Ball of Foot Pain

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

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

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

Morton’s Neuroma

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

Stress Fractures

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

Capsulitis/Plantar Plate Rupture

Capsulitis is defined as inflammation in the joints between the metatarsal bones and the toes. There are many causes of capsulitis, including faulty biomechanics, overuse, and injury just to name a few. Many times a plantar plate rupture, which is a rupture of the ligaments on the bottom of the joint, are what causes the pain. Usually when a patient presents with this it is a condition, it has been going on for a while and they are in a lot of pain. This condition may take a while to treat, since most of the time it takes a while to present itself. Usually orthotics, padding in the shoes, anti-inflammatory medication, injections and possibly surgery can fix this condition.

In conclusion, there are many conditions that can cause pain in the ball of the foot. It is important to get a proper diagnosis before beginning treatment. If you wait to see help it may take that much longer to get treated and be healed.

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

Are all varicose veins the same?

Veins

Are all varicose veins the same?

There are two types of varicose veins. The first is known as telangiectasia, which are superficial spider veins. These types of veins appear to be cosmetically unappealing but they tend to be in the outer layer of the skin. These veins usually cause no problems but they can lead to deep varicose veins. The second type of veins are called varicose veins, or medically speaking varicosities. These veins tend to do deeper in the skin and can cause numerous problems.

There are two systems in the body that carry blood. The first is the arterial system which carries blood from the heart to the toes. The other system is the venous system which returns blood from the toes to the heart. This blog will be dedicated to learning about disease of the venous system.

The two types of venous mentioned above disease of the venous system. The venous systems is divided into two parts, the deep and superficial. These two systems connect via valves, which pump the blood between the 2 systems when one moves and walks. The varicose veins develop in the deep system and the spider veins develop in the superficial system.

What types of problems can the venous system cause?

When the deep venous don’t pump the blood properly it can cause skin discoloration to the ankles. What happens is the iron in the blood will “leak” into the skin and cause brown discoloration to the ankles. If this condition isn’t treated this can lead to wounds to the insides of the ankles. When one develops these wounds it’s called “venous leg ulcers”. Usually these wound are associated with a lot of leg swelling. The best way to treat this is to resolve the swelling, usually multiple layer compression wraps, called Unna Boots. This helps to treat the swelling and wounds. Long term patients who have this problems of swelling and brown discoloration are recommended to wear compression stockings. Compression stockings are not well tolerated since patents state they are tight and hard to put on. There are different types include zip up ones and different amounts of compression.

In conclusion, if you have superficial or deep veins in your legs it is a good idea to talk to your physical about it before it becomes a chronic problems and difficult to treat

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

Exercise and how it relates to your health and your feet

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

What benefits does exercise have on your overall health?

A study was done by the prestigious Mayo Clinic, which found that exercise has 7 main benefits to one’s health.

1.      Exercise controls one weight

2.      Exercise fights disease and other health related problems

3.      Exercise overall improves ones mood

4.      Exercise increased energy

5.      Exercise allows one to sleep better

6.      Exercise can have a positive effect on one’s sex life

7.      Exercise can be fun

To gain these benefits not much exercise is required. What is recommended is a few days a week for 30 minutes of moderate exercise, including walking, biking or swimming.

What about my diet?

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

What about my feet and exercise?

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

What about specific foot exercises?

In addition, there are exercises that can be done specifically for the feet to increase strength and flexibly. Most people will learn to do these exercises if they have an injury or condition that they are being treated for. I would recommend doing these exercises when you have no foot issues, which would prevent any problems from occurring.

In conclusion, exercise and diet can have a significant effect on your health and ultimately your life. Before you start any exercise and diet program please consult your physician.

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

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

Bunions and Hammertoes, the bread and butter of Podiatry

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

What exactly is a bunion and a hammertoe?

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

Who gets a bunion and hammertoes?

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

How can one treat bunions and hammertoes?

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

What does this type of surgery entail?

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

Depending on what type of surgery you have the recovery can range from 2-8 weeks with the use of crutches or walker. The type of surgery performed will dictate the type of weight bearing that is allowed. 2 months post operatively one may begin to return to regular shoe gear. After surgery it is highly recommended to wear custom orthotics long term to prevent re-occurrence of the deformity.

For more information, please visit http://www.footnj.com/podiatrist-new-jersey-about-us/23/234-hammertoes

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

All you need to know about ingrown toenails

What is an ingrown toenail?

