How long will it take for my heel pain to go away?  This is a great question.  Plantar fasciitis is one of the most common problems that we see at our clinic.  Some people come in fairly quickly after the problem starts.  These people can have fairly fast improvement and/or full recovery.  Other people tough it out and wait to come in until several months or sometimes even longer than a year.  The longer that you wait before treating this problem, the longer it will take for the problem to resolve in general.  Also sometimes there is much more inflammation associated with the plantar fasciitis.  

When a patient comes in to our clinic with plantar fasciitis or heel pain, we like to do ultrasound diagnostic imaging and evaluate the status of the plantar fascia.  Most commonly, the inflammation is at the attachment site at the calcaneus or heel bone.  The normal thickness of the plantar fascia in this location is 3–4 millimeters.  If the plantar fasciitis is 6 mm or greater typically it is going to take some time for this to get better.  In more severe cases the plantar fasciitis may be 8–10 millimeters thick and this will take much more work to resolve.  The more severe cases can take several months before there is 90% improvement or better.  In these cases there may even be a partial tear of the fascia.  Usually if it is this severe, patients are put in a cast boot and we do a cortisone injection.  But this is just part of the solution.  The nice thing about a cortisone injection is that it offers immediate and fairly dramatic improvement.  But if this was the only treatment that we provided, the problem very likely would recur.  

We have to combine this with other treatments to make certain that the problem continues to improve and resolve.  This includes mechanical support such as prescription orthotics good shoes and good house shoes (no barefoot!).  For severe cases we also often utilize extracorporal shockwave therapy.  This is a great treatment alternative to a cortisone injection.  I actually recommend a cortisone injection or the shockwave therapy, but we don't combine these two treatments.  These two treatments do not complement each other.  Remember that the recovery time for plantar fasciitis is quite variable as we discussed above.  And again, the more severe cases can "turn the corner" quite a bit quicker if a more aggressive treatment such as a cortisone injection or shockwave therapy is done.

Please contact us if you have any questions, concerns, or if you would like to make an appointment at (425) 391-8666.

There are a lot of treatments available for fungal toenails. Being that there are a lot of treatments available, this tells us that fungal toenail treatment can be challenging. The most affective techniques we have found is a combination of therapeutic approaches. We have an FDA approved laser that we combine with some topicals and an oral vitamin that has given us a very high success rate. Often times we are able to avoid oral medications that require liver function testing. Our protocol is the most successful protocol we have seen and it has taken us years to develop. Patients have seen dramatic improvement in their nails.

1) Young children usually have flat feet, because their feet haven't formed arches yet. However, this may be a problem if the arches don't form!

2) Over 2 Million people in the United States seek treatment for plantar fasciitis. 

3) Did you know that toenails grow slower than fingernails do?

4) Walking is the best exercise for you, and it helps blood circulation!

5) The skin at the bottom of your feet is the thickest skin on your entire body.

Did you know that the average person will walk approximately 115,000 miles in their life time? That's more than four times the circumference of the earth. No wonder many people experience heel pain. In fact, plantar fasciitis is the most common cause of heel pain. Plantar fasciitis is when there's pain and inflammation of the plantar fascia. Usually this pain occurs in the morning time, when you take your first step out of bed. If you experience a stabbing pain at the bottom of your foot, near your heel, then it's likely that you might have plantar fasciitis. There are many surgical and non-surgical ways to treat plantar fasciitis, however. Our clinic provides many options for patients such as anti-inflammatory medications, corticosteroids, custom orthotics, surgery and shockwave therapy. Contact us today for an appointment and we'll help you get back on your feet!

