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Friday, 14 December 2018 11:25

Foot Drop

By Pagemaker787, CC BY-SA 4.0,

Foot drop can occur for many reasons. These include injury to the nerve following knee surgery or paralysis from polio or other neurological disorders. There are many common procedures that we perform for foot drop. One of the most common is an isolated posterior tibial tendon transfer. This procedure is used to help what is called a slapping gait or foot drop. Another common procedure performed for this as well is the bridle procedure, which is very similar to the posterior tibial tendon transfer. However it incorporates other tendons as well to provide increased stabilization.

Often times these tendon transfer procedures can allow patients to get out of a brace and provide brace-free ambulation. It is important before performing a tendon transfer procedure that patients obtain a neurological workup including nerve conduction studies. We also find it necessary to address a tight calf muscle and review with the patient their expectations. The surgery can be performed in an outpatient setting and the outcomes for this procedure are highly successful. With the procedure most people spend about 6-8 weeks non-weightbearing at which time they can begin to walk in a boot and return to ambulation. This includes physical therapy and can be up to 3 months.

If you experience foot drop and would like to no longer use a brace and be evaluated to see if you’re candidate for one of these procedures please contact our office at 425–391–8666. Myself, Dr. Brandon Nelson, or my partner Dr. Timothy Young would be happy to see you.

Thursday, 06 December 2018 11:21

Plantar Fibroma Treatment Options

A Plantar fibroma can be difficult to treat. At our clinic, we have come up with a very effective treatment protocol. A plantar fibroma is a combination of scar tissue, inflammation and swelling/edema involving the plantar fascia in the mid arch. It is often noticeable as a nodule or marble-like bump in the mid arch on the bottom of the foot. It is important to address the biomechanics involved, so a prescription custom orthotic with a specific accommodation for the fibroma is essential. In addition, injections of cortisone combined with dry needling are extremely effective. 

This is usually done under ultrasound guidance. Topical verapamil is an excellent adjunctive treatment. Because this is so effective the majority of our patients do not require surgery. Surgical excision of a plantar fibroma can have a high recurrence rate so its nice to have other options for our patients.

If you have these type of symptoms or problems, both myself Dr. Timothy Young, and my partner Dr. Brandon Nelson have had excellent experience and results in this regard.

Thursday, 06 December 2018 11:20

Big Toe Joint Pain

Osteoarthritis of the big toe manifests as swelling and pain around the inside of your foot near the base of your big toe. Patients often experience increased pain with activities and walking that is elevated by rest. Trauma can be the primary cause of osteoarthritis but position of bones can have a large influence as well.

We have many great treatment options for arthritis of the big toe included both surgical and non-surgical options. The best indicator of which category of treatments is appropriate is based of radiological examination, an x-ray. If you suffer from big toe pain, make a appointment so we can evaluate your joint and get you pain free. Myself, Dr. Brandon Nelson, or my partner Dr. Timothy Young would be happy to see you. 

Friday, 30 November 2018 11:18

Is That a Wart?

Plantar Wart - Wikipedia

We often have patients come to our clinic and they will call the front office staff, requesting an appointment to have a plantar wart treated. When we do see them back in the exam room, we find that is not a plantar wart at all. Even their family doctor will have frozen this painful area on the bottom the foot several times but it just keeps coming back. 

It turns out that this is actually either callus with a deep core or what we call a porokeratosis. There are significant differences. Plantar warts are very vascular. The plantar verruca is a viral infection that is like a parasite. And the plantar wart "wants" its own blood supply. The wart recruits our own body to produce more local blood vessels in a process called angioneogenesis. This is very similar to the same phenomenon that some tumors demand their own blood supply through the same process (angioneogenesis). So at our clinic, when we evaluate these and remove the outer callus layer, the deep layer will either have pinpoint clotted capillaries or active pinpoint bleeding. This is seen in the vast majority of true plantar verruca. We specialize in diagnosis and treatment of plantar verruca.

If you are experiencing foot or ankle pain, please give us a call at 425-391-8666 or make an appointment online today.

Friday, 26 October 2018 11:15

Alternatives to Cortisone Injections

Many of the problems that we see at our clinic involve musculoskeletal issues that can be treated in some situations with cortisone injections. Examples include plantar fasciitis and other inflammatory conditions. Some of our patients have other musculoskeletal problems and one of our patients recently told me that he wanted a cortisone injection but was concerned because he can only have a limited number of cortisone injections per unit of time.


In general we recommend no more than 3 cortisone injections at any one anatomical location over the course of approximately 12 months. However this same patient may also have to have a cortisone injection in their back, or in their elbow or shoulder. Then there becomes the concern of having too much extra cortisone any given time frame. There are alternatives to cortisone. We can do injections of sterile injectable Traumeel which is a non-cortisone-based anti-inflammatory. We generally do up to 3 of these injections approximately every 1–2 weeks. It's not quite as strong as cortisone but there is not the risk of potential tendon damage or cortisone overuse. 


Another alternative is PRP, platelet rich plasma injections.  We also do injections of Supartz, this is a synthetic joint lubricant. Supartz is not an anti-inflammatory but it hasn't excellent joint protection of fact and is very effective at treating intra-articular damage and arthritis.  It has a protective effect on the existing cartilage.


