Please remember this warning when next summer rolls around.

It is always around the summertime, when the sandals get taken out of the closet and the discovery of unsightly toenail fungus becomes apparent. I feel for my patients who want a quick fix for the problem. Unfortunately, there is no quick fix for this problem. Toenail fungus takes time to infect the toenails and by the time it is noticeable, it has already been present for an extended time.

Toenail fungus is caused primarily from a dermatophyte (big word) infection. It can occur in many areas of the body including the head, face, groin and foot and can be very contagious. A person can get toenail fungus from a previous fungal infection in the foot like athletes foot and from another outside source. Some places are public showers, your own shower (if you have a member with the problem), and pools. While a lot of podiatrists like to slam pedicurist for being a cause, please keep in mind; these nail salons don’t want you to get it either!  I always advise my patients that if are going to go to a pedicurist, make sure it is clean.

Once the fungus invades the toenail, you will notice a change in the color and shape of the nail. In advanced cases the nails will thicken and a debris will form underneath the nail. Whatever you do, don’t jam instruments under the nail as this will only push the infectious material deeper into the nail bed.

So what do we do? Prevention is key. If you have any other fungal infections make sure to treat them quickly. Athletes foot can be treated with topical medication very successful if the problem is not out of hand. Practice good hygiene with your feet, keeping them clean and dry between the toes. If you notice skin peeling and itchiness, you should be evaluated for care.

Watch out with your shoes; Fungus loves DARK, MOIST and WARM areas. This sounds exactly like my shoes at the end of a tough work day. Let them dry and spray them with an antifungal/antibacterial spray like Lysol.

So now what do we do if there is a fungus invading the nail. There are many treatments that are available. Be very careful with over the counter miracle cures. Go and discuss it with your favorite podiatrist…perhaps one in Plymouth Meeting, PA 😉 A good assessment and treatment plan can be decided together. There are topical cures. These must be used religiously for 6-12 months. It is also important to ddecide if that is an option, if the nail is infected back towards the base of the toenail, this may not work. Also, there are oral medications that help with compliance (all you have to do is swallow a pill) but with any oral medication it should be discussed with your doctor as the risks and benefits must be weighed out.  There is also the addition of laser therapy. This involves the use of a laser to destroy the fungus. It will sometimes requires multiple treatments. For full eradication the nail will likely show results after 6 months.

Unfortunately, none of these treatments are guaranteed. I feel that nail fungus is a disease that can spread, so it is important to treat the problem and not ignore. So while we sit here in our cold Northeast, dreaming of our summer activities, remember that the true cure takes time, that is why I think now’s the time to treat those toenails, while we can hide them in our boots and sneakers, only to have those sandals look fantastic with our perfect toenails.

So think about it, we have the technology to treat you and help you here at Barking Dogs Foot and Ankle Care. Give us a call and we’ll see you soon.

Podiatrist take care of kids?!?

We do!

At Barking Dogs Foot and Ankle Care, Dr. Pagano and Dr. Varghese are comfortable and experienced in the care of our smallest patients.
We treat any foot and ankle issue that your child may be experiencing. This include dermatology issues like ingrown toenails and warts.  Dr. Varghese has been published in peer reviewed journal for her work in dermatology.

Neurological issues like Charcot Marie Tooth and numbness.

Orthopedic issues like FLATFOOT, juvenile bunions and other foot deformities. We believe in avoiding “benign neglect” or the “they’ll just grow out of it principle” seen in treating our pediatric patients. With a good evaluation, we can help parents make decisions on treatment options and promote a future healthy pain free lifestyle for your kids.

Dr. Pagano  teaches Pediatric Orthopedics and Surgery at Temple University School of Podiatric Medicine and has been featured in many publication reviews of pediatric research (Compendium of Podiatric Medicine 2009-present).

We also treat fractures, wounds and foreign bodies that sometime the tweezers at home cannot seem  to work out.

We’ve got you covered.

More importantly, we have children also.   We have been to the doctor’s offices and know the feeling of feeling helpless for the most important parts of our lives, our children.

Our staff is made up of three wonderful women, June, Tricia and AnnaMaria, all of whom are PROFESSIONAL MOMS!

Have a pediatric patient with a foot and ankle problem and are not sure where to go?  Call us at 484.681.9485 and get the family oriented treatment that Dr. Pagano and Dr. Varghese offer at Barking Dogs Foot and Ankle Care!

Podiatry for all ages


Barking Dogs is Expanding into King of Prussia!

Exciting news everyone!

In the past year we have grown to serve the needs of our patients!

We are now open in King of Prussia every Tuesday morning at the Einstein Health Care Network King of Prussia Building in the Multi Specialty Section.

Dr. Pagano will be seeing patients from 8:30 AM to 12:00 PM handling any of your foot and ankle problems. The  office is located at:

210 Mall Boulevard
King of Prussia, PA, 19406

To make an appointment, please call our office at 484-681-9485 or email us at

“Einstein’s outpatient care facility located in King of Prussia features a wide range of medical specialists and services, including primary care, obstetrics and gynecology, orthopedics, podiatric surgery, radiology and outpatient laboratory services, and physical medicine and rehabilitation from MossRehab, the top-ranked rehabilitation facility in Pennsylvania according to U.S. News & World Report. Ample parking is available on site.” – See more at:

“We’re very excited to be in a position to grow and give patients the excellent care that we have been providing in Plymouth Meeting for the last 5 years!”  -Dr. Pagano

Beautiful New Office, Same Barking Dogs Foot and Ankle style of Care

Beautiful New Office, Same Barking Dogs Foot and Ankle style of Care

Barking Dogs Foot and Ankle Care Welcomes Dr. Stephanie Varghese!!!

