Do you have a rash on your leg?

 I once had a woman come to me as a patient for an evaluation of a dark rash on the front of her right leg with mild swelling.  She says the rash always stays the same but the swelling is worse at the end of the day.  The key to her story is that she has almost no swelling when she wakes up in the morning.  She saw a dermatologist who prescribed some antifungal creams for this rash but it never cleared up.  She was very frustrated.  What was this rash?   

The official diagnosis was venous stasis dermatitis from venous insufficiency.  Well to break it down, this is a circulation issue.  Not the arteries.  She had good pulses in her feet (pedal pulses) so the arteries were bringing the oxygenated blood to the feet.  This is the most important part of foot health – the arterial circulation.  You must have good arterial circulation to literally keep your feet but that is another topic.  

This patient had insufficient venous circulation.  It is easier for the arteries to bring blood down to the feet with the help of gravity but the veins have to bring the deoxygenated blood back up to the heart and lungs against gravity.  So to help this venous blood to travel up, there are valves in the veins that push this blood up.  Over time, sometimes these valves get damaged, become insufficient and cannot do a good job at this so the venous blood pools in the legs and the legs increasingly swell.  Superficial and deep varicose veins develop and the venous purplish blood deposits some of its contents called hemosiderin deposits.  

This is what is responsible for the “rash” on this patient’s legs.  This is called venous stasis dermatitis.  So that is why the antifungal did not work as it is not a fungus nor did the steroids work as it doesn’t help the venous blood travel up the leg.  If this persists, venousstasis ulceration can develop with the increased swelling as the fluid has nowhere to go but out and the skin breaks opens.  

Increased age, smoking, genetics, obesity, trauma and pregnancy are all risk factors of venous insufficiency.  Compression stockings (support hose), pneumatic compression devices, weight loss, elevation and exercise can all help manage this condition.  Wound care is needed for an open wound (ulceration) and sometimes if severe enough, referral to a vascular specialist is necessary.

New NJ Podiatrist

 Introducing Dr. Amit Kalra!!

 Dr. Amit Kalra joins Family Foot & Ankle Specialists, in Hillsborough and Piscataway, NJ. 

As an athlete myself I know what it is like to have a foot/ankle injury. My mission here at Family Foot and Ankle is to make sure we give you the best and most up to date treatment for whatever issue you may have; Welcome!” 

Extensive Education “I pride myself on the education I have received to date and the years it took to get me to where I am today. By educating myself, I am able to provide my patients with the best and highest quality care imaginable.” 

• Bachelor of Science in Nutritional Sciences, Cornell University, Ithaca, NY Class of 2003 
• Masters of Science in Exercise Physiology, Ithaca College, Ithaca, NY Class of 2005 
• Doctor of Podiatric Medicine, Scholl School of Podiatry at Rosalind Franklin University Medical Center, North Chicago, IL Class of 2009 
• Residency in Foot & Ankle Surgery, Long island Jewish Medical Center/NSLIJ Health systems, Long Island, NY Class of 2012 

Highly Qualified “By continually educating myself and attending local and national seminars, workshops and conferences I stay abreast of new therapies to help my patients in all aspects of Foot and Ankle care.” 

• Board Qualified in Foot Surgery by the American Board of Podiatric Surgeons 
• Board Eligible in Reconstructive Rearfoot & Ankle Surgery 
• Member, American College of Foot and Ankle Surgeons 
• Certified, Foot and Ankle Arthroscopy

Are You A Bathroom Surgeon?

Taking Care of an Ingrown Toenail is Simple and Easy...

How many of you are bathroom surgeons?  You know what I mean.  You have an ingrown toenail that is painful and you decide to go to the bathroom and take out a nail clipper and try to digout the nail.  You know you have done that before.  So, how did you do?  Did you cut that “V” at the top like grandma told you to do?  Or, did you take that little file at the end of the nipper and try to pop it out? 

Well, if you did any of the above, you’ve found out very quickly that it didn’t work and in matter of fact, you have made it worse.  Now, the skin is all red, and there is some icky pus oozing out of the corner.  Now you have caused an infected ingrown toenail. 

The above situation is very common.  You think it is not a big deal to eliminate the ingrown.  However, because you are not as flexible as Cathy Rigby and you do not have the right tools or knowledge, you simply can’t do this yourself.  That’s good, because otherwise, I would be out of a job. 

Most people do not go see their podiatrist to take care of this problem because of three things: 1) Time, 2) Fear, and 3) Money.  What if I told you that the whole process of removing an ingrown toenail takes five minutes and it is virtually painless (definitely a lot less painful then if you did it yourself) and that insurance covers this procedure?  You still might be hesitant to come in but once you do, I can tell you the most common responseI get from my patients is, “Is that all? I should have done this months ago.”

So, now I am going to give away the big secret of how to remove the painful nail.  Please do not share this with anyone, because I might be left without a job.  The first thing we do is explain the procedure to you. We do everything in our power to relax you.  We have drinks (not the hard stuff) and snacks and might tell a joke or two.  Then, I will numb your toe.  This takes all about 20 seconds and from here on in, you will not feel a thing. 

Then I use a regular nail nipper to just cut the ingrown away.  Here comes the big secret.  If you just remove the ingrown without doing anything else, it will come right back.  Just circle your calendar for six months from now and you will find yourself in the same pickle.  This is because the ingrown toenail damaged the root and the root will continually produce another ingrown.  So, to prevent this, I apply four swabs of 89% phenol, which stops the root from making another ingrown.  The rest of the nail will grow back normally.  You will now have a normal nail. 

Afterwards, you can go back to most activities.  If you run or play soccer or other sports, you might need a few days of rest.  You can definitely go back to work immediately (oh, bummer).  To care for the toe, all you have to do is wash it with a cleanser and apply an antibiotic ointment and a band-aid.  This comes in a kit which we will give you.  We will check your toe a couple of times to assess the healing. 

So stop being a bathroom surgeon and get your feet properly taken care of.