Monday, April 13, 2015
All you need to know about ingrown toenails
What is an ingrown toenail?
Ingrown toenails are one of the most common problems a podiatrist will treat. Many people have different ideas of what an ingrown toenail is. Basically, an ingrown toenail is when the edge of the nail grows into the skin, which can cause pain and/or an infection. Ingrown toenails can be caught at any stage, from the first ounce of pain, or when it is neglected and a patient has a raging infection due to the ingrown toenail.
Who gets ingrown toenails?
The answer is simple; anyone can get an ingrown toenail. I tend to see them in a younger and older population. It is common is teenagers because they tend to pick at their toenails, and they don’t tell their parents that they have an infection. Usually when a teenager comes in with ingrown toenails there is a moderate to severe infection.
On the other hand, I tend to see a lot of senior citizens with ingrown toenails due to the fact that as people age they tend to get worsening fungus to their nails. The fungus s will thicken a nail to a point that it causes incurvation to the nail edge, and then an ingrown toenail. These ingrown toenails are not as severe as the above mentioned ones and besides treating the ingrown toenail, I treat the fungus, so the ingrown toenail doesn’t return.
What type of treatments options are there for ingrown toenails?
If a patient has an ingrown toenail that is just incurvated into the edge of the nail, usually without anesthesia, I will remove the nail edge, using podiatric instrumentation. If the patient cannot tolerate this procedure without anesthesia or if the incurvated nail is all the way down the nail bed, numbing the patient’s toe with anesthesia is required.
With a more severe ingrown toenail, where an infection is involved, numbing the toe with anesthesia is a requirement. It is then followed by removal of the ingrown toenail, removal of the infection and placing the patient on antibiotics.
Are there long term solutions for treatment chronic ingrown toenails?
If a patient keeps on getting ingrown toenails, there is a procedure that can be performed where the chronic offending nail margin is removed and then with a chemical, or a surgical procedure, the nail root is removed. This is called a matrixectomy and there are many different types, the point is to stop the problems of getting ingrown toenails.
In conclusion, wherever you fall on the spectrum of ingrown toenails, do not wait until it is too late to seek treatment.
For more information, please visit our website at www.footnj.com
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Monday, March 2, 2015
Winter and your Feet
This year we have had a very late and cold winter. Due to the significant low temperatures I have been seeing a lot of people with complaints of cold, discolored feet. Many of these patients are young healthy woman and are concerned about losing the circulation in their feet. Many of these patients state that they have never had these symptoms before and are concerned. After testing and further questioning, these patients are diagnosed with Raynaud’s phenomenon.
What is Raynaud’s phenomenon?
Raynaud’s phenomenon is a condition of vasospasms, which means there is decreased blood flow due to the cold temperature or stress. This can cause the toes and fingers to turn different colors, including purple, red or blue. Other symptoms of this phenomenon are extreme cold extremities and pain. This phenomenon is not to be confused with Raynaud’s disease, which is a systemic condition usually caused by a disease process.
The three colors of Raynaud’s are white, which is the initial stage, when there is decrease blood to the toes. The second stage is blue fingers and toes, which is due to a decrease in the oxygen to the extremities. The third and last phase is when the toes turn red, which is when temperature increases and blood returns to the digits.
How is this diagnosed and treated?
Diagnosis can be made by either clinical appearance or via a biopsy. Many patients that first present with this have a confusing appearance to their toes. It looks like a mix of Raynaud’s and dermatitis (which is a skin irritation). A biopsy will deny or confirm the diagnosis.
There are many options for treatment. The first option for a mild case is to wait until the weather gets warmer or the stress decreases. Stopping to smoke and decreasing caffeine intake can also diminish the symptoms. There are topical medications that can be prescribed to help vasodilate, or increase blood flow to the digits. If a topical medication does not work there are oral medications, which are blood pressure medications. Since blood pressure medications vasodilator the arteries they will help to decrease the symptoms of the Raynaud’s. If a patient has a severe case, which is associated with other diseases, there is surgery to help decrease the symptoms. Lately, Botox has been used in extreme cases of painful Raynaud’s
In conclusion, during the winter months, it is important to keep your digits warm and not allow long times of exposure to cold climates. If you are unsure of what is causing your skin to change colors, please go to your physician for a consultation.
For more information, please visit our website at www.footnj.com
Monday, February 2, 2015
Alternative Treatment for Peripheral Neuropathy
In my past blogs I have discussed peripheral neuropathy and how it affects the feet. For a review, peripheral neuropathy is when the feeling/sensation to the feet decrease to a point where there is numbness, tingling and burning. This becomes a dangerous problem if a patient can’t feel their feet and they get a cut or sore. Without being able to feel the injury, it becomes difficult to treat it and this can many times lead to infection, gangrene and amputation. Many diabetics suffer from this condition, but more recently I have seen people without diabetes suffer from similar symptoms.