Barking Dogs Foot and Ankle Care is proud to announce the addition of Dr. Stephanie Varghese, DPM to the practice.

“I’m lucky to work with the residents at Suburban Hospital where Dr. Varghese was the chief surgical resident.  She spent time in the office and really got to know our patients. I was able to observe her and feel that she treats patients the way we have been treating here in Plymouth Meeting for the past 5 years.

We’re growing and we needed someone who cares about their patients first and foremost.  The timing was right and we are happy and excited to have her. She’s is a great addition and an excellent physician.” – Dr. Pagano

Dr. Varghese starts August 29, 2016 and she is accepting new patients. Call now for an appointment: 484-681-9485

Stephanie Varghese, DPM

Dr. Varghese is a board qualified surgeon and associate at Barking Dogs Foot and Ankle Care. She grew up in Dallas, Texas as a Dallas Cowboys fan but quickly learned the error of her ways, moved to Philadelphia, met her husband, and now bleeds green (Go EAGLES!).

A collegiate lacrosse player injured in her final year, Dr. Varghese first found her love for podiatric medicine. “I understand loving your sport and I enjoy getting athletes properly rehabbed and back to their activities.”

After receiving her Bachelor’s degree at Austin College in Sherman, Texas, she went on to earn her Doctorate in Podiatric Medicine from Temple University School of Podiatric Medicine. During her time at Temple Dr. Varghese participated in several dermatology research projects and developed a love for diagnosing and treating skin disease, soft tissue tumors/masses, fungal infections and wounds.

She then went on to complete three years of extensive surgical training at Suburban Community Hospital in East Norriton, Pennsylvania where she was chief resident in her final year. Dr Varghese is trained in all aspects of podiatric medicine with a focus on forefoot surgery, rearfoot/ankle reconstruction, diabetic limb salvage, dermatology, and sports medicine.

Dr. Varghese believes good medicine starts with taking your time with each patient and yearns for medicine to look like it did many years ago when your doctor lived in your town, knew your name, understood your story, and was ready to help at any time. Her hope is to bring back this aspect of medicine to modern day practice.

A few fun things to know about Dr. Varghese…

  • She loves water sports but could do without sharks and other menacing deep sea creatures.
  • She is a proud mother of a brand new baby girl, Reagan.
  • She worked on the research backing the new topical antifungal, Jublia.
  • She loves to travel and experience new cultures and of course the food!
  • She has been published in Foot and Ankle Quarterly, dermatology edition
  • She is always encouraged by her husband to wear her Eagles gear when visiting family in Dallas
  • She has been known to eat her weight in chocolate chip cookies
  • She hopes to complete her first marathon this year


  • American College of Foot and Ankle Surgeons; Associate
  • American Podiatric Medical Association
  • Pennsylvania Podiatric Medical Association
  • Einstein Medical Center Montgomery, Staff Podiatric Medicine and Surgery
  • Suburban Community Hospital, Staff Podiatric Medicine and Surgery

Dr. Varghese starts August 29, 2016 and she is accepting new patients. Call now for an appointment: 484-681-9485

Podiatrist, Surgeon, Happy Person

Podiatrist, Surgeon, Happy Person


Associated Press – Plymouth Meeting, PA –
While the world is exploding with Pokémon fever, there is a podiatrist in Plymouth Meeting, PA who is seeing an increase in business. Dr. Nicholas Pagano, a podiatric surgeon and founder of Barking Dogs Foot and Ankle Care, is concerned with the amount of injuries that are spawning from the new craze.
“This gives new meaning to the weekend warrior, people are getting off of their couches and chasing around these crazy things and running into multiple foot injuries. Overuse injuries like plantar fasciitis and tendonitis to direct trauma like stubbed toes and sprained ankles. This is due to wandering around unsteady ground as well as not paying attention to your surrounding environment from staring at their phones.” says Pagano.

It’s a problem that is going to get worse before it gets better. There are a few simple steps that Dr. Pagano recommends to prevent injuries.
“It’s always important to STRETCH prior to activities and if you are going to focus on your phone, have a buddy to be your guide when walking around.”
If you do suffer an injury, hope is not lost and Dr. Pagano is more than happy to help.
“We have instituted a SAME DAY POKEMON Appointment Policy, because of the need for immediate treatment. We’re kinda of becoming the Pokémon Urgent Care Center of Montgomery County” says Pagano.

-Thomas L. Waldron, freelance reporter
-If needed to contact Barking Dogs Foot and Ankle Care for an appointment, please call Dr. Nicholas Pagano at 484.681.9485

Spenco Teams up with Legendary Shoe Retailer to Host Medical Events in New York City

A series of professional Medical Nights sponsored by Spenco helped educate New York City podiatrists on the benefits of Spenco’s insoles and footwear.

The May events, held in conjunction with the well-known local Eneslow footwear store, helped educate members of the medical community on new options for patients with foot problems.

About 15 podiatrists and some assistants attended the catered events, where they received a tour of the Eneslow stores and custom orthotics production room.

Dr. Nick Pagano, one of Spenco’s resident podiatrists, gave a history of Spenco Medical Company.

He demonstrated the features of the company’s flagship Total Support® Insole, as well as other specific types of insoles, including the new Spenco MedicsTM Diabetic Insole.

“The benefit of events like this is exposing doctors to new and different products that may help their patients,” said Spenco Product Manager Brian Mangione. “Not everyone needs custom orthotics, and podiatrists can help those patients more quickly and affordably with other options.”

Each doctor received a complimentary pair of Spenco footwear, which Eneslow carries.