How important is debridement in onychomycosis?

This paper has generated some good discussion:
Study to determine the efficacy of Clotrimazole 1% cream for the treatment of onychomycosis in association with the mechanical reduction of the nail plate
"Onychomycosis is invasion of the nail by dermatophytes yeasts and moulds [Calderon RA, Hay RJ. Fungicidal activity of human neutrophils and monocytes on dermatophyte fungi Tri. Quinckeanum and Tri. Rubrum. Immunology 1986;61:289–95; Degreef H. Onychomycosis. Br J Clin Pract Syn Suppl 1990;71:91–7; Zaias N. Clinical manifestations of onychomycosis. Clin Exp Dermatol 1992;17(1):6–7]. Causative organisms include T. rubrum and T. mentagrophytes. Fungi invade the distal and lateral under surfaces of the nail. The prevalence of onychomycosis approximates to 5–10% of the population and is increasing significantly in recent years [Stutz A. Allylamine derivatives—a new class of active substances in antifungal chemotherapy. Angew Chem 1987;2:320–8].Clotrimazole 1% cream is the most commonly prescribed topical antifungal agent in the United Kingdom although its use on nails has not been widely documented. Past inefficiencies may be due to the thickness of the nail plate. The mechanical reduction of the nail minimises the nail as a barrier to the absorption of the cream and increases the permeability of the nail plate.Subjects were ambulant and healthy with no systemic medication, no past history of anti-fungal agents and an ankle-brachial index indicating sufficient circulation for healing to occur. The infecting organism was identified by microscopy and culture. A total of ninety-two infected nails were isolated over a four-year period. The age range was 60–78 years. Nails were drilled every 14 days by the same operator and the area of infection mapped. Clotrimazole 1% cream was applied twice daily during the trial period and the percentage clearance rate was recorded. After 12 weeks there was an average improvement of 96.2% with the infection in 80% nails completely resolved. "
Discussion

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Feds accuse foot doctor of massive Medi-fraud

This not good:
"Federal prosecutors say a Middlesex County podiatrist bilked the government of hundreds of thousands of Medicare dollars by submitting claims for treatments that were little more than massaging feet and clipping toenails. A civil complaint filed in federal court in Newark said Ming Tung, who lives in East Brunswick and has offices there and in Jersey City, ignored warnings about improper billings, instead filing more claims. Two years ago, authorities say, Tung received $856,000 in Medicare payments, or nearly 24 times the average reimbursement for a New Jersey foot doctor. Last year his filings topped $1.6 million. In many cases, Tung billed for visits to low-income apartment complexes in Middlesex and Hudson counties, where he allegedly gave foot massages in the lobbies. " Full story

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The Mid Tarsal Joint

The midtarsal joints is one of those joints that is subject to so much ongoing debate, discussion, scientific and theoretical modeling. Chris Nester has attempted to, at least, get everyone speaking the same language with this new publication: Clinical and Experimental Models of the Midtarsal Joint Proposed Terms of Reference and Associated Terminology Journal of the American Podiatric Medical AssociationVolume 96 Number 1 24-31 2006. Discussion here.

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The Mid Tarsal Joint

The midtarsal joints is one of those joints that is subject to so much ongoing debate, discussion, scientific and theoretical modeling. Chris Nester has attempted to, at least, get everyone speaking the same language with this new publication: Clinical and Experimental Models of the Midtarsal Joint Proposed Terms of Reference and Associated Terminology Journal of the American Podiatric Medical AssociationVolume 96 Number 1 24-31 2006. Discussion here.

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