Peripheral Arterial Disease and its role in the Lower Extremity

In the past few years there has been an increase of awareness of Peripheral Arterial Disease, also known as PAD, but what exactly is PAD? How does it affect the lower extremities? And how can it be prevented and treated?

What is PAD?

PAD, which is sometimes referred to as PVD, Peripheral Vascular Disease, is a blockage in the arteries of the legs and pelvis. The most common symptom is pain in the legs while walking, this pain usually resolved at rest. This is an ambiguous symptom and many times can go undiagnosed for a while. If the disease worsens and is untreated it can lead to cold blue feet, wounds, gangrene, and even amputations.

How do I get PAD?

People who are at high risk include smokers, diabetics, people with high cholesterol and high blood pressure.  In addition, men over 50, who are obese, have had a heart attack or a stroke are at higher risk. Smoking is the number one factor that can be altered in order to decrease the risk of getting PAD.

How do I get diagnosed and how is it treated?

If you are concerned that you have PAD, share your symptoms with you physician. Even if the symptoms don’t fit the exact criteria of PAD it does not mean you don’t have PAD. The symptoms can vary and can be vague. Your physician will begin by ordering a test called an ABI/PVR. This is a painless test, where blood pressure cuffs are placed on the arms and legs and measurements are taken. Based on the results you can be diagnosed with PAD. Other tests can be performed, including an ultrasound, angiography, CT or MRI scan.

The sooner treatment is sought the better the long term outcomes. Quitting smoking, controlling diabetes, high blood pressure and high cholesterol are of essence. In addition, exercise is important to increase blood flow to the legs. If these methods are unsuccessful a vascular surgery consultation is the next step in treatment. There are many different methods and techniques where a vascular surgeon can open up the compressed blood vessels. Different balloons and/or stents can be utilized, but will be determined by the degree of the disease, the patient and many other factors. If the disease is to a point where there is gangrene, then usually an amputation is required. An ulceration caused by PAD is treated by aggressive wound care, but more importantly by increase the blood flow to the area of the wound.

In conclusion, if you have mild symptoms or severe symptoms the earlier treatment is sought the better long term outcomes.

For more information, please visit: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Peripheral-Artery-Disease-PAD_UCM_002082_SubHomePage.jsp

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Gout- A Red, Hot, Swollen Foot

What is gout?

Gout, which used to be known as a “rich man’s disease”, is more common than thought. Gout is when there is an increased in uric acid crystals in the body that are then deposited in different joints in the body. The most common joint being the big toe joint, followed by the ankle joint.

How do I get gout?

Gout is more common in men than females and starts in the 30-50 age range. This does not exclude someone older or younger than this. If an attack is not treated a second attack at some time in the future is common.  It is recommended that if you have 2 or more attacks to be on medication for the rest of one’s life.

How do I know if I have gout?

An acute gouty attack usually happens overnight. It begins when someone wakes up and their foot is red, hot and swollen. Usually patients say that even the bed sheets cause severe pain to the area. Usually patients are in so much pain they have a hard to walking and usually limp their way into the office.

Can I prevent an attack?

Certain people are prone to attacks based on genetics, other medical problems and diet. A large component of gout is based upon one’s diet. Foods to avoid include shellfish, sea food, wine, beer, organ meats. Lifestyle changes can go a long way in preventing gout. Low BMI, exercise and caffeine are ways to prevent a gouty attack.

How is gout diagnosed?

The most accurate way to diagnose gout is to take the fluid out of the joint that is red, hot and swollen. This fluid is then sent to the laboratory and inspected for gouty crystals. This process many take a few days and therefore, many physicians treat gout based on the clinical symptoms and appearance of the joint.

How do I treat gout?

Acute gouty attacks can be treated many different ways. A cortisone (steroid) injection into the joint that is affected helps with reducing the pain, swelling and inflammation. Different oral medications can help as well. NSAIDs (non-steroidal anti-inflammatory medication), Colchicine, a steroids are a few medications that can be used in an attack. You physician will discuss which medication is the best for you based upon your other medical problems. If someone has more than 2 attacks, consultation with a rheumatologist is recommended. At this point Allopurinol or Probenecid medication is recommended for long term use.

If you wake up with a red, hot, swollen painful foot do not wait and call your doctor an emergency appointment. Your doctor will need to rule out an infection and delaying treating gout can have long term consequences to your bones.

For more information, please visit our website at www.footnj.com

Our New Associate!

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Toe Nail Fungus and Athlete’s foot: How they are related

On our blog we keep coming back to common topics such as toenail fungus because 7% of adults suffer from this problem. On this blog, not only will I focus on how it is transmitted, how it can be treated, but I will discuss the relationship between toenail fungus and skin fungus.

Toenail fungus, also known as onychomycosis, and tinea pedis (aka athlete’s foot), which is foot fungus are related. Some patients present with either of these problems, but many patients present with both. Both are caused by fungi, which are microscopic, extremely contagious and a challenge to treat. These fungi live in dark, moist, hot environments. If someone sweats in their socks, swims in a public pool, or if they are diabetic, these are some causes for an increased risk in fungus.

