Dr. Irina Tsyganova

Dr. Irina Tsyganova
Another Day at the Office

Tuesday, November 10, 2015

Ball of Foot Pain

It seems to be this time of year that I see a lot of patients with complaints of pain to the ball of their feet. I’m not sure if it is the transition from summer sandals to boots, but I would like to take this blog to discuss different conditions and how they present themselves as ball of foot pain.

What are the Most Common things seen in the ball of the foot?

Metatarsalgia, which is a common term used to describe pain to the ball of the foot is all encompassing of many different conditions causing pain to the ball of the foot. Morton’s neuroma, stress fractures, capsulitis and plantar plate ruptures are just a few examples of things that can cause ball of foot pain.

Morton’s Neuroma
Morton’s neuromas is an enlarged nerve that tends to find itself between the 3rd and 4th metatarsal bone. It causes nerve pain, such as burning, tingling and possibly numbness to the ball of the foot. Most of the times it is more severe with tight shoes. Treatment including wider shoes, padding, injections and possibly surgery. It can be diagnosed with an ultrasound and/or MRI and of course with clinical exam.

Stress Fractures

Stress fractures are tiny microscopic fractures in the bone that over time present itself with pain to the metatarsal area. The 2nd metatarsal is the most common bone that develops stress fractures, and that has to do with the biomechanics of the foot. It may be hard to diagnose because a fracture isn’t always visible in a plain x-ray until at least 10-14 days after the onset of symptoms. Many times patients are treated for a stress fracture until a future x-ray can proof otherwise. Treatment includes immobilization is a walking boot or cast.

Capsulitis/Plantar Plate Rupture

Capsulitis is defined as inflammation in the joints between the metatarsal bones and the toes. There are many causes of capsulitis, including faulty biomechanics, overuse, and injury just to name a few. Many times a plantar plate rupture, which is a rupture of the ligaments on the bottom of the joint, are what causes the pain. Usually when a patient presents with this it is a condition, it has been going on for a while and they are in a lot of pain. This condition may take a while to treat, since most of the time it takes a while to present itself. Usually orthotics, padding in the shoes, anti-inflammatory medication, injections and possibly surgery can fix this condition.
In conclusion, there are many conditions that can cause pain in the ball of the foot. It is important to get a proper diagnosis before beginning treatment. If you wait to see help it may take that much longer to get treated and be healed.

For more information, please visit our website at http://www.footnj.com/nj-podiatrist-our-services

Wednesday, September 16, 2015

Are all varicose veins the same?


Are all varicose veins the same?
There are two types of varicose veins. The first is known as telangiectasia, which are superficial spider veins. These types of veins appear to be cosmetically unappealing but they tend to be in the outer layer of the skin. These veins usually cause no problems but they can lead to deep varicose veins. The second type of veins are called varicose veins, or medically speaking varicosities. These veins tend to do deeper in the skin and can cause numerous problems.
There are two systems in the body that carry blood. The first is the arterial system which carries blood from the heart to the toes. The other system is the venous system which returns blood from the toes to the heart. This blog will be dedicated to learning about disease of the venous system.
The two types of venous mentioned above disease of the venous system. The venous systems is divided into two parts, the deep and superficial. These two systems connect via valves, which pump the blood between the 2 systems when one moves and walks. The varicose veins develop in the deep system and the spider veins develop in the superficial system.

What types of problems can the venous system cause?
When the deep venous don’t pump the blood properly it can cause skin discoloration to the ankles. What happens is the iron in the blood will “leak” into the skin and cause brown discoloration to the ankles. If this condition isn’t treated this can lead to wounds to the insides of the ankles. When one develops these wounds it’s called “venous leg ulcers”. Usually these wound are associated with a lot of leg swelling. The best way to treat this is to resolve the swelling, usually multiple layer compression wraps, called Unna Boots. This helps to treat the swelling and wounds. Long term patients who have this problems of swelling and brown discoloration are recommended to wear compression stockings. Compression stockings are not well tolerated since patents state they are tight and hard to put on. There are different types include zip up ones and different amounts of compression.
In conclusion, if you have superficial or deep veins in your legs it is a good idea to talk to your physical about it before it becomes a chronic problems and difficult to treat
For more information, please visit our website at footnj.com

Monday, June 1, 2015

Exercise and how it relates to your health and your feet

I decided to write this blog on the importance of health and fitness in relation to your overall wellbeing as well as the health of your feet. This is a topic that is near and dear to me. I make it a point to exercise multiple times a week and eat quite healthy. In my practice, I make it my business to relay the important about how I feel about this topic to my patients. To many times I hear obese patients tell me their other doctors haven’t mentioned weight control, eating right and exercising. I feel that if I can have an influence on at least one person to improve their life for the better why not give it a try.

