It is worth noticing that almost all reports used different treatment protocols and some of them did not even report the basic laser parameters. What strikes the most is the fact that the range of fluencies which were used in therapies was very broad and this parameter directly influences what energy is supplied to the fungal cells to cause the destructive effect.
Most of the studies were small, uncontrolled, non-randomized trials. Only 5 trials had a significant number of patients of over 100. Only three of them were said to be placebo controlled. Ortiz et al \cite{Ortiz2014} designed the control group to be the same patients as in the treated group. They randomized feet into either undergoing laser treatment with cooling or simply cooling as a sham therapy. It is highly unlikely that patients were unaware which foot underwent the laser treatment an which was given the sham therapy.