How can these two types of fungus be diagnosed?

Athlete’s foot and onychomycosis can be diagnosed by either clinical exam or by microscopic examination. Athlete’s foot can be diagnosed via a skin shaving, which is examined microscopically. Similarly, onychomycosis can be diagnosed via a clipping of the toenail and then subsequent examination at the laboratory. Many times treatment will begin before definitive diagnosis due to the clinical suggestion that a physician is dealing with fungus.

How do I know if I have either of these two fungi?

Athlete’s foot appears as red, itchy patches of flaky skin on the top or bottom of the foot. Athlete’s foot in between the toes appears to be macerated, or soft and white, as well as red and flaky. Toenail fungus may have many different appearances, including thickened, irregular, discolored nails. The nail can appear to be black, yellow, white or green.  

How can I treat these two types of fungus?

Athlete’s foot can either be found between the toes or on the top and bottom of the foot. Despite what type you have these can be easily treated with antifungal creams.

Onychomycosis is more difficult to treat since the fungus imbeds deep into the toenail. It can be treated with oral antifungal medications, which in some patients can have adverse effects on the liver. Antifungal nail lacquers are also used for treatment and are common due to the lack of systemic effects that oral antifungals have. Surgical removal of the fungal toenails is common for someone who has a few infected toenails.

Lastly, laser treatment is the most advanced technology on the market (and its FDA cleared) to treat onychomycosis. At our office we use Sciton ClearSense laser to treat the toenail fungus. Treatment includes 4 easy, pain free treatments. The treatments last about 15 minutes, causes minimum pain and patients tolerate it extremely well. We recommend treatment with antifungal lacquer simultaneously to get maximum results.

Toenail fungus and athlete’s foot have been around a long time and as science and technology becomes more advanced the treatment gets more precise with better results. To date, treatment with laser technology for toenail fungus has gotten the best success rates.

For more information please visit www.scitonclearsense.com.

To make an appointment for a consultation and for more information, please visit our website at http://footnj.com/podiatrist-new-jersey-about-us/23/240-laser-toenail-fungus-treatment

Diabetes and your feet

In a previous blog we have discussed how diabetics should go about caring for their feet, but how does diabetes affect the feet? How can a diabetic prevent themselves from getting into trouble with their feet?

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Just a little bit of background information….

Type II diabetes mellitus, also known as adult onset diabetes, affects over 280 million people worldwide.  The increase in obesity in the United States is a contributing factor for the increase in the number of people afflicted with this disease. As the disease progresses over time, it affects the eyes, kidneys and feet.

Diabetes affects the feet via peripheral neuropathy. Peripheral neuropathy is when the nerves are damaged. This is caused with either increases or fluctuations in blood sugar levels. As diabetes progresses neuropathy can cause tingling, burning and eventually numbness to the toes and feet. The concern that podiatrists and other medical practitioners have is that if a diabetic can’t feel their feet they may injury or cut their feet and may not feel it. This can then lead to a diabetic foot wound, subsequent infection and possibly even amputation. It is recommended that a diabetic follow up closely by a podiatrist a few times a year for a foot checkup.

Other important factors in relation to diabetes and feet are poor circulation. Peripheral vascular disease, also known as PVD, can cause blockages in the blood flowing to the legs. Someone can have PVD with or without diabetes. A combination of diabetes, neuropathy and PVD can be destructive. If a diabetic has a lack of sensation to the legs, and diminished blood flow to the feet, an open sore can be catastrophic. A diabetic may form an ulceration, which they cannot feel and then with PVD they cannot heal. Due to this it is highly recommended for close follow up for diabetic foot exams.

If I am a diabetic, what are measures I can take to prevent any foot infections?

Besides close follow up by a foot specialist it is recommended for diabetic to do daily foot inspections. By checking ones feet daily a small cut or lesion can be identified and should be immediately reported to ones physician before an infection sets in. It is also recommended to keep the spaces between the toes dry and the skin on the top and bottom of the foot well hydrated with moisturizer. It is recommended to wear white diabetic socks, where one can spot blood or pus, before even realizing they have a sore. Lastly, wearing comfortable protective diabetic shoes is advisable. Diabetic shoes with heat molded inserts are covered by Medicare and most insurance plans. This can be dispensed during a foot checkup.

For more information please visit the American Diabetes Association at http://www.diabetes.org and our website at footnj.com

What exactly is a podiatrist?

I’ve been writing this blog now for a few weeks and many of you may be wondering what exactly is a podiatrist and what can podiatrist do? In the world of foot and ankle medical care there seems to be a misunderstanding as to the level of care podiatrists can offer their patients

To start at the very beginning one must obtain a 4 year Bachelor’s degree. The major one chooses is not important but rather taking the appropriate pre-med courses, i.e. chemistry, biology, physics, are required. After completing a Bachelor’s degree, medical school is required. This is where podiatrists differ from other medical specialists. There is actually a special medical school just for podiatrist, which is called Podiatric Medical School.  This school is 4 years in duration and it is as grueling as any medical school. The first 2 years of school require didactic classes covering all aspect of the human body. The second 2 years of school are clinical rotations, including non-podiatric and podiatric rotations.