Ingrown toenails are one of the most common problems a podiatrist will treat. Many people have different ideas of what an ingrown toenail is. Basically, an ingrown toenail is when the edge of the nail grows into the skin, which can cause pain and/or an infection. Ingrown toenails can be caught at any stage, from the first ounce of pain, or when it is neglected and a patient has a raging infection due to the ingrown toenail.

Who gets ingrown toenails?

The answer is simple; anyone can get an ingrown toenail. I tend to see them in a younger and older population. It is common is teenagers because they tend to pick at their toenails, and they don’t tell their parents that they have an infection. Usually when a teenager comes in with ingrown toenails there is a moderate to severe infection.

On the other hand, I tend to see a lot of senior citizens with ingrown toenails due to the fact that as people age they tend to get worsening fungus to their nails. The fungus s will thicken a nail to a point that it causes incurvation to the nail edge, and then an ingrown toenail. These ingrown toenails are not as severe as the above mentioned ones and besides treating the ingrown toenail, I treat the fungus, so the ingrown toenail doesn’t return.

What type of treatments options are there for ingrown toenails?

If a patient has an ingrown toenail that is just incurvated into the edge of the nail, usually without anesthesia, I will remove the nail edge, using podiatric instrumentation. If the patient cannot tolerate this procedure without anesthesia or if the incurvated nail is all the way down the nail bed, numbing the patient’s toe with anesthesia is required.

With a more severe ingrown toenail, where an infection is involved, numbing the toe with anesthesia is a requirement. It is then followed by removal of the ingrown toenail, removal of the infection and placing the patient on antibiotics.

Are there long term solutions for treatment chronic ingrown toenails?

If a patient keeps on getting ingrown toenails, there is a procedure that can be performed where the chronic offending nail margin is removed and then with a chemical, or a surgical procedure, the nail root is removed. This is called a matrixectomy and there are many different types, the point is to stop the problems of getting ingrown toenails.

In conclusion, wherever you fall on the spectrum of ingrown toenails, do not wait until it is too late to seek treatment.

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

Winter and your Feet

Winter and your Feet

This year we have had a very late and cold winter. Due to the significant low temperatures I have been seeing a lot of people with complaints of cold, discolored feet. Many of these patients are young healthy woman and are concerned about losing the circulation in their feet. Many of these patients state that they have never had these symptoms before and are concerned. After testing and further questioning, these patients are diagnosed with Raynaud’s phenomenon.

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition of vasospasms, which means there is decreased blood flow due to the cold temperature or stress. This can cause the toes and fingers to turn different colors, including purple, red or blue. Other symptoms of this phenomenon are extreme cold extremities and pain. This phenomenon is not to be confused with Raynaud’s disease, which is a systemic condition usually caused by a disease process.

The three colors of Raynaud’s are white, which is the initial stage, when there is decrease blood to the toes. The second stage is blue fingers and toes, which is due to a decrease in the oxygen to the extremities. The third and last phase is when the toes turn red, which is when temperature increases and blood returns to the digits.

How is this diagnosed and treated?

Diagnosis can be made by either clinical appearance or via a biopsy. Many patients that first present with this have a confusing appearance to their toes. It looks like a mix of Raynaud’s and dermatitis (which is a skin irritation). A biopsy will deny or confirm the diagnosis.

There are many options for treatment. The first option for a mild case is to wait until the weather gets warmer or the stress decreases. Stopping to smoke and decreasing caffeine intake can also diminish the symptoms. There are topical medications that can be prescribed to help vasodilate, or increase blood flow to the digits. If a topical medication does not work there are oral medications, which are blood pressure medications. Since blood pressure medications vasodilator the arteries they will help to decrease the symptoms of the Raynaud’s. If a patient has a severe case, which is associated with other diseases, there is surgery to help decrease the symptoms. Lately, Botox has been used in extreme cases of painful Raynaud’s

In conclusion, during the winter months, it is important to keep your digits warm and not allow long times of exposure to cold climates. If you are unsure of what is causing your skin to change colors, please go to your physician for a consultation.

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

Alternative Treatment for Peripheral Neuropathy

Alternative Treatment for Peripheral Neuropathy

In my past blogs I have discussed peripheral neuropathy and how it affects the feet. For a review, peripheral neuropathy is when the feeling/sensation to the feet decrease to a point where there is numbness, tingling and burning. This becomes a dangerous problem if a patient can’t feel their feet and they get a cut or sore. Without being able to feel the injury, it becomes difficult to treat it and this can many times lead to infection, gangrene and amputation. Many diabetics suffer from this condition, but more recently I have seen people without diabetes suffer from similar symptoms.

