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.

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Podiatrist Reviews

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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?

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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