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Friday, 21 September 2018 11:03

Treatment Options for Bunions


Bunions are a challenging foot condition for any patient. They can be extremely uncomfortable with certain activities as well as certain shoe gear. The majority of patients experience pain around the big toe joint or the bottom of the second toe. The bunion is really just a sign of mechanical instability of the inside of the foot complicated by genetic foot structure. We see quite a few patients that are curious about conservative measures and how they can fix the bunion deformity. It is a very important topic to touch on, as conservative measures will never reduce the bunion deformity.

The bunion deformity itself is related to the alignment of the bones of the feet and no amount of taping stretching or splinting will ever change it. With that being said there are some conservative measures that can be employed that will slow down the progression of a bunion. But, the only way to fix a bunion is through surgical intervention. With proper procedure selection, the recurrence rates are rare. The majority of bunion procedures take less than 2 hours to fix and patients can walk on the bunion procedure after correction.

Our clinic performs bunion surgery every Monday. We have an on-site surgery center which is a huge cost savings and time savings. We can often provide same-day bunion consultations and are happy to describe all conservative measures and surgical approaches to helping resolve your bunion pain.

If you are experiencing bunion pain, give us a call today at 425-391-8666 or contact us online for an appointment.

Friday, 14 September 2018 10:59

Prescription Orthotics vs Custom Inserts

I get a lot of questions about prescription orthotics vs a custom insert or an over the counter foot bed. The difference is apples and oranges; one is made by a doctor, the other is sold by a shoe store. A prescription orthotic can only be prescribed and fit by a foot and ankle physician. The average foot and ankle physician or podiatrist will have completed 4 years of podiatric medical school and another 3 years of residency. A podiatric physician is the foremost expert on foot and ankle biomechanics and provides the highest quality foot and ankle care.

Typically for a prescription orthotic, a complete medical history is performed, x-rays, a biomechanical evaluation a gait analysis and a 3-D image of both feet is taken. The podiatric physician then combines their years of knowledge and your pathology to make a device that can helps control your foot and ankle pathology. An over the counter inserts or custom insert has no scientific research to support it and is a piece of plastic sold to try and fool the general public. Additionally the average insert ranges from 60-1000 dollars and the prescription orthotic usually has insurance coverage as it is made by a physician. Do not be fooled by a shoe store or advertisement that takes advantage of the general public if you have foot or ankle issues have it evaluated by a podiatric physician .

Give us a call at 425-391-8666 or contact us online for an appointment today. Both myself, Dr. Brandon Nelson, and my partner, Dr. Timothy Young, will be happy to assist you.

Friday, 14 September 2018 10:56

Resistant Plantar Warts

Over the years we have developed protocols for treating resistant plantar verruca or plantar warts. We have become a resource for the local medical community. For example a family doctor was not able to successfully treat warts with liquid nitrogen will send their patient to our clinic. We have found that warts do not always respond to traditional treatments such as liquid nitrogen freezing, canthrone (or beetle juice), topical salicylic acid and other local treatments. With these patients we may have to do additional treatment measures. One example of an aggressive treatment is bleomycin. Bleomycin is a chemotherapy medication to target the blood supply for the verruca. Plantar warts or verruca are like a parasite. They want their own blood supply.  


This phenomenon is called angioneogenesis.  The bleomycin is highly effective. We save it in reserve for plantar verruca that do not respond to traditional measures. Another option is injections of Candida albicans antigen. We inject 0.3 cc of the Candida antigen directly adjacent to the verruca. This can be done sequentially over the period of several weeks and also can be combined with other treatments. Surgical excision is yet another option.  


If you or a family member has plantar warts that have been resistant to treatment please let us know. Either myself, Dr. Timothy Young, or my partner Dr. Brandon Nelson would be happy to see you.  We have developed these highly effective treatment protocols.