With summertime just around the corner, we are starting to see a lot more Achilles problems, injuries and overuse injuries. We see a number of Achilles tendon ruptures, and fortunately this is not that common. The most common condition we see is calcific changes of the Achilles tendon. There can be problems for within the tendon itself in the middle of the tendon up above the heel bone (watershed region) but very often it occurs at the insertion of the Achilles tendon, at the posterior aspect of the calcaneus. When there is inflammation at the insertion of the Achilles tendon over time this inflammation can lead to degenerative changes and calcific changes within the tendon itself (Calcific Achilles tendinosis, sometimes referred to as Achilles tendinitis). Over time this can progress to bone formation and when you look on x-ray see a large spur. X-rays can be helpful if it's a fairly large spur or area of calcific changes. But my favorite diagnostic evaluation technique is ultrasound imaging. With ultrasound imaging even very small areas of calcific changes show very clearly at the insertion of the Achilles tendon. There are a number of treatment options for this if it's caught before the spurs too large.

• The #1 treatment for this is prescription orthotics to control the side to side motion of the foot that would otherwise cause mechanical shearing at the insertion of the Achilles tendon.
• A special brace for Achilles problems called an Achillotrain brace.
• Eccentric Achilles strengthening exercises are also very helpful.
• EPAT–extracorporal pulse activation technology also known as shockwave therapy. This is the newest treatment that we offer at our clinic. The shockwave therapy is typically done once a week for 3 treatments. For more severe cases it is 5 treatments over a 5 week course. The maximum improvement often occurs between 12 and 16 weeks post initiation of treatment. This is a great treatment because there is no down time and no injection required. If you would like to know more about shockwave treatment for Achilles tendinitis or have other questions regarding this type of heel pain or Achilles problems please let us know. Both Dr. Brandon Nelson and myself, Dr. Timothy Young treat a lot of these sports type Achilles problems.

Bunions are an inherited foot condition that can be accelerated by shoe gear and activities. Some patients will have bunions for years that cause no pain and discomfort and within weeks of shoe gear or activities become painful. Not everyone requires bunion surgery and it is important to be evaluated by a professional who treats a large number of bunions. There are many techniques to slow the progression of bunions nonsurgically. In addition for surgical repair of bunions there are many procedures can be chosen from. The most important thing is to have the bunion evaluated by bunion professional. Whether you are interested in having bunion surgery or needing help to slow down the progression of your bunion we will be happy to help.

Hammertoes can cause a lot of pain and discomfort. Often times we see hammertoes associated with bunions and it is important to treat both conditions. These can be challenging conditions for patients, and it is important to find proper fitting shoes and comfortable shoe gear. There are quite a few options to help alleviate hammertoe pain and discomfort and slow down the progression of the deformity. Patients that are interested in hammertoe surgery will require an x-ray to evaluate the deformity and determine the appropriate procedure selection. In addition we always recommend general overall foot evaluation to make sure additional deformities are not associated with the hammertoes. The majority of hammertoe procedures can be performed at our on-site surgery center, which saves patients both time and money.

Heel spurs can cause pain in the bottom of one’s foot and can be quite debilitating. This is a very common condition that we treat at Issaquah Foot and Ankle Specialists. We use the most advanced techniques to get patients painfree as soon as possible. We have been treating heel spurs for years and have seen thousand of patients for this condition. One of the best things that you can do to help the heel spurs is to not go barefoot around the house and stretch your calf often. The majority of our patients with heel spurs we can make 100% pain-free without surgery. Don’t let morning pain in your feet ruin your day come see the #1 heel pain experts.

Procedure: Cheilectomy

Location: First metatarsal phalangeal joint (base of the great toe)

Goals of procedure: To remove arthritic spurs, to improve the range of motion and reduce pain.

Why do patients request this surgery?  They request this surgery because the great toe joint becomes stiff and painful.  It often becomes enlarged.  This may start off after an injury from several years prior.  Sometimes it is a genetic problem.  Either way, over time mild arthritis becomes progressively more pronounced.  One of the hallmarks is very large arthritic spurs (osteophytes) on the top of the great toe joint and sometimes the base of the great toe itself.  There are often defects in the cartilage and cartilage thinning also.  This may also present in combination with a more typical bunion.