After completing a four year Podiatric Medical School, the degree of Doctor of Podiatric Medicine is granted. This is also knows as a DPM. Despite obtaining this degree, a podiatrist is years away from practicing on their own. After school a 3 or 4 year Podiatric Medicine and Surgical Residency is required. This is offered by different hospitals around the country. The residency is a grueling number of years, requiring late nights, weekend, and many “on call” days. During these few years one is trained to be an excellent foot and ankle physician and surgeon. This is the time in a podiatrist’s career that they will see a lot of diversity within the specialty. Usually during residency, the resident works with 20+ different podiatrists, and therefore, it is an opportunity to learn many skills from a wide array of physicians.
After completion of residency there are many options for what type of work a podiatrist can obtain. Many podiatrists enter private practice, with a mix of office hours and surgeries. Some podiatrists are employed by hospitals and treat hospitalized patients, and some podiatrists tent to see and treat more trauma. Despite what type of arrangements one enters all podiatrists are the same in that their expertise in all things foot and ankle are far superior to any other specialty in the medical profession.

I personally did a three year surgical residency where I was heavily trained in trauma as well as foot and ankle reconstruction. Despite this I am also well equipped to deal with day to day pathologies, such as heel pain, toe nail fungus, and tendonitis. If someone has a problem related to the foot and ankle, a podiatrist should be sought out.

For more information on what podiatrist do visit the American Podiatric Medical Associations website at APMA.org, or visit our website at www.footnj.com

High Arches; when high is too high

Recently during a patient encounter the patient said to me “Doc I was told I have high arches, but aren’t having arches a good thing”. I responded that although having an arch in the foot is good there is a point when arches become too high that it turns into a problem.
An excessive high arch, also known as Pes Cavus, literally translates in Latin to a “hollow foot”.  A cavus foot type is less common that the flat foot type, with about 10% of the population having this foot type. Despite the rarity, people that have this foot type can have just as many symptoms in the foot and ankle as people with flat feet.
How does someone get a Cavus foot?

A cavus foot can either be passed down through genetics or acquired during one’s life. Genetically there are rare neurological disorders that can be represented with a high arch foot. These disorders tent to have multiple other symptoms throughout the body. A cavus foot can be acquired whether due to muscle weakness that can cause the development of the high arch or a clubfoot deformity that was not fixed correctly. There can be many causes of high arch feet and amongst the literature there is still some ambiguity as to cause in some instances.

What are the symptoms of a Cavus foot?

The symptoms of this type of foot can vary and are hard to predict. Depending on what type of shoe gear someone wears will also predict their symptoms.  Symptoms can include pain in the metatarsal region, constant ankle sprains with weak ankles, Achilles tendonitis, difficulty with shoe fitting, stress fracture, and knee pain, just to name a few.  Formation on of hammertoes is a common side effect of a long lasting cavus foot type.

How does one treat a Cavus foot?

If someone if diagnosed with this type of foot and they have minimal pain or no pain the goal is to prevent symptoms in the future. Proper fitting shoe gear is essential. That would include a shoe with a build in arch. High heel shoes will put more pressure on the toes and metatarsals and can cause more discomfort and even metatarsal stress fractures. Custom molded orthotics can be built for a high arch foot which can prevent foot pain.

If cavus feet are causing severe symptoms surgery can be performed. Before undergoing surgery your surgeon will determine where in your foot is the deformity coming from. This can be performed by a simple test, which includes standing on a block and seeing if the deformity disappears. Once surgery is decided upon there are many options of how to fix the deformity. You and your surgeon will decided what procedure is most suited for you.

Don’t ignore a high arch just because you may think it is normal. If you are having any foot discomfort please see your physician for treatment.

For more information, please visit our website at www.footnj.com

All you ever needed to know about Ankle Sprains

Who is affected by ankle sprains?

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Ankle Sprains are one of the most common sports injuries. Sprained ankle can affect any type of athlete as well as non-athletic individuals. Ankle sprains typically occur from rolling ones ankle, therefore, it is common in basketball, baseball, football and many other sports. Ankle sprains are also commonly seen when someone takes a misstep, slips on ice or misses a curb.

Are there different types of ankle sprains?

There are three different levels of ankle sprains as well as three different types of ankle sprains. Ankle sprains can be graded from a level 1 to a level 3. Level 1 is when there is mild damage to the ankle ligaments, level 2 consists of a partial ligament tear and level 3, being the worst type of sprain, is a complete rupture of the ankle ligaments.

There are three different types of ankle sprains. The first being a lateral ankle sprain, which is the most common type. This is when one twists their ankle and injuries the ligaments located laterally, or on the “outside of the ankle”. This is seen with jumping injuries, such as in basketball.  The second type of ankle sprain is when there is a medial ankle sprain, or when the deltoid ligaments are injured. These are the ligament on the “inside of the ankle”. The last type of ankle sprain, which is the most severe, is a high ankle sprain, or a syndesmotic sprain. This is when there is a sprain of the ligament connecting the tibia and fibula, the two long bones of the leg. This is caused via high contact, high intensity sports. This ankle sprain is commonly misdiagnosed as the first two types of sprains.

