me. The Very efficient and professional staff is kind, welcoming and very helpful. Dr. Dupont treats you as a valued customer, as he is extremely though, asking all the right questions, with easy to understand answers. He is committed to explaining what, why, and how long each step of his treatment will take and its part in the total treatment.

A visit to Dr DuPont’s is an Excellent experience by an excellent practitioner with a terrific staff.

Wendy Grahman

My husband Richard and I have been seeing Dr. DuPont for the past several years. We see him for periodic nail care and he attends to any other foot problems we have.

He is professional, efficient and personable. His office is always very clean and the staff is helpful and friendly. I heartily recommend Dr. DuPont to anyone seeking podiatric care.

Ann Shrum

I've been a patient of Dr. Dupont's since he began his practice here in Sonoma at Golden Gate Foot & Ankle on 1st St W. I had bunion surgery on my left foot and it went beautifully. He is professional, pleasant, and very responsive to discuss any concerns with my feet and ankles. His office personnel are so good at working with you on your appointments (which I've needed to get in sooner a couple of times), and treat their patients with great respect. They are always pleasant, and the office is open and welcoming. I highly recommend his practice and have to several friends that are now his patients.

Lynnette Bourne

Dr. Dupont was very helpful with my recent foot pain due to a probable neuroma. I went in to the office having a lot of difficulty walking because of the foot pain and left pain free after treatment. He was good at explaining why I had the condition, options and treatment. He is professional and friendly.

Tanya Marsh

I walked into his office fighting back tears because my feet were hurting me so terribly, every step had become an effort. By the time I left his office 30 minutes later, the pain that had bothered me for years had been resolved and has not returned. Within minutes of looking at the issues with my feet, Dr. Dupont accurately diagnosed, treated and bandaged the painful spots that I had been dealing with. My primary care Dr had treated me, but without any success and my dermatologist completely misdiagnosed, offering no support. This left me extremely discouraged and I struggled for many months before discovering Dr. Dupont.

Sandy Pollack

Choosing Dr. Dupont for your footcare is a step in the right direction. He is very knowledgeable, on time with appointments, has a very courteous staff, and has a terrific, easy-going, friendly manner. Thank you Dr. D for your expert care!

Randy Cook

I trust Dr. Dupont. He listens well, asks good questions, helps me understand my condition and my options. Just what I want in a podiatrist! (And my feet think so too!)

Stephanie Hamilton

I recently had hammertoe surgery performed by Dr. DuPont. I am sorry I waited so long. I had excellent care from Dr. DuPont and I am so happy with the results,.

Dun W

Dr. Dupont was great. Saw him for ingrown toenail service. it was literally painless. great job!

Tobin Hansen

Brett is very professionally qualified and shows a caring manner to his patients

Amelia Morgan

Dr. Dupont to care of my dad. He had bunion surgery with excellent results.

Skip Wangbickler

A most pleasant experience.

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