It is important to find the cause of these symptoms and attempt to treat the cause. If treating the cause doesn’t help with the symptoms, then this condition can be treated with medication. Traditionally there have been strong prescription medications that have been used to reduce the symptoms. These medications have many negative side effects, which cause can noncompliance issues. In addition, many patients who need these medications will be on many other prescription medications and there is hesitation about adding “another medication” to one’s regime.

Therefore, we have an alternative treatment option that is all natural, has no reported side effects and doesn’t interact with other medications. In our office we dispensed a Vitamin Supplement called NeuRx-TF. It is a vitamin supplement consisting of 4 different vitamins, which are Alpha-Lipoic Acid, Benfotiamine (or Vitamin B1), Vitamin B6 and Vitamin B12. This specific vitamin, NeuRx-TF, is different than any over the counter equivalents. Many patients will purchase an over the counter Vitamin B12 complex and have minimal changes in their symptoms. It is the exact formulary of this vitamin that helps with neuropathy.

The most important aspect of this vitamin is that the ingredients are fat-soluble. It is the fat-solubility of this vitamin that allows it to be absorbed and metabolized in the body. It is this property that allows blockage of the pathways that destroy the nerves, which entail cause neuropathy. The Vitamin B6 and B12 component of this vitamin can help reduce clotting of the circulatory system and prevent plaque from forming in the small tiny arteries to the feet.

In conclusion, there are alternatives ways to treat neuropathic symptoms. Many patients suffer way to long before coming to seek treatment. I always tell my patients that earlier you seek treatment for neuropathy the better your outcome will be.

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

2015: A new year, A new you, and new feet

2015: A new year, A new you, and new feet

As the New Year approaches many people make New Year’s Resolutions. Usually the resolutions are related to health and fitness. Foot health is related to one’s overall health. Many people run to the gym and start eating better right after January 1, but seeing your doctor is also related to your overall health. Most people go to their doctor’s’ for regular checkups, for example getting mammograms and Pap-smears yearly are common, but when was the last time you went to the podiatrist for a general foot checkup.

Many people think that they should only visit a podiatrist when they have a problem, but as podiatrist I belief it is just the opposite. Many foot related problems and injuries are avoidable with a regular checkups and exams. Many foot ailments occur with overuse, improper shoe gear and abnormal foot biomechanics.

Seeing a podiatrist for an exam is painless and most likely you will learn more about your feet than you ever thought was possible. A quick exam of your shoes and sneakers, and the way you walk barefoot can tell a lot about your foot. Many people go to the pharmacy and go to the foot care aisle and buy miscellaneous products to help their foot problems. To be honest I see many patients in the office who have tried these products and many times they have made their foot problems worse.

A big part of getting healthy in the New Year is working out. I personally love to exercise and I tell my patients all the time it is important to change your sneakers 2-3 times a years. In addition, custom molded orthotics is important to keeping your foot in a neutral position. Post people have flatfeet, some have high arches and few people have perfectly normal feet. Therefore, most people would benefit from a pair of orthotics. I personally have been wearing custom molded orthotics in my shoes for the past 25 years, without them I tend to have more pain and problems.

Many patients, who are adults, will tell me about their children’s foot problems. People are surprised to hear that I see many children. The truth is many foot problems begin in youth but are not noticed until adulthood. Therefore, having your child see the podiatrist is very important. Flatfeet are normal in an infant and even a toddler, but as your child approaches young adult hood, flatfeet isn’t normal and this should be addressed. One more thing that is important is to look at your feet, because one’s foot type in genetic. So if you are having problems with your feet, there is a 50% chance your child will also.

S

o now that the New Year is upon us make it a priority to call your local podiatrist and ask for a consultation and a general foot exam.

To book an appointment with us and for more information please visit our website at www.foonj.com

New Medications to Treat Toenail Fungus in New Jersey EHT

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.

Jublia (efinaconazole)

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

Podiatry in The Media

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.

Kim Jong-un

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.

RG III

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.

Julius Randle

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

Hyperbaric oxygen therapy and its role in Podiatry

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

http://shoremedicalcenter.org/departments/wound_care

PRP and its role in Podiatry

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

Foot and Low Back Pain: How they are interconnected

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

Lasers and its role in Podiatry

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

Heat and your feet eht nj

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 2^nd and 3^rd 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 

Heel Pain in Children

One of the most common causes of heel pain in young athletic children is something called Sever’s disease or calcaneal apophysitis. In this blog I will discuss what exactly is Sever’s disease, who it affects, how it can be treated and is it avoidable?

What exactly is Sever’s disease?