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

Bunions can prove painful, get bunion treatments from the Washington Bunion Center

The great toe with the bunion often goes underneath the second toe. As part of this the second toe further deviates out of alignment toward and sometimes over the second toe in combination. The second toe can gets so bad that we call it a crossover toe. When this happens, it's difficult to treat this without surgical repair. The surgical repair again involves repairing the bunion and the alignment of the great toe itself. As far as repairing the second toe. This often involves shortening the metatarsal and shifting it to help get the second toe back in alignment.

This is called a Weil osteotomy. The second metatarsal head is shifted in the same direction that the toe is deviated. This tends to get that joint–the second MTP joint back into alignment and straighten the crossover toe. This is always a challenging condition and it's not uncommon to have to pin the joint after the correction is done. We often have to do capsule work in the second MTP joint also to help release the tight contractures here and scar tissue. If you have concerns regarding bunions or second toe problems or even capsulitis specifically, we would be happy to see you in consultation either myself, or my partner Dr. Nelson.

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

Friday, 31 August 2018 10:43

Bunions And Second Toe Capsulitis Part 2

We have previously discussed the relationship of the first metatarsal and bunions to problems with the second toe and the second metatarsal. This includes dislocation of the second metatarsal phalangeal joint (MTP joint) the same basic premise applies. We have to address both the dislocation of the second MTP joint directly and we also have to realign and repair the entire first metatarsal and the bunion. This may involve stabilizing the first metatarsal cuneiform joint with a fusion as part of the bunion repair.


Regarding the second MTP joint, we often would have to consider a plantar plate repair (capsule repair) or direct repair of the capsule and possible transfer of the flexor tendon that goes to the tip of the second toe and on the bottom of the joint. We utilized this tendon to help keep the toe from dislocating upward out of position.

If you have concerns regarding bunions or second toe problems or even capsulitis specifically, we would be happy to see you in consultation either myself, or my partner Dr. Nelson.

Friday, 24 August 2018 10:41

Bunions and Second Toe Capsulitis Part 1

A bunion is due to a number of different conditions but one of them is the entire first metatarsal being out of alignment. The metatarsal becomes out of alignment including the entire metatarsal becoming elevated. When this happens the next weightbearing bone over which is the second metatarsal gets disproportionate pressure. The second metatarsal and the second MTP joint or second metatarsophalangeal joint is not designed for that increase weightbearing pressure and stress.


When this happens usually either the individual gets capsulitis or even a dislocated second MTP joint, a stress fracture of the second metatarsal, or arthritis of the midfoot where the second  metatarsal meets the rest of the foot. Therefore as part of the treatment for severe cases we usually have to correct the bunion and get the first metatarsal back into alignment to shift pressure off the next in line second metatarsal.  


If you have concerns regarding bunions or second toe problems or even capsulitis specifically, we would be happy to see you in consultation either myself, or my partner Dr. Nelson.


Give us a call at 425-391-8666 or contact us online for an appointment today.

Friday, 17 August 2018 10:40

Cartiva Implants

This is the first and only FDA approved synthetic cartilage for the treatment of Hallux Rigidus. This implant has been proven now with clinical data out almost 7 years. It is a great alternative to fusion that helps to maintain motion of the joint. It is a quick procedure that is easy to recover from and provides lasting results. Patients often experience very little pain and can walk immediately after surgery. The unique biomechanical polymer mimics natural cartilage and helps the joint glide smoothly.

The data supports a 97% reduction in pain, 176% improvement in function and a 93% patient satisfaction. We have had quite a few patients that have undergone this procedure and could not be happier. They have benefited from our onsite surgery center which saves time and money. This procedure is great for active patients that want to maintain joint function and avoid a fusion. We can even help you get insurance approval. If you have Hallux Rigidus or Limitus and are thinking about surgery schedule a consolation today to see if you are a candidate for Cartiva.