How can I avoid this surgery?  Wearing stiff shoes and orthotics can help.  Some of our patients are also treated with synthetic joint lubricant (Supartz injections ).  This is often a progressive problem over time.

Overview of surgical technique: The joint is opened up surgically and arthritic spurs are removed, a large portion of the top of the first metatarsal was also removed to improve range of motion, and defects in the joint are cleaned up the joint was flushed and repaired and sutured.

Details of surgical technique: There is a surgical incision on the top of the foot at the great toe joint (first metatarsal phalangeal joint/1rst MTP joint).  The incision is deepened and capsule is identified and an incision was made within the capsule to access the joint itself.  Capsule was freed from the joint to allow further exposure of the joint and full exposure of the spurs on the top of the joint.  Loose fragments of bone and cartilage are removed.  The large bone spurs or osteophytes on the top of the joint are removed and a portion of the top of the joint is removed also this is done with a saw and a burr.  Sometimes an osteotome is utilized for this purpose.  Once the bone is been resected and smoothed down it is again flushed out.  Capsule is sutured to repair this.  Skin and subcutaneous tissue are sutured and repaired and a dressing is placed on the wound.  The patient was then placed in a cast boot. 

Postop expectations: Dressing changes are done weekly and the patient is in a cast boot for the first typically 3–4 weeks postop.  Patient will have postoperative pain medication initially but some of our patients have very little pain.  The patient is able to put full weight on the heel and partial weight on the forefoot during the postoperative course while they are in the cast boot.  The first 3-4 days after any foot surgery we recommend that the foot is elevated as possible to decrease swelling and potential discomfort.  After this it is fine to be much more active with the use of the cast boot.  Sutures are typically removed approximately 2–3 weeks postop or if absorbable sutures are utilized, then no suture removal is done.

Potential problems: The foot must stay clean and dry to minimize the risk of infection.  It is possible to have some nerve damage although it's not common.  Most "numbness" is temporary and produces or completely resolves over time.  The big challenges the fact that the joint was stiff before surgery and still full often have some residual stiffness after surgery.  The adaptive changes that happened to the joint over time are not completely resolved by simply removing the spurs.  Over time the arthritis can continue to progress in some patients eventually need fusion of the joint.

Frequently ask questions:

-Is there bone he involved with this surgery?  No, no screws or plates are utilized because the cheilectomy involves removal of spurs and a "joint clean up".  The bone is not reset and there is no osteotomy or fusion involved with this procedure therefore there are no screws or implants.

-Does this surgery guarantee that I would never have other surgery or problems?  The answer to this is that many patients do very well with this procedure and they're managed with orthotics and possibly the synthetic joint lubricant injections afterwards to help offer additional improvement.  Some patients do have progression and require eventual fusion.

-Can I still do sports after this surgery?  The answer is that your foot will be improved after the surgery for most patients.  And you will have improved function of the joint.   If you were able to do sports before the surgery than most patients have improvement in their activity level after surgery.

Ankle arthritis is a common condition we treat that is usually caused from a previous ankle fracture. When ankle arthritis becomes severe enough or painful enough, often times an ankle fusion or ankle arthroplasty is performed. The determination as to which procedure is selected ultimately comes down to the condition of the ankle joint, any pre-existing deformities and patient demand and stature. One of the the first things that I offer to my patients who are contemplating an ankle fusion or an ankle arthroplasty is artificial joint fluid injection therapy. This procedure is different from corticosteroid injection in that it’s a synthetic joint fluid that helps lubricating the joint and decrease inflammation in the joint. This procedure can be done multiple times to help with pain and has a great success rate even for people that have a significant amount of ankle arthritis. This therapy is a great alternative for people that are contemplating fusion or arthroplasty and we have had good success rates utilizing this procedure. I often recommended patients to try the artificial joint fluid before proceeding with a fusion or arthroplasty. At Issaquah Foot & Ankle Specialists we are the only people Washington State that offer this alternative therapy and are happy to discuss it further with you.