It is important to find the cause of these symptoms and attempt to treat the cause. If treating the cause doesn’t help with the symptoms, then this condition can be treated with medication. Traditionally there have been strong prescription medications that have been used to reduce the symptoms. These medications have many negative side effects, which cause can noncompliance issues. In addition, many patients who need these medications will be on many other prescription medications and there is hesitation about adding “another medication” to one’s regime.
Therefore, we have an alternative treatment option that is all natural, has no reported side effects and doesn’t interact with other medications. In our office we dispensed a Vitamin Supplement called NeuRx-TF. It is a vitamin supplement consisting of 4 different vitamins, which are Alpha-Lipoic Acid, Benfotiamine (or Vitamin B1), Vitamin B6 and Vitamin B12. This specific vitamin, NeuRx-TF, is different than any over the counter equivalents. Many patients will purchase an over the counter Vitamin B12 complex and have minimal changes in their symptoms. It is the exact formulary of this vitamin that helps with neuropathy.
The most important aspect of this vitamin is that the ingredients are fat-soluble. It is the fat-solubility of this vitamin that allows it to be absorbed and metabolized in the body. It is this property that allows blockage of the pathways that destroy the nerves, which entail cause neuropathy. The Vitamin B6 and B12 component of this vitamin can help reduce clotting of the circulatory system and prevent plaque from forming in the small tiny arteries to the feet.
In conclusion, there are alternatives ways to treat neuropathic symptoms. Many patients suffer way to long before coming to seek treatment. I always tell my patients that earlier you seek treatment for neuropathy the better your outcome will be.
For more information, please visit our website at footnj.com
Monday, January 5, 2015
2015: A new year, A new you, and new feet
As the New Year approaches many people make New Year’s Resolutions. Usually the resolutions are related to health and fitness. Foot health is related to one’s overall health. Many people run to the gym and start eating better right after January 1, but seeing your doctor is also related to your overall health. Most people go to their doctor’s’ for regular checkups, for example getting mammograms and Pap-smears yearly are common, but when was the last time you went to the podiatrist for a general foot checkup.
Many people think that they should only visit a podiatrist when they have a problem, but as podiatrist I belief it is just the opposite. Many foot related problems and injuries are avoidable with a regular checkups and exams. Many foot ailments occur with overuse, improper shoe gear and abnormal foot biomechanics.
Seeing a podiatrist for an exam is painless and most likely you will learn more about your feet than you ever thought was possible. A quick exam of your shoes and sneakers, and the way you walk barefoot can tell a lot about your foot. Many people go to the pharmacy and go to the foot care aisle and buy miscellaneous products to help their foot problems. To be honest I see many patients in the office who have tried these products and many times they have made their foot problems worse.
A big part of getting healthy in the New Year is working out. I personally love to exercise and I tell my patients all the time it is important to change your sneakers 2-3 times a years. In addition, custom molded orthotics is important to keeping your foot in a neutral position. Post people have flatfeet, some have high arches and few people have perfectly normal feet. Therefore, most people would benefit from a pair of orthotics. I personally have been wearing custom molded orthotics in my shoes for the past 25 years, without them I tend to have more pain and problems.
Many patients, who are adults, will tell me about their children’s foot problems. People are surprised to hear that I see many children. The truth is many foot problems begin in youth but are not noticed until adulthood. Therefore, having your child see the podiatrist is very important. Flatfeet are normal in an infant and even a toddler, but as your child approaches young adult hood, flatfeet isn’t normal and this should be addressed. One more thing that is important is to look at your feet, because one’s foot type in genetic. So if you are having problems with your feet, there is a 50% chance your child will also.
o now that the New Year is upon us make it a priority to call your local podiatrist and ask for a consultation and a general foot exam.
To book an appointment with us and for more information please visit our website at www.foonj.com
Monday, December 1, 2014
New Medications to Treat Toenail Fungus
In the past few months there have been 2 new topical antifungal medications to become FDA approved. These 2 medications are Jublia and Kerydin, it has been the first time in decades that there have been new FDA approved prescription antifungal medications. These medications are being advertised on TV and in magazines and there have been a lot of patients asking about them. I will take this blog to discuss these medications.
has been getting a lot of media attention. Jublia has been advertising a toenail with fungus wearing a purple helmet having a boxing match with a fungus and winning. This medication works as an antifungal liquid topical medication. It is applied to the toenails affected with fungus daily for about 48 weeks. Many patients are shocked when I mention that most topical antifungal medication need to be applied for that long. But the fact is toenails grow approximately 1mm per month, so it takes about 9-12 months for the entire toenail to grow from start to finish. Having said that Jublia and all topical antifungal medications need to be applied for about a year.
How effective is this medication and what are the side effects?
There have been many studies to check the efficacy. A complete cure was noted in 15-18% of patients. The nails were “mostly clear” in 23-26% and there a mycological cure (microscopically clear of fungus) in 54% of patients. These percentages are the highest we have seen in this class of mediations.
