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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.

HOW FOOT HEALTH CAN SAVE YOUR LIFE… or me just introducing myself

I’m Dr. Nicholas Pagano, a podiatrist practicing here in lovely Bucks and Montgomery Counties.  I’d like to welcome you to my blog.  My wife, Alayna, and I founded Barking Dogs Foot and Ankle Care in Plymouth Meeting, PA with a vision to improve the health of as many people we possibly can, one foot at a time.  We wanted to bring a bit of freshness to the typical doctors office and make our patients feel comfortable and at home with our practice.  Take a look at our site to see what you think,

In addition to Barking Dogs Foot and Ankle Care, I work as an associate in Souderton, PA and am on staff at Chestnut Hill and Grandview Hospitals.  I also teach Pediatric Podiatry at Temple University School of Podiatric Medicine in the Orthopedics department.  These different locations and forums give me a wide variety of patients and a wide variety of problems.

I have a collegiate background in running.  This was what originally focused my studies on Podiatry.   I enjoy helping athletes continue their sport at the highest possible level.  But over the years I’ve learned that Podiatry allows me to positively affect so many lives from babies to the elderly, from broken bones to diabetic care and beyond.

I’m going to use my blog as a forum to discuss the many problems people encounter with their feet and their ankles.  I’ll give you my opinions on how to prevent and treat these issues.  Its my hope that this blog will lead you down the path of great foot health.

Stay tuned for upcoming blog topics including: Summer Injuries (Disney Injuries and the ill fated flip-flop,)  sports injuries, heel pain,  bunions, hammertoes, shoe selection (one of my favorites), running, training, when is surgery necessary?, and when you should call a doctor?

This will be an educational forum but also entertaining.  I promise you, the life of a podiatrist is more exciting than you might think.  Now, a question for you…  What is one of the most common causes of summer injuries?  I’d love to know what you think.

Broad Street Foot Pain

Hello my fellow Broad Streeters!  This is Dr. Pagano, a podiatrist/owner of Barking Dogs Foot and Ankle Care in Plymouth Meeting, PA. I am also a former distance runner at La Salle University in Philadelphia. Welcome to my blog.

 A very common issue among my runner patients is the looming concern of stress fractures in their feet.  As we train and pound the roads and trails, it not uncommon to develop this type of overuse injury. But how do you know if it’s a stress fracture or not?  How do you treat it?  Should you run through the pain?  How long does it take to heal?

 First, let’s talk about what a stress fracture in the foot really is.  Simply said, it’s a small crack in the bone.  The repetitive nature of running and the constant ground impact puts unusual stress on the bones in our feet.   Couple this with rigorous daily training and any of the 26 foot bones can fracture or easier said, break.  Unlike football and other so called “contact sports,” foot pounding on varied surfaces is the dangerous “contact” in running.   


There are many things that can lead to stress fractures including:

  • training error
  • incorrect shoes
  • genetic factors
  • poor nutrition


  • Severe pain that limits your ability to run
  • Rapid or gradual swelling in the foot 
  • Very specific location of pain
  • Bruising

Unfortunately, in my experience runners have stages of these fractures. An injury starts as a tweak that bothers you, but you run through it. Next this injury hurts while running but you can complete your run. Soon, even walking causes pain and you are unable to run. Unfortunately, most of my patients come into my office well after the final stage.


An x-ray can help to diagnose and rule out others foot problems like bone tumors and infections of the bones. Unfortunately, because a stress fracture can be a very small crack in the bone, it does not always show up on x-rays until it forms a bone callous (thickening). Bone scanning and MRIs can also help to diagnose, but it’s the pinpoint pain you feel that usually helps confirm the diagnosis.


How do we treat stress fractures? With the worst advice a runner wants to hear: stop.   A bone takes up to two months to resolve and this rest period is essential to heal the bone appropriately.  Since many runners find it difficult stop and rest, a major complication is the bone not healing properly.  What’s my advice: listen to your body, if you feel pain, address it. And rest it. You may have heard of RICE (REST, ICE, COMPRESSION, and ELEVATION).  And make sure you get seen by a podiatrist who runs…wink, wink.


  • Always wear shoes that are fitted by a specialist.  Go to a running boutique. Its runners who work in these stores and they are trained to properly fit different foot types and runners of all levels.  
  • Make sure you don’t run on old tattered shoes! You should replace your shoes approximately every 300-500 miles.
  • Make sure you follow an appropriate training plan. There are plenty of coaches or free online training programs!
  • Take your vitamins and eat right.

If you are having trouble getting motivated while training for Broad Street, think about how good you’ll feel to finish with all those people cheering you on, there’s no better feeling. It’s the best ten miler in the country!

 Always feel free to stop by the website at and leave me an email. I love hearing from my patients and