Sever’s disease, which is also called calcaneal apophysitis, is inflammation in the growth plate of the calcaneus (which is the heel bone). This occurs in a growing child, usually between the ages of 9-11. It presents as heel pain and is usually brought on by an increase in physical activity. If the pain in this area gets severe many times the child will be limping due to the pain. If this worsens it can lead to a red swollen heel.

How is Sever’s disease diagnosed?

Sever’s disease is usually diagnosed by signs, symptoms and clinical exam. A typical patient will be a 9 or 10 year old boy that has been playing a lot of soccer, or basketball, and has pain to the back of his heel while playing sports. He states when he rests the pain resolved. Squeezing on the back of the heel will elicit pain with Sever’s disease. In addition, x-rays can be taken, but are usually normal.

What Causes Sever’s disease?

This is caused by overuse and the stress that it causes to the bone and tendons. Many times with this disease the bones and the child are growing at an excessively quick rate.

How is Sever’s disease treated?

The principles of treatment are RICE, which include rest, ice, compression and elevation. Stretching the tendons attached to the heel (i.e. Achilles tendon, plantar fascia) is very important. Wearing good supportive shoes with custom orthotics will help. If the pain is severe oral anti-inflammatory medications can help.  Physical therapy may help if none of these other treatments resolve the pain. Many times taking a break from physical activity is required until the pain is resolved.

Even if treatment is not sought out it will resolve slowly on its own within a few weeks.

How can I prevent my child from getting Sever’s disease?

Stretching before and after activity is very important, avoiding excessive amounts of physical activity is good to prevent any type of injury. Lastly, wearing the appropriate supportive shoes with orthotics can prevent many different foot aliments.

For more information, please visit our website at http://www.footnj.com/podiatrist-new-jersey-about-us/23/237-heel-pain

How can the Holiday’s affect your feet?

No matter what holiday you celebrate caution should be taken so you don’t have problems with your feet. Most holidays are filled with family, prayer and of course eating too much food.  Many of these activities can lead to problems with feet.

To start off many people go to pray with their family during the holiday, which means people will dress in their Easter best. Most times this means that shoe gear is more about appearance than comfort. I agree that it is okay once in a while to wear stylish, not so comfortable shoes, but if someone isn’t used to this type of shoe they may run into problems. As the weather is warming up and Easter/Passover is upon us many people will wear high heeled open toe shoes. I would like to warn those high heel open toe shoe wearers to be careful about developing blisters or wearing shoes that are too tight. Most importantly, twisting ankles is a common occurrence for the novice high heel wearer. A good suggestion would be to wear comfortable shoes to the event and perhaps change into a high heel shoe once at the location.

The second aspect of a holiday weekend for people to be aware of is the eating aspect of it. Most holidays are centered around families sitting and eating large quantities of food. The two groups of people to be concerned about this are diabetics and people who suffer from gout. Diabetics who over indulge are concerned about elevated blood sugar levels. As I have spoken about in past blogs, long term elevated blood sugar levels can lead to neuropathy, diabetic wounds, infections and a multitude of other problems.

People with gout can exacerbate their condition or bring on a gouty attack with certain foods. Therefore, they should be careful not to eat large quantities of meat, seafood or drink too much wine. If someone with gout has questionable symptoms of an attack they should seek attention with their physician. Remember the most common place for a gouty attack is the big toe joint of the foot.

In conclusion, holidays are times to spend with loved ones, but be careful because anything in excess can cause problems down the road.

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

Medical Foot Wear Podiatrist Shoes Podiatrist shoes 08234

What does warmer weather mean for your feet?

As this long and snowy winter finally comes to an end, everyone cannot wait to get out of their boots and into slippers, sandals and flip flops. But are sandals bad for your feet and what can you do to wear open toe shoes in the summer without any problems?

In the summer most people, including myself, like to expose their feet in some sort of open type of shoe, but before doing this think of the risks that this may involve. If you are a diabetic or have peripheral vascular disease, wearing an open type of shoe can be a disaster. If you are a diabetic with neuropathy (see earlier blog for definition) and you are wearing open toe shoes and get a cut on your foot, it can get infected and by the time you notice it there can be an infected wound. Therefore, it is highly recommended for diabetic and people with PAD to wear closed toe shoes throughout the entire year.

Another problem with wearing open toe shoes is that many sandals and flip flops that are sold in the summertime have no support built into the shoe. Therefore, many people in the summer tend to spend long hours outdoors exercising, walking and doing leisurely activities. This means that people spend more time on their feet with less support than during the winter. If someone wears a shoe with no support for hours at a time they are more than likely to begin to get achy, sore feet. Many patients actually spend weeks of the summer suffering with painful feet and by the time they seek help it is the beginning of fall and they are returning to supportive shoe gear. At the Foot and Ankle Center in Egg Harbor Township, NJ, we have a solution to this problem. We sell Spenco sandals/flip flops. Spenco’s are a sandal orthotic; the orthotic is built into the sandal. This is a great solution because this way you can still enjoy wearing a sandal during the warm months, but you can have support at the same time.