How do I know if I have an ankle sprain?

Sprains are typically diagnosed via physical examination from a physician. X-rays are taken to rule out fractures and will help determine if there is a tear of the ankle ligaments.
What are my treatment options?
Conservative treatment is usually attempted first and is determined based on the severity of the injury. Usually ice, elevation, compression, immobilization and limited weight bearing is the initial treatment. At some point in the healing process physical therapy will be a key component is regaining strength and flexibility in the ankle. Depending on how significant the injury your physician will determine when it is necessary to begin physical therapy.

What if those conservative treatment methods don’t work?

If all of the ankle ligaments are torn in an ankle sprain of if someone has had multiple ankle sprains in a short amount of time your physician may recommend surgery to repair the ankle. The level of repair of the ankle ligaments will be evaluated via MRI or CT scan. Once your physician determines how many ankle ligaments need repair, you will undergo surgery to repair the ankle. Post operatively you will be immobilized for 6-8 weeks. Once you are out of an immobilization device aggressive physical therapy will begin to regain strength in the ankle.

Ankle sprains are very common sports injury and can affect everyone. The key is to seek treatment soon after the injury in order to avoid long term complications.

For more information, please visit our website at www.footnj.com

Common Sports Foot Injuries: Diagnosis and Treatment

Turf toe

http://footnj.com/podiatrist-new-jersey-about-us/23/235-sports-injuries
Turf toe, which is a sprain of the big toe joint, is commonly seen in football and soccer injuries. It is caused when the big toe is hyperextended. This injury is seen more when participating in sports that require wearing cleats and running on artificial turf. The big toe joint is used to push off when walking or playing sports and therefore, with this type of injury rest is the primary treatment. It is difficult to immobilize the big toe, therefore, a rigid shoe, ice, rest, anti-inflammatory medication and physical therapy is usually required. Healing times varies, but is usually a minimum of 4-6 weeks. If a turf toe injury occurs and is not treated appropriately it can become a chronic problem with pain to the big toe joint. If this is the case, long term use of the toe will become painful for the athlete. Upon initial injury, treatment should be sought out by a physician.

Shin Splints
Shin splints, also known as medial tibial stress syndrome, are an injury commonly seen in running, track and field and in general, in overuse syndrome. This is seen with pain along the lower shin, which is located between the knee and ankle joints.  It is defined as a strain on the muscles around the tibia bone. This injury can be seen as a running season ends, due to the excessive about running and stress to the tibia bone and muscles surrounding it. This can be difficult to diagnose, since there are many different causes of pain to the lower leg. X-rays as well as bone scans and MRIs can be used to help with a diagnosis. Treatment includes rest, ice, decrease activity, strapping, physical therapy, whirlpool, phonophoresis etc. Proper shoes gear, as well as orthotics, can help with the biomechanical aspect of the injury. An untreated shin splint may lead to a tibial stress fracture.

Stress Fractures
Stress Fractures or a hairline fracture is a small crack in the bone. It is most commonly seen in the tibia or metatarsal bones. It is caused by an excessive amount of activity in a short period of time. There are a variety of symptoms with this type of injury and can be difficult to diagnosis. Initially x-rays will be ordered, but stress fractures do not appear on x-rays for the first 10-14 days. Therefore, a bone scan, MRI or CT scan can help with a diagnosis. Treatment is via immobilization in a cast or walking boot. Healing time is a minimum of 4-6 weeks. If gone untreated it can lead to a complete fracture, which will require a longer healing time or surgery.
No matter what the injury, when treatment is sought out right after the initial injury the prognosis is more favorable for the long term. If the athlete hopes to participate in their activity for many years to come, these injuries should not be ignored and should be treated by a physician immediately.

For more information, visit our website at www.footnj.com

The “Ins” and Outs of Ingrown Toenails

How do people develop ingrown toenails?

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In grown toenails, also known medically as Onychocryptosis,  are caused when the edges of the nail grow into the skin and cause pain. Many times this is caused by incorrect trimming of nails, tight shoe gear or nail disease. Onychomycosis, also known as  fungal nails, is a common cause of ingrown toenails. A fungus will cause the toe nail to thicken and subsequently to grow into the nail corners, causing pain. If someone has an ingrown toenail that is not treated pain can intensify to a point where shoe gear is not tolerable. If an ingrown toenail remains untreated an infection can develop. When an ingrown nail becomes infected is called a paronychia.

How do I treat an ingrown nail to prevent an infection?
Proper nail trimming is the key to prevention. Podiatrists recommend cutting nails straight across and not into the corners. Many adolescents tend to be “pickers” and this is a common age group for infected ingrown toenails. If someone is developing an ingrown it is recommend seeing a physician as soon as possible. The physician has proper instrumentation to help relieve the pressure an ingrown nail may be causing.