If you have a condition and are worried about having too many cortisone injections and would like to consider alternatives please let us know. Either myself, Dr. Timothy Young or my partner, Dr. Brandon Nelson would be happy to review treatment options. Give us a call at 425-391-8666 or make an appointment online today.

Friday, 19 October 2018 11:14

Prevent Foot and Ankle Running Injuries

Saturday, 06 October 2018 11:12

Bunion Surgery Considerations

Bunion xray

One of the most common questions I hear from patients is “do I need bunion surgery?”. The question I ask back is, “do you have pain on a daily basis, does the bunion limit your activities and are you having a hard time fitting in shoe gear?” Bunions are a progressive deformity that increase in size and can begin to affect the other toes. Bunions cannot be reversed with any amount of stretching or splinting and can only be fixed surgically.

The surgical procedures depends on multiple factors including; the size of the bunion, activity levels, bone quality and overall foot structure. With proper procedure selection bunion surgery is highly successful and patients are extremely satisfied. The average procedure can take between 45 minutes to about 2 hours, sometimes a little longer if other toes are involved or other soft tissue structures need work.

One of the best parts of our practice is we typically perform 2-3 bunions every Monday and have an onsite surgery center. We have intravenous sedation that we provide to make the overall experience comfortable and stress free. Our protocols for recovery decrease down time and speed recovery.

Give us a call at 425-391-8666 or make an appointment online for a consultation.

Saturday, 06 October 2018 11:09

Platelet Rich Plasma and Stem Cell Therapy

Platelet Rich Plasma

Platelet Rich Plasma and Stem Cell Therapies continue to provide significant improvements in medical conditions, specifically tendinopathies and arthropathies. Tendonitis and arthritis can both be extremely challenging and painful conditions. Quite a few patients require surgical intervention for both and that is why we are excited by these new medical procedures that show great promise. Example, I recently saw a patient that had osteoarthritis of the ankle. She had seen numerous other providers and her options presented were fusion of the ankle or joint replacement, both of which are painful and have a long period of recovery. I recommend stem cell therapy and she is currently more than 1 year post procedure and pain free.

Both Dr. Young and I (Dr. Brandon Nelson) are excited to be able to offer this procedure for patients with arthritis and have seen promising results. We also see our cost is significantly lower as compared to hospital based physicians or medical groups that advertise or promote these procedures. PRP and stem cell can be a great alternative to surgery and can work for common foot and ankle conditions.

If you have any questions or concerns, do not hesitate to give us a call at 425-391-8666 or make an appointment online.

Friday, 28 September 2018 01:07

Midfoot Arthritis and PRP — A New Approach


Midfoot arthritis is one of the more challenging problems that we treat at our clinic. It often affects the second or possibly third metatarsal-cuneiform joint. There is localized swelling and pain in the midfoot. Especially with activities like walking or running, and as soon as the heel comes up off the ground there is a compression load to the top of the midfoot. Ultrasound imaging usually shows extensive bone spurs in this area and inflammation. X-rays can also show the bone spurs but often this is more difficult to visualize with an x-ray.

Treatment in the past has included a midfoot fusion and sometimes a simple bone spur cleanup procedure and release of the tight calf muscle as another alternative. We often treat this with injections of Supartz which is a very effective synthetic joint lubricant. This is helpful as an initial treatment. A new treatment that we are now offering is a series of 2-3 PRP injections (platelet rich plasma) approximately 3–4 weeks apart. This is followed by shockwave therapy or EPAT. PRP injections into an arthritic joint have been helpful at improving the underlying arthritic condition.  They can help with regeneration of some of the cartilage elements. Although the joint is never perfect, the improvement can be quite significant. We use ultrasound guidance when we do these platelet rich plasma injections. The procedure itself actually has very normal pain because of our local anesthetic technique.

If you are experiencing midfoot arthritis or any foot/ankle pain, give us a call at 425-391-8666 or make an appointment online. Myself, Dr. Timothy Young or my partner Dr. Brandon Nelson would be happy to see you.

Friday, 21 September 2018 11:05

Resistant Plantar Warts With Children

We have found over the years that kids do not like freezing, especially freezing plantar warts. Children remember how uncomfortable or painful freezing can be. Therefore whenever possible we use cantharone plus instead of freezing. This Cantharone treatment also has the nick name of  "Beetle Juice". The cantharone comes from Blister Beetles. It is a great treatment because it is very similar clinically to freezing, but does not hurt. And we can titrate this cantharone treatment. For example if we have our patients leave the cantharone on for 1.5 hours that may be all somebody needs and also they should cause minimal discomfort in the days following treatment.


However some of our patients want the most aggressive possible treatment. Therefore may have them leave it on for 5 or 6 hours and this can cause more discomfort for several days afterwards as it can cause a very deep blood blister. This is similar to what would happen with freezing but again there is no pain with the initial treatment with the cantharone and the freezing is very uncomfortable.  

If one of your children has plantar verruca that are difficult to treat we would be happy to see them. Either myself Dr. Timothy Young or my partner Dr. Brandon Nelson would be happy to see them. Give us a call at 425-391-8666 or make an appointment online today.

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