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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Thursday, September 4, 2014
What exactly is PRP?
In more recent years PRP (Platelet rich Plasma) has become popular in the world of professional athletes. Many well-known athletes such as Tiger Wood and Koby Bryant have used PRP to help aid in healing different tendonitis and musculoskeletal injures. PRP is the platelets that are extracted from the plasma (which make up a large component of blood). These platelets are rich in growth factors and it is thought that the growth factors are what aids in speeding up the healing process. There is still a lot of unknowns about how exactly PRP works but there has been major strides in the world of sports medicine, oral surgery and fractures with PRP and its role in healing.
How is PRP prepared?
PRP can be done as an in office procedure or during surgery in the operating room. It is a simple procedure with minimal discomfort. It would begin with a phlebotomist extracting blood from a vein in one’s arm. The blood is then mixed in a centrifuge; this process allows the platelet rich plasma to be separated from the entire blood content. The PRP is then mixed with a local anesthetic and injected into the area of injury. The whole process in the office takes less than 30 minutes with minimal discomfort. After the procedure there may be discomfort to the area for a few days. Icing is recommended if there is mild pain.
What conditions can be treated with PRP?
PRP has been shown in studies to be most effective for chronic tendonitis. In addition it can be beneficial in acute injuries and fractures. In our practice we have been using PRP in an office setting for acute and chronic injuries such as Achilles tendonitis, plantar fasciitis, and chronic pain from ankle sprains. We have had great success and find that within a few days of the procedure many patients are pain free. Sometimes more than one treatment with PRP is required to get the full effects from the PRP.
In conclusion, there are still more studies that are required to determine how exactly PRP works, but to date the results are promising as patients who have been suffering from chronic problems are responding well to PRP injections.
For more information and to schedule an appointment to have PRP done, please visit our website at http://footnj.com/podiatrist-new-jersey-about-us/23/242-platelet-rich-plasma-injections
Thursday, August 7, 2014
Foot and Low Back Pain: How they are interconnected
Previous to me becoming a Podiatrist I had no idea how interconnected low back pain is related to foot and ankle problems. As a Podiatrist I have good relationships with spine and back physicians since their patients suffer from foot and ankle problems and vica versa.
How is the back related to the foot and ankle?
The anatomy and physiology of the foot and ankle isn’t exclusive to the foot and ankle. As a Podiatrist when I do a foot exam I focus on 4 different components. I focus on the vascular system, dermatological exam, an orthopedic exam and a neurologic exam. These 4 components of an exam are not exclusive to the foot and they need to be investigated further if there is a deficit in one of them.
In relation to back problems, I will usually see a deficit in the neurologic exam in the foot.
What exactly does this mean?
Let’s say a patient has a pinched nerve or disc degeneration in the L4-L5 Lumbar Spine, which is causing them symptoms of pain in their low back. They will most likely have numbness, lack of sensation, weakness or burning in different parts of the foot. Many times a patient with low back pain will complain of pain that shoots from their back to their feet. It is the podiatrist and neurologist job to figure out if the pain is exclusively from the back or if there is a foot component as well.
Many times when I have this dilemma of where the pain is coming from I will order a Nerve Conduction Test and an Electromyography Test (EMG). These tests will be able to determine exactly where the problem is arising from.
How do you treat foot problems related to back problems?
When a patient presents with back and foot problems I am honest with them and I let them know that I will try to cure their foot and ankle problems but they may still have residual problems in their back. Many patients can be helped with their foot problems by changing their shoe gear, wearing a custom orthotics, ice, stretching and even anti-inflammatory medication. Physical therapy is a great modality which can focus on the foot and ankle as well as strengthen the core muscles to help alleviate back problems. In addition, there are medications to help with nerve pain, such as Gabapentin (Neurontin) and Lyrica (Pregabalin).
In conclusion, when a patient presents with symptoms in the foot and the back I like to take a multi system approach. I like to engage the patient, myself, their neurologist or back specialists and a physical therapy. Many patients with these symptoms present feeling that there is no treatment to help them, but with a little effort their pain can be reduced significantly.
For more information, please visit our website at www.footnj.com
Monday, July 7, 2014
Medical Lasers have many different uses within the medical field; some uses include Lasik eye surgery, cosmetic surgery, tumor removal, dental procedures etc. In the field of Podiatry Medical Lasers can be useful to treat many different conditions. In this blog I will discuss the relevance of lasers to the field of podiatry.