How do I know if I have an infection and how can it be treated?
If an ingrown nail is untreated an infection can develop. The signs and symptoms of an infected toenail, also known as a paronychia, are redness, swelling, pus, increased pain and an odor. If one is suspicious that they have an infection it is recommended to see a physician as soon as possible. If it truly is an infection your physician will recommend removing the offending nail border and draining the infection. This will require local anesthesia to the toe, which can be done in the office with minimal post-operative pain. Once the infection is drained you will most likely be placed on antibiotics for a few days. You will be given instructions on how to dress the wound and follow up with your physician in a few days.

What if I continue to get infected ingrown toenails?
If you tend to get infected toenails a few times a year it is recommend to remove the cause of the problem. This would be done via a procedure called a matrixectomy, where the root of the offending nail is permanently destroyed.  This  surgical procedure can be performed in the office with local anesthesia to the toe. Once the toe is anesthetized the physician will remove a section of the nail that has been causing the problem. At that time a chemical can be placed over the nail root to kill the root. One can also have a similar procedure where the nail root is physically removed from the body. There are different methods of removing/destroying the nail root. Whichever method you and your physician choice will determine your post-operative course. Most patients are completed healed within two weeks.

In summary, ingrown toenails and infection are preventable. If they do develop seeking medical attention is necessary, which can prevent worsening of the problem in the present and in the future.

For more information, visit our website at www.footnj.com

Why are thousands being infected through contaminated cross shared manicure and pedicure instruments?
Autoclaved, disposable or personal tools are Wstill not a must for these procedures.

With so many lawsuits connected to deaths, chronic infections and disfigure- ment from pedicures, you would think the public would be clamor- ing for reform. Just the opposite, most consumers completely blow off the risks and have the “it won’t hap- pen to me” attitude.

Approximately $6 Billion dollars are spent on spa related nail care every year, making it a huge indus- try. Unfortunately, along with that pretty pedicure you can take home: hepatitis B and C, cutaneous herpes, warts, bacterial and fungal infec- tions, and even HIV. These can be deadly, especially in the diabetic or immune-compromised patients.

So . . . before you kick off your shoes, consider the potential downsides of pedicures.

Your Achilles Heel: Injury and Treatment

How do I know if I have Achilles tendonitis?
Achilles tendonitis, also known as Achilles tenosynovitis or Achilles tendinopathy, is inflammation of the Achilles tendon.  Symptoms include pain in the back of the calf, usually close to the heel and most commonly 2-6 cm from the insertion of the Achilles in the heel bone.  Others symptoms may include swelling, difficult with walking or a hard time exercising. This tendonitis is usually caused by overuse syndrome while active, which can affect athletes. Treatment includes ice, rest, anti-inflammatory medication, heel lifts, Achilles tendon stretching etc. If someone does not treat this injury appropriately it may lead to an Achilles tendon rupture.

Why does it seem that so many professional sports player get Achilles ruptures and can anyone get them?
The answer to this question is that anyone can rupture their Achilles rupture. An Achilles rupture is more common in men, ages 30-40. It is common in what is known as a “weekend warrior”, someone who is not quite athletic and then pushes themselves to exercise on their free time and these people tend to overdo it and then tear their Achilles.
Ruptures are caused my many different things such as overuse, Achilles tendonitis, certain antibiotics etc. When one tears their Achilles traumatically they usually hear a “pop” in the back of their calf and then they are unable to bear any weight. If someone experiences these symptoms they will most of the time present to the Emergency Room with them complaints. If the patient is a young, healthy, athletic patient most of the time the surgeon will recommend repairing the tendon. If one is older, more sedentary they may choose to allow the tendon to repair with conservative methods.
Many famous sports players have suffered from Achilles ruptures. Ryan Howard, from the Philadelphia Philles and Kobe Bryant, from the Los Angeles Lakers, are athletes who have ruptured their Achilles. These professional sports players ruptured their Achilles from an excessive amount of exercise and pressure placed on their calf and ankles. Both of these athletes opted for surgery in order to return to their pre injury athletic abilities.

How do I treat an Achilles tendon rupture?
If one chooses conservative treatment it includes a minimum of 8 weeks in a cast with no weight to the affected leg. There is a high chance of re rupture if one chooses this method of treatment. This is recommended for someone who is not very active and whom may be medically unstable for surgery.
Surgery is the primary method to fix an Achilles tendon rupture. Surgery usually requires general anesthesia as well as a long recovery period. The type of surgery one will have will depends on how bad the rupture is. Sometimes one can repair it with sutures or it may be more extensive where a graft from within your body or from a cadaver is needed. Recovery includes 6-8 weeks in a cast non weight bearing. Following that physical therapy will be needed to regain strength in that extremity.
In conclusion, these injuries, whether tendonitis or a rupture, can be quite debilitating and need treatment from a physician. If someone is unsure of what they are suffering from a visit to their physician will help with a diagnosis and treatment. These symptoms should not be ignored since they can cause long term problems with ambulation.