One more thing to consider when wearing open toe shoes in the summer is applying sun screen to your feet. Many people forget to do that and skin cancer can form on the feet. So don’t forget to apply sunscreen before leaving the house.

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

For more information on how to purchase Spenco sandals please call the office at 609-272-1450

Podiatry and the Importance of Utilizing Other Specialties

Many patients present to a Podiatrist with a variety of foot and ankle complaints. As a Podiatrist I like to take a whole body approach to treating patients. I tend to utilize other medical specialist to help with diagnosis, treatment and ultimately to heal patients. I think all physicians should use all the tools that are available to them to help treat patients.

While performing a foot exam I tend to break down the exam into four components. The four components of the foot exam are the dermatological, vascular, orthopedic and neurologic aspects. I think that during an exam it is important to listen, examine and ask appropriate questions in order to get a complete picture of what the problem is. The foot and ankle are connected to the body and even though someone may think their symptoms are in the feet many times it is related to something else going on in the body.

For example, during the winter months many patients come into the office complaining about cold, purple toes. They state that as the weather gets colder they toes change colors, from red to white to blue to purple. It is important to perform a vascular lower extremity exam, but it is also important to ask if they get similar symptoms in their fingers. This disorder can be a variety of things, include Raynaud’s, Chilblains, but what is important is to ask general questions. Once I diagnosis the problem I frequently get other specialties involved in the patient’s care. I will refer the patient to a vascular surgeon, since this is not only a lower extremity problem, but a vascular problem as well.

Another example that I see very frequently is a patient who presents with numbness, tingling and burning to the feet. When a patient presents with neurological problems in the feet the first question I ask is do they have a history of pain back, spinal stenosis or disk disease. Nine out of ten times the patients have low back complaints and nine out of ten times the foot problems are coming from the back. At this time I complete my exam and make my treatment plan. Most times a neurologist consult is recommended. Many people say “well I came to see you because of my feet but you are sending me to a neurologist”. What I explain is that the foot is connected to all other systems of the body.

So whether the foot problem is related to the circulation (vascular), the skin (dermatology), the nerves or the biomechanics I utilize other medical specialists to give my patients a complete and thorough  treatment plan.

With medicine emerging and physicians becoming sub-specialized it is importation for doctors to rely and ask for assistance from their counter parts to help treat their patients.

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

Deep Vein Thrombosis and its relationship to podiatry

Deep Vein Thrombosis and its relationship to podiatry

What exactly is a Deep Vein Thrombosis (DVT)?

DVT is when a blog clot forms in the deep veins, this most commonly occurs in the legs. Symptoms of a DVT can include pain, swelling, redness in the leg. These symptoms can present themselves in different medical conditions, such as infection or lymphedema, therefore, if someone suspects they have a DVT IMMEDIATE medical attention should be sought.

How does a DVT develop?

There are three main risk factors for developing a DVT. They are venous stasis, hypercoagulability and damage to the endothelium. Venous stasis is when the veins are static and not moving. Hypercoagulability is when the blood has a higher change of clotting. Endothelial damage is damage to the blood vessels. Each of these causes has multiple causes. These 3 risks factors together are known as Virchow’s triad. The more risk factors a person has the higher chance of developing a DVT.

Who is at risk for developing a DVT?

Taking Virchow’s triad into consideration the following are some of the risk factors for developing a DVT: immobilization, obesity, surgery, birth control pills, age, cancer, pregnancy, trauma to the leg, infection, HIV and blood clotting disorders etc. There are many other risks factors, but these are the common ones.

How are DVT’s diagnosed and treated?

Immediate diagnosis is critical because if a DVT goes undiagnosed it can travel to the lungs, cause a Pulmonary Embolism and possible death. If a patient has a painful, swollen, red calf an Ultrasound should be performed immediately. There is a blood test that can help rule out a DVT but it is not as sensitive as the ultrasound in diagnosing a DVT.

A DVT is treated with anticoagulation medication, such as Coumadin, Lovenox, or  Xarelto . Treatment is usually required for a few months after a DVT is diagnosed. If someone has a history of DVT a filter can be placed surgically in their veins.

Can I prevent a DVT?

If someone has many risks factors they can take medication for prevention. In addition, exercise, compression stockings and staying active can help.

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