A big question patients have is what the side effects are. The side effects are in 2% of patients and are minor. They include the following: ingrown toenails, redness, blisters to the surrounding skin, itching, burning and pain.
What about Kerydin (tavaborole)?
Kerydin is a little less effective than Jublia. The complete cure rate is 6.5-9%, the mostly clear percentage is between 15-18%. The mycological cure rate is between 31-36%. Only 1% of patients have side effects and they are ingrown toenails, redness and a skin reaction called dermatitis
Which Medication is best for me:
Each person needs to talk to their physician about which medication is better for them. They are both very similar with slightly different effective rates. Women who are pregnant, may become pregnant or who are nursing should not go these medications.
For more information, please visit our website at http://footnj.com/podiatrist-new-jersey-about-us/23/240-laser-toenail-fungus-treatment
Monday, November 3, 2014
Lately there have been famous sports players as well as politicians who have complex foot and ankle injuries. I would like to take this blog to review some of their injuries and their road to recovery.
Last week it was revealed that Kim Jong-un, the leader of North Korea was out of the media spot light for the past 6 weeks. There was a lot of speculation as to where he was and what lower extremity alignment he was suffering from. This week it was brought to light that he had a cyst in his tarsal tunnel that was surgically removed. In my past blogs I have discussed tarsal tunnel syndrome. In a nut shell, this syndrome is when the tarsal tunnel, which is a tunnel in the ankle region, can cause pain including numbness or burning. The cause can be multifactorial, including compression of the nerve in the tarsal tunnel with long periods of standing, bulging varicose veins. Sometimes there can be a cyst in the tarsal tunnel, which can cause the above mentioned symptoms. If this occurs the only way to treat this would be surgical removal of the cyst. This surgery is extensive due to the fact that the entire tarsal tunnel needs to be opened and the cyst needs to be meticulously extracted. The recovery consists of 4-6 weeks in a cast, non-weight bearing with crutches. The cyst may reoccur as well as the symptoms, therefore close monitoring of the symptoms is required.
In September Robert Griffin III of the Washington Redskins had a severe ankle injury which was a dislocated ankle. Luckily there were no fractures noted during MRI tests. He was extremely lucky that he did not have any bony chip fractures, which are usually common with ankle dislocations. Due to the fact that he is in good shape and athletic he is ready to return to his team. Due to extensive physical therapy he will attempt to return to play.
Last week Julius Randle of the LA Lakers had a devastating fracture of his tibia. The tibia bone, which is one the bones in the leg, is much larger than the bone next to it, the fibula bone. Tibial fractures are less common then fibular fractures, but due to their larger size they tend to be a worse injury. Tibia fractures usually occur from a trauma, car accident and falls. They usually require surgery, which can vary from using plates, screws and other pieces of hardware. This type of injury can take many months, 4-6, at least to recover. Due to the fact that the bone is so large and the fact that it holds up the body weight this injury can take a long time and a lot of physical therapy to recover from.
In conclusion, famous people are not excluded from foot and ankle injuries. Due to the fact that sports players perform excessive amounts of physical activity they are more prone to worse injuries.
For more information, please visit our website www.footnj.com
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Monday, October 6, 2014
Hyperbaric oxygen therapy and its role in Podiatry
What is hyperbaric oxygen therapy (HBOT)?
HBOT is the use of oxygen in a highly pressurized room. It is used for many different medical applications. HBOT therapy is performed in a hospital setting; it consists of a patient being placed in a chamber for a few hours where 100% oxygen is being delivered. Approximately 30 sessions are required for treatment, with treatment being 5 days a week. Each treatment lasts up to about 2 hours.
What does HBOT therapy work and what can be treated with HBOT?
HBOT works by increasing oxygen, which in fact increasing the capability of oxygen to be transported in the blood. This in term stimulates growth factors and stem cells to the area being treated, which promote healing. This allows healing of many different alignments. Initially, HBOT was used to treat decompression sickness, which related to injury during scuba diving. With time and research it has been known to treat many other alignments. In relation to the foot and ankle: diabetic wounds that have a bone infection, gangrene, failed skin flaps, crush or traumatic injuries are examples of what can be treated with HBOT.
What is required to be approved to undergo HBOT?
Medical clearance is required before undergoing HBOT therapy. Your physician will require you to have an EKG, chest x-ray and a physical exam. There is a number of contraindication to HBOT. Patients with cardiac problems, COPD, fever, cancer or middle ear issues are not able to undergo HBOT therapy.
How is HBOT used with other treatments?
Many times HBOT will be used concomitantly with other treatment modalities. For example, if a patient has an infected diabetic wound and bone infection this patient can be treated with HBOT. In addition, this patient will be managed by a wound care specialist to treat the wound, an Infectious Disease specialist to treat the patient with antibiotics and their Primary Care Physician who will be managing their overall care. HBOT in the world of Podiatry is one application to help treat a wide variety of medical conditions.
For more information please visit our website at www.footnj.com and visit Shore Medical Center Wound Care and Hyperbaric Oxygen’s website at
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