For more information please visit our website at www.footnj.com

Flatfeet For Everyone

On a day to day bases we hear people complain that they have flatfeet, but what exactly is flatfeet, what is the cause and how is it treated? A flatfoot, medically known as pes planus, is when the arch of the foot collapses. The biomechanical cause is when the subtalar joint, the joint below the ankle joint, is out of its’ correct alignment.
At what age can flatfeet begin to develop?
Many parents are concerned when they see their toddlers beginning to walk because it may appear to them that their toddler walks flatfooted. The fact is that before the age of five there is an increase of fatty tissue to the foot, and in addition, it takes up until that age for all the bones in the foot to be developed. Therefore, parents shouldn’t be concerned about flatfeet until around age five. There is a difference between in toeing and flatfeet and if one is concerned they should be evaluated by a physician.
How can one treat their young children and adolescents who suffer from flatfeet?
As children begin to increase their physical activity and play more sports parents may begin to notice that a flatfoot is developing. Around this time children playing sports may begin to complain of foot pain while doing their activities. Many times during this age a flatfoot develops and if treated early enough one can prevent it from worsening, which will ultimately prevent problems later in life. Conservatively it can be treated with orthotics, which are devices worn in the shoes in order to lift the arch and give more arch and heel support. If parents are interested in a more permanent fix there is a surgical procedure where an implant called an arthroereisis is place in the foot. The implant is placed in the subtalar joint, which is the joint directly beneath the ankle joint. The function of the implant is to correct the flatfoot deformity at the crux of the problem. Basically the implant acts as an “internal orthotic”. The surgery is performed as a same day procedure, with a 4 week recovery time. Children and young adults tolerate the procedure well and are ultimately fixing the cause of the flatfeet.
What about adults that develop flatfeet?
Many people don’t develop flatfeet until later in life. When adults begin to develop this problem it is usually due to different reasons than for children. Adult acquired flatfoot can be caused by illness, overuse, tendon injury etc. With an adult flatfoot it is more noticeable when one is non-weight bearing. The symptoms of an adult flatfoot may be different than with children and may only cause discomfort sporadically. Adult flatfoot is treated according to the symptoms. Many of these patients suffer from tendon pain in the arch area, which can be treated with orthotics, supportive braces, anti-inflammatory and physical therapy.
No matter what the age or cause of flatfeet there are many different treatment options for all different ages.

For more information please visit our website at www.footnj.com

Diabetic Foot Care and Shoes

According to the American Diabetes Association, one in five people with diabetes end up at the hospital due to the foot problems.  Poor foot care can tragically lead to amputation of the foot or leg. To avoid this it is imperative that you learn proper foot care techniques and check your feet daily: top, bottom and in between the toes.

It is also important that you wear shoes at all times to protect them from injury.  Diabetic neuropathy of the feet may cause a loss of sensation and the patient may not even realize when an injury has occurred.

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What precautions should I take to prevent injuries to my feet due to diabetes?

Washing your feet every day can help prevent serious health problems. Be sure to:

• Use lukewarm water and test the temperature with your hand before stepping in to make sure it’s not too hot!
• Completely dry your feet after washing, as infections like to form in moist areas such as between the toes.
• Soften skin with water-based hand and foot creams as dry and cracked feet often cause infections.  Do not place moisturizing creams in between the toes. Avoid oil and petroleum jelly as they actually dry the skin.

Other suggestions include:

• If you are a diabetic, controlled by diet or medication, you should never cut your own toenails. All toenail care and trimming of corns or calluses should be done by a podiatrist as recommended by the American Diabetic Association and almost all insurance companies.
• Quit smoking as it decreases oxygen and blood flow to the feet.
• Don’t cross your legs.
• Avoid sitting or standing in the same position for lengthy periods of time.

What types of shoes should I wear?If you are a diabetic suffering from peripheral neuropathy or circulation problems of the feet it is important to have shoes that are wide, soft, have high toe boxes as well as padded heels and tongues. Patients with reduced sensation or circulation wearing improperly fitting shoes run an increased chance of developing foot ulcerations and infections.

The federal government through Medicare has developed standards for a properly fitting diabetic therapeutic shoe. Shoe manufacturers submit their designs through Medicare for approval as a diabetic therapeutic shoe. For those patients who are diet or medication control diabetics, with symptoms of peripheral neuropathy or circulatory insufficiency, Medicare will pay for one pair of diabetic therapeutic shoe per calendar year as well as three pair of diabetic therapeutic insoles for the shoes.

Dr. Irina Tsyganova and her office staff can measure and fit patients who meet Medicare's standards of eligibility for diabetic therapeutic shoes. The shoes can be dispensed and picked up at Dr. Tsyganova's office. At that time, Dr. Tsyganova and her staff will make sure that the fit is proper.

Medicare provides for a diabetic patient with certain specific complications to be dispensed one pair of diabetic therapeutic shoes each year.  Medicare will pay for 80% of the cost.  If you have Medicare co-pay insurance, the company will pay the additional 20% leaving the patient with no out of pocket expense for the shoes. This is provided that all deductibles are met and that the patient has not previously been dispensed diabetic therapeutic shoes in the same calendar year.