How do Lasers work?
LASER, which stands for Light Amplification by Stimulated Emission of Radiation, work by having an intense beam of light, of a specific wavelength, which then allows the beam to focus on a small area. By having the beam focus on a small area the Laser can be used for surgical work by removing a lesion, burning, destroying or cutting etc.
Are Medical Lasers safe?
Medical Lasers has a source of radiation that is minute, due to the fact that the source of light is so small that it is safe and poses no health risks. Due to the fact that the light is so small it allows a physician to treat specific lesions without destroying the surrounding healthy tissues.
How are lasers used in Podiatry?
In our private practice we utilize 2 different types of laser to combat many different medical conditions.
Our first laser, which is called Sciton Laser, more specifically JOULE ClearSense . This laser is used to treat toenail fungus (also known as onychomycosis) and plantar warts. As per the Sciton’s website, the way the laser works is that the temperature of the laser is high that is heats the nail and decreases the nail fungus and increases the growth of the healthy nail. (http://www.sciton.com/treatments/onychomycosis)
This treatment is painless and takes 15 minutes. We recommend 4 treatments within a 2 month period.
In relation to treating plantar warts, it is a onetime treatment, also using the ClearSense, that requires a local anesthetic prior to treatment. The treatment of the plantar warts works similarly to the fungal nails, in that is heats the warts and kills the roots.
What about other applications in Podiatry?
We use K laser in our office to treat many different alignments such as plantar fasciitis, Achilles tendonitis, and pain from residual ankle sprains. The way it works is to increase blood flow to an area, which will then increase the oxygen to the area and then increase the healing to the area. We recommend 10 treatments within a 5 week time frame. The treatment is under 10 minutes, is painless and you are able to drive home without sequela.
As technology advances, scientists are finding new ways to treat old conditions. I have had success with these lasers that I have not seen in the past, therefore, I recommend someone with these conditions to try the laser and they will notice the improvement of their conditions.
For more information please visit our website at footnj.com
Monday, June 2, 2014
Heat and your feet
As the summer months approach the topic of sun burns tend to be popular discussions as people spend more times outdoors. I would like to discuss burns in general, and the different degree of burns and how they relate to the foot and ankle.
What are the different levels of burns and how are they treated?
A burn can be caused by many different factors, such as over exposure to the sun, a fire, a chemical burn etc. It is the degree of the burn that will dictate the treatment as well as the outcome.
First Degree Burns
A first degree burn only affects the epidermis, which is the outer most layer of skin. Symptoms include red painful patches to the area affected and this can last up to 10 days until the burn resolves. These types of burns tend to resolve on their own. The most common type of first degree burn is caused by sunburn and as it is well known that sunscreen can prevent these types of burns.
Second Degree Burns
A second degree burn penetrates deeper into the epidermis and the dermal layer of skin. This type of burn can causes extremely painful blisters, which can become infected and cause a skin infection called cellulitis. This may take 3-8 weeks to resolve. Sometimes these types of burns can cause long term scars.
Third Degree Burns
This type of burn penetrates into the epidermis and throughout the entire dermal layer of skin. This type of burn can cause the skin to look white, yellow or brown. Many times this type of burn requires immediate attention at a burn center. This type of burn can cause severe scaring, require many skin graft surgeries and perhaps even amputation. These types of burns are highly susceptible to infection.
Fourth Degree Burns
A fourth degree burn is so severe in many cases it causes death. This is when the burn extends from the superficial skin to the level of fat, muscle or bone. Most of the times these burns require amputation as a treatment option. In addition, these patients are so medically compromised that infection and death are serious complications.
So how are burns related to the foot and ankle?
This is an easy answer, with the summer around the corner many people forget to put sunscreen on their feet. This can lead to painful burns. In addition, I have treated numerous diabetics who “forgot” a heater was on or fell asleep in the sun and caused severe 2nd and 3rd degree burns to the feet.
In conclusion, do not forget to place sunscreen on your legs and feet. Also if you are a diabetic be careful with the heat and your feet.
For more information, please visit our website at footnj.com and visit our NEW location at:
3003 English Creek Avenue, Suite C5
Egg Harbor Township, NJ 08234
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