What benefits does exercise have on your overall health?

A study was done by the prestigious Mayo Clinic, which found that exercise has 7 main benefits to one’s health.
1.      Exercise controls one weight
2.      Exercise fights disease and other health related problems
3.      Exercise overall improves ones mood
4.      Exercise increased energy
5.      Exercise allows one to sleep better
6.      Exercise can have a positive effect on one’s sex life
7.      Exercise can be fun
To gain these benefits not much exercise is required. What is recommended is a few days a week for 30 minutes of moderate exercise, including walking, biking or swimming.

What about my diet?

Diet is a huge component to the exercise, and they usually go hand in hand. Having a balanced diet or protein, carbs and fat is important to maintain a healthy weight. Obviously, if one has medical conditions their diet and exercise will have to be tailored and followed closely by their physician.

What about my feet and exercise?

Most types of exercise will put a lot of force and pressure on one’s feet. The less weight and body fat a person has the less impact their feet will take. Many times certain foot and ankle conditions can be alleviated with weight loss.

What about specific foot exercises?

In addition, there are exercises that can be done specifically for the feet to increase strength and flexibly. Most people will learn to do these exercises if they have an injury or condition that they are being treated for. I would recommend doing these exercises when you have no foot issues, which would prevent any problems from occurring.
In conclusion, exercise and diet can have a significant effect on your health and ultimately your life. Before you start any exercise and diet program please consult your physician.
For more information, please visit our website at www.footnj.com

Monday, May 4, 2015

Bunions and Hammertoes, the bread and butter of Podiatry in New Jersey

Bunions and Hammertoes, the bread and butter of Podiatry

I have written in a previous blog about bunions and hammertoes, but because this is such an important part of what I do and see on a daily basis I thought it would be a good idea to revisit it. Many patients not only present with a bunion but with a hammertoe of the adjacent toe.

What exactly is a bunion and a hammertoe?

A bunion, or better known medically speaking as Hallux Abducto Valgus Deformity (HAV), is a bony deformity of the foot that tends to worsen over time. A bunion is a deviation of the big toe and the associated metatarsal bone. It occurs when the big toe drifts over to the lesser toes and causes what appears to be “a bump” on the side of the feet. A hammertoe is when a toe starts to curl and may appear to be dislocated at the knuckles of the toe. Typically, as a bunion worsens and moves over it will push against a hammertoe thus making it worse.

Who gets a bunion and hammertoes?

It is difficult to predict who will get a bunion. It can be seen in a wide array of people including young teenagers, middle aged individuals and seniors. The causes of a bunion are debated within the medical community but it seems to be caused by many different factors including genetics, flatfeet and tight shoe gear. When a hammertoe is associated with a bunion, the bunion is usually the cause of the hammertoe. When there are hammertoes of all the toes, and no bunion deformity, it is usually due to significantly high arched feet.

How can one treat bunions and hammertoes?

There foot deformities are usually first treated conservatively. Bunion splints, toe spacers, hammertoe crests, ice, wider shoes, appropriate orthotics and medication can help treat these painful deformities. Conservative treatment is successful most of the time to prevent surgical intervention. These treatment modalities are usually all that is necessary, but in some circumstances surgical intervention is warranted. 

What does this type of surgery entail?

There is a wide array of different types of surgeries to correct the deformities. Your surgeon will determine which type of surgery to perform based on your symptoms, age, x-rays of your feet, level of activity etc. Once the surgeon takes all these factors into account she will let you know if you will have hardware placed in the foot to help correct the deformity.  Surgery does require anesthesia and is usually performed in an operating room under the surveillance of an anesthesiologist. 

Depending on what type of surgery you have the recovery can range from 2-8 weeks with the use of crutches or walker. The type of surgery performed will dictate the type of weight bearing that is allowed. 2 months post operatively one may begin to return to regular shoe gear. After surgery it is highly recommended to wear custom orthotics long term to prevent re-occurrence of the deformity.
For more information, please visit http://www.footnj.com/podiatrist-new-jersey-about-us/23/234-hammertoes

Monday, April 13, 2015

All you need to know about ingrown toenails in New Jersey 08234 EHT Podiatrist

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

Monday, March 2, 2015

Winter and your Feet

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

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