All diabetics and patients with peripheral neuropathy or circulatory insufficiency should refrain from wearing shoes that will put pressure on bony prominences of the foot. Types of shoes to be avoided are shoes with high heels, pointy toes, thin soles and low toe boxes. In addition, these patients should avoid flip-flops and sandals because they provide very little protection from the environment.

http://footnj.com/podiatrist-new-jersey-about-us/23/232-diabetic-foot-care-and-shoes

Podiatrist Reviews

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http://www.healthgrades.com/provider/irina-tsyganova-38jv5/patient-ratings

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Toenail Fungus Laser Treatment Foot Doctor Podiatrist Laser Away Toenail Fungus

Dr. Irina Tsyganova is at the forefront of laser nail care, successfully treating Onychomycosis painlessly with this new technology.  Before the advent of laser treatment, the only remedies available to treat this condition were oral medications with potential complications such as liver damage, as well as largely ineffective topical medications.

The laser application is a quick, easy, safe and highly effective procedure that treats the fungus at the source.Dr. Tsyganova welcomes you to stop by for a free consultation to find out if you are a good candidate for the laser nail fungus treatment.

Dr. Tsyganova uses the Our office uses the best FDA approved product on the market, the Sciton JOULE™ http://www.sciton.com/products/joule.html to treat toe nail fungus.  Sciton JOULE™  is rated as the top none-invasive laser on the market today!

F.A.Q. About Laser Toenail Fungus Treatment

How is toenail fungus diagnosed?In most instances physician will evaluate signs of infection and will be able to tell you right away if your nails are infected. In other cases, biopsy of the nail tissue will be required, which is often reimbursed by a health insurance.

Is the laser treatment also available for fingernails?Yes, we offer the laser treatment for fingernails.

How does the laser works?The Laser kills the fungus that lives in and under the toenail. The laser light passes through the toenail without causing damage to the nail or the surrounding skin. At the time of the procedure, the toenail will not become instantly clear, because it takes time to grow out.

What can I expect in the doctor's office?Dr. Tsyganova will determine if you are a candidate for toenail fungus laser treatment. He will also answer any questions you may have about the procedure and outcome.

Is toenail fungus laser treatment safe?There are no age or health restrictions or limitations.  In clinical studies there have been no adverse reactions, injuries, disabilities or other known side effects.

Is the laser toenail fungus treatment painful?The procedure does not require injections of anesthetic.  Majority of people do not feel pain or discomfort from the laser. Some people report a mild warming sensation, and very few feel a pinprick from the laser.      

Is there a recovery period?No. Toenail fugus laser treatment is painless with virtually no discomfort.

How long does the fungus toenail laser treatment take?Consultation and Procedure may take between 20 to 30 minutes

When can I apply nail polish to my toenails or have a pedicure?You can apply nail polish immediately after the foot laser treatment. It is important to remove all nail polish and nail decorations the day before your treatment, otherwise physician will not be able to assess the severity of the condition.

Can the toenail fungus come back?The toenail fungus is killed after the treatment is concluded. There is a chance of re-infection, however, because the fungus is a part of normal skin flora and present everywhere in the environment.

Does fungus laser treatment really work?In the recent clinical study, 90% of the treated patients grew out a normal looking nail after two to three treatments. Sometimes only one treatment is necessary. Treatments are usually spaced one month apart. Upon conclusion of the treatment, the nail plate should grow out normally in 6-12 months.  This result is exceptionally higher than any oral or topical medication presently on the market.

How much does toenail fungus laser treatment cost?
Cost of the complete treatment is $800. All necessary follow up treatments included in this price.
Does my insurance pay for this?Because this treatment is considered cosmetic, health insurance plans do not cover it.

http://footnj.com/podiatrist-new-jersey-about-us/23/240-laser-toenail-fungus-treatment

Sterile Pedicure

Why are thousands being infected through contaminated cross shared manicure and pedicure instruments?
Autoclaved, disposable or personal tools are Wstill not a must for these procedures.

With so many lawsuits connected to deaths, chronic infections and disfigure- ment from pedicures, you would think the public would be clamor- ing for reform. Just the opposite, most consumers completely blow off the risks and have the “it won’t hap- pen to me” attitude.

Approximately $6 Billion dollars are spent on spa related nail care every year, making it a huge indus- try. Unfortunately, along with that pretty pedicure you can take home: hepatitis B and C, cutaneous herpes, warts, bacterial and fungal infec- tions, and even HIV. These can be deadly, especially in the diabetic or immune-compromised patients.

So . . . before you kick off your shoes, consider the potential downsides of pedicures.

People with diabetes are at risk for a number of complications. Foot infections are common. If they develop a break in the skin, it can be a life-threatening complication.

I would caution individuals with diabetes not to receive a pedicure because of the sanitary conditions of the salon, the skills of the individual performing the pedicure, and the cleanliness of the instruments used.

A 43-year-old San Jose, California woman’s husband remembers the small cut on her toe that led to her death from a skin infection in 2004. A 46-year-old Ft. Worth, Texas mother left the pedicure salon with a small abrasion on her heel and died of staph related illness in Feb 2006. Her family is still embroiled in a wrongful death lawsuit.