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

Friday, 20 July 2018 06:22

How to Treat Ankle Sprains

Ankle sprains are a common injury we see during the summer, especially as people begin to get outside and enjoy the Pacific Northwest summer. I like to encourage my patients to wear high top hiking boots and make sure to ramp up to get in shape for hiking. Wearing a pack when going for a walk or a jog around the neighborhood is a great idea. The most common type of ankle sprain encountered is an inversion type. An inversion ankle sprain involves your foot rolling inward and accounts for 80% of all sprains. Most people tend to treat ankle sprains with the “RICE” protocol. “RICE” stands for rest, ice, compression and elevation.

With very mild ankle sprains this is appropriate, however if your sprain involves a tear of a ligament you should see your foot and ankle specialists. Ligament tears occur frequently and if misdiagnosed can lead to long term complications such as ankle instability and ankle arthritis. I personally see quite a few complications on a weekly basis from untreated or undertreated ankle sprains. The best piece of advice I can impart is to see your podiatrist to have your ankle sprain evaluated and prevent long term complications.

If you are experiencing any ankle pain, give us a call at 425-391-8666 or visit us online for an appointment.

Arthritis is an extremely common pathology encountered and as we mature becomes more frequent for us as individuals. Most people will experience what is called post-traumatic arthritis or arthritis that occurs years after an injury. An example of this is, if you had fractured or broken your ankle you may develop arthritis in that ankle in years to come. Arthritis usually starts with pain and swelling of a joint that progressively becomes more uncomfortable, especially with activities. Another example we see a lot of is, arthritis of the big toe or 1st metatarsal phalangeal joint. Patients often relate a history of stubbing the big toe or having a turf toe type injury. Another less common form of arthritis is Rheumatoid arthritis. Rheumatoid arthritis is where your body’s own immune cells attack your cartilage and destroy these cells causing arthritis.

Arthritis in general is the loss of cartilage within a joint. Cartilage is on the ends of bones and where two bones meet and define a joint, each bone will have cartilage on opposing surfaces to allow joints to move smoothly. When that cartilage begins to wear away that is when pain and swelling take place. Some over the counter options that seem to help are fish oil and glucosamine. Others swear by turmeric or tart cherry juice. It is best to have your arthritis evaluated and make sure that is truly the cause of pain. An x-ray is usually sufficient to determine if arthritis is the cause and to discuss the best treatment options. Some of the best treatment options I have seen to help provide relief and spare long term joint destruction are Supartz and Platelet Rich Plasma or Stem Cell Therapy. Supartz is an artificial joint fluid that helps lubricate the joints and has had some great research to support the use. Platlet Rich Plasma or Stem Cell Therapy has come to light recently but seems to be promising. We have been using these therapies for years and have used themon thousands of patients. If you suffer from arthritis in the foot or ankle and would like to be evaluated for these options come see us at Issaquah Foot & Ankle Specialists. 

Call us at 425-391-8666 or visit us online to make an appointment today.

Ingrown toenails are basically a bacterial infection in your nail border. Most people experience pain and swelling with some drainage from the site. It seems to be more common with children than adults, and and more so in boys than girls. There also appears to be a genetic predisposition, where usually somebody else has suffered from them in the past, like their dad. People try all types of home remedies to speak of. Kids learn all sorts of ideas like cutting a notch in the toenail, placing cotton under the corners of the nails, and more extreme ideas like performing your own removal of the nail. I can tell you none of these work.

The best option is to soak the nail. I recommend soaking the nail twice daily in 2 tbsp. of Epsom salts and warm water for 10 minutes. Then cover the nail with antibiotic ointment and a bandage. If the offending nail does not resolve in a couple days it is recommended to see your local podiatrist. Usually oral antibiotics only prolong the inevitable. I see quite a few people that try multiple rounds of oral antibiotics, all to no avail. It is much easier to come in and have the nail fixed. The procedure itself is simple and quite quick to perform. Patients always wonder why they didn’t come in sooner. If you are suffering from an ingrown we will happily help you resolve that painful nail so you can enjoy the rest of your summer. 

Call us today at 425-391-8666 or make an appointment online.

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