“Death by Pedicure” is the first inside book on the “dirty secrets of nail salons.” Dr. Robert Spalding, Jr., TN podiatrist, has spent 10 years lecturing on the problems in the nail salon industry. This book goes into detail concerning foot and nail infections that have been mentioned by every major news wire and TV station in the U.S.

You may never be 100% safe from infection when receiving a pedicure, but there are many simple precautions consumers can take to protect themselves.

1. What does the salon look like? If it’s not clean and shiny like a doctor’s office, don’t stay!
2. Check the photo on the license of the nail technician. Make sure they match.
3. Ask about sanitation procedures. Instruments should be autoclaved in a steam sterilizer just like surgical instruments. When in doubt, bring your own! In our office we can offer you individual medical grade instrument sets available to purchase and clean yourself.
4. Is the spa chair pipe-less and cleaned after each pedicure?
5. Never let the technician use a sharp blade to trim a callus or cuticle. This puts you more at risk. If your calluses or heel fissures are that thick, please visit your podiatrist PRIOR to the nail salon. Tools that use razor blades may ONLY be used by a doctor.

Nail salons are definitely improving their sanitation and trying to make you safer, but you must be a savvy consumer. Demand a safe pedicure or you and your family may be sorry!

Let me introduce a waterless paraffin pedicure that is available in our professional podiatry office. It was designed for those individuals who suffer from diseases such as dia- betes, arthritis, high-risk pregnancy patients, chemotherapy patients and other medical disorders that may otherwise prohibit the use of these services. It was also intended for those who have had bad pedi- cures and for those who describe themselves as “germaphobes.”” You may already be familiar with paraf- fin wax treatments at spas and nail salons -- it’s a luxurious addition to a manicure or pedicure. This helps to moisturize the foot and has the same effect as soaking a foot in a tub of water. However, this approach is environmentally better since you do not waste water and it is more sanitary. But you may be surprised at what else paraffin wax is used to treat.

Paraffin wax is a common option in heat therapy treatments for people with arthritis or other rheumatic diseases -- the heat helps increase blood flow and relax the muscles, which can help relieve pain caused by arthritis, osteoarthritis and fibromyalgia. Paraffin wax can even soften hardened skin caused by scleroderma, a disease in which col- lagen accumulates on the body -- it increases the skin’s elasticity, allowing for increased move- ment and mobility. Enhance your pedicure with the moisturiz- ing properties of paraffin. The paraffin and heat softens and improves skin all over the feet, especially in tough, calloused areas.

But the benefits of paraffin wax don’t stop there. Because paraf- fin wax treatments are a form of heat therapy, they’re often used for muscle, tendon and ligament ailments. As with conditions like arthritis, they increase blood flow, improve joint stiffness and reduce pain. They’re also used to treat bur- sitis, tendonitis, sprains and pulled muscles.

It’s about going green and being safe. A waterless pedicure is just how it sounds. Foot baths have been replaced by sanitized steamed tow- els. By wrapping your feet in these towels, your chances of catching a fungus or bacteria from the foot bath vanish. As an added bonus, you are helping the environment by preserving water without lifting a finger.

Our office is different in many ways. We autoclave our instruments just as they do in a hospital; this sterilizes, not sanitizes, our equip- ment. Everything else is disposable, making sure there is no chance for cross contamination. All files are thrown away or given to the client to take home with them, ensuring that nothing is ever used on anyone else.

In case you already have had a bad experience with

the dirty salons and suffer from toe nail fungus, we are offering the laser treatment by the best device available, “Rolls Royce” of all laser machines – Sciton Clear Sense laser – the newest laser technology on market that gives patient the advanced care they desire.

http://footnj.com/podiatrist-new-jersey-about-us/23/245-sterile-pedicure

All You Ever Needed to Know About Bunions

                                       All you ever needed to know about Bunions

What is a bunion?

http://footnj.com/podiatrist-new-jersey-about-us/23/231-bunions

A bunion, medically known as hallux abducto valgus, 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. 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.

Who gets a bunion?

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 above mentioned factors may help foresee who will get a bunion. 

What are signs that you have a bunion?

Pain is the most common symptoms of a bunion deformity. Many people many experience this with tight shoes. Redness, swelling and decreased motion of the 1st toe joint can also be signs that you are suffering from bunion pain. 

How can one prevent a bunion formation?

The best preventative medicine for bunions is custom molded orthotics and comfortable shoe gear.

How can one treat bunions?

Bunions are usually first treated conservatively. Bunion splints, toe spacers, rest, ice, wider shoes, appropriate orthotics and medication can help treat painful bunions. 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 bunion surgery entail?

There is a wide array of different types of bunion surgery. 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 most of the time surgery includes removing the “bump”, realigning the big toe and the metatarsal. If there is arthritis involved in the bunion deformity then the arthritic spurring will be removed during surgery. Bunion surgery does require anesthesia and is usually performed in an operating room under the surveillance of an anesthesiologist. 

Recovery includes 6-8 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 our website at www.footnj.com