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Morton's foot type

Our clinic sees a lot of patients with pain in the balls of their feet. This type of pain can often be attributed to neuromas. Most people with neuromas will experience electrical type pain or burning pain. This type of pain usually occurs between the 3rd and 4th toes, but can also be seen between the 2nd and 3rd as well. Neuromas are more common in females than males and seen to usually occur between the 4th and 6th decade of life.

Some patients may experience more pain with shoes on than without shoes and hard surfaces such as wood floors or tiles can exacerbate symptoms. Currently there are many treatment options available for neuromas including steroid injections, shockwave, padding, and surgery and sclerosing therapy. Sclerosing therapy or alcohol injections are highly successful in the treatment of neuromas and have close to a 90% resolution of symptoms rate.

The process involves injecting dehydrated alcohol near the painful neuroma. The alcohol works to dehydrate the nerve and stopping the pain signal conduction. The typical neuroma takes approximately 4 to 6 injection spaced about 2 weeks apart each. We perform this treatment on patient that are contemplating surgery and see excellent results and often times do not need to progress with surgical removal of the neuroma. If you are thinking about having your neuroma removed or have daily pain from a neuroma a consultation could be extremely beneficial.

If you are experiencing any foot or ankle pain, do not hesitate to call us at 425-391-8666 or contact us online. 

Friday, 20 April 2018 05:51

Lumps and Bumps on the Top of the Foot

Spurs

 

The top of the midfoot is a common area to have foot problems. It's a very common area to have a bump on the top the midfoot.  These bumps can be due to underlying arthritis (like degenerative joint disease or osteoarthritis). The most common location of this would be the second metatarsal-cuneiform joint. This is where an arthritic spur or osteophyte tends to form. There is irritation of the joint both deep inside the joint and on top. The reactive bone builds up on the top forming a large lump that can be painful in shoes. The pain can be both from the pressure from the bump and also from the underlying arthritis. 

 

You can have a similar situation with the first metatarsal-cuneiform joint. This is a bit different because some people get a bump here without significant arthritis and this is often in a high arch foot type. This particular point in the arch can be the apex of the arch when one thinks about a triangle it's the top of the triangle in regard to the top of the arch also. Another common cause of bumps on the top of the foot is a ganglion cyst. He had a less common bump would be a gouty tophi or deposit of uric acid. The good news is these are simple things to evaluate and determine what is actually causing this whether it is because of bone spur or ganglion cyst or other soft tissue issue.

 

If you have concerns like this please feel free to contact myself–Dr. Timothy Young, or my partner Dr. Brandon Nelson

 

 

Thursday, 05 April 2018 05:41

The Avulsion Fractures

Avulsion fractures are very common foot injuries. There is quite a range of different potential injuries and scenarios. One example is a large avulsion fracture of the base of the fifth metatarsal. The peroneal brevis tendon attaches here, and the tendon is stronger than bone. Like with some ankle sprains and twisting of the ankle, the peroneal tendon is put under violent rapid strain including at its attachment site. And it pulls a large section of bone away from the rest of the larger bone–fifth metatarsal. 

On a smaller scale, other examples include where a ligament attaches to bone. For example the ligaments on the outside of your ankle. Or the ligaments that connect the larger heel bone (calcaneus) with the next bone (cuboid). The lateral ligaments over the calcaneal cuboid joint are also quite strong.  With some foot injuries these ligaments are strained under tension, and rather than the ligament rupturing they pull a section of bone where they are attached to the larger section of bone (and it looks like a chip fracture). 

These larger chip fractures often can be seen on x-ray. Sometimes they are small enough and difficult to isolate that they are best seen with ultrasound imaging and can easily be missed with an x-ray. Therefore, avulsion injuries can involve a small or larger section of bone that is pulled and fractured. Again these can be diagnosed with an x-ray, fluoroscopy, ultrasound imaging, MRI or CT scan. Once they are diagnosed, the treatment is often a cast or cast boot to protect and immobilize the area. These can be treated similar to a bad ankle sprain or in some cases they are treated like a regular fracture. Because the avulsion fragment can be large and attached to the tendon, it can be difficult for this to reattach to the bone from the constant pulling of the tendon. 

If you have any injury that needs treatment or evaluation, or second opinion please let us know. Dr. Brandon Nelson and myself, Dr. Timothy Young, see and treat many of these injuries and have on-site xray, fluoroscopy, and ultrasound imaging.

If you are experiencing any foot or ankle pain, do not hesitate to call us at 425-391-8666 or contact us online.

 

Thursday, 05 April 2018 05:35

Considering Bunion Surgery?

 

At Issaquah Foot & Ankle Specialists we do approximately 2-4 bunion surgeries every single Monday. It is important to seek out surgeons that are doing multiple procedures a week of the type of procedure you are having done. There are a plethora of bunion surgical procedures available and proper procedure selection is the most important part of this. Often times our clinic is sought out for a second opinion and it is important to recognize that not all procedures are the same .

I like to discuss the long-term benefits of a bunionectomy in the procedure and support the long-term functioning of the joint. One of the great things about our clinic is that we have an on-site surgical Center and this allows us to provide a huge cost savings to most patients. The typical bunion surgery can be anywhere from 1 out of 3 hours and can involve cutting and repositioning bones or fusing joints. All of our procedures allow patients to walk after surgery. This can be a big benefit especially for people that have a hard time using crutches. If you have a bunion and would like it evaluated for either conservative or surgical measures please make an appointment and we would be happy to help.

Friday, 23 March 2018 05:32

What is a Mucinous Cyst?

 

Very common but seldom talked about!

 

What is that thing on your foot? You recently developed a small blister like area just behind your toenail. It's not going away it's not inflamed and it doesn't look infected. To get the definitive diagnosis you will need to come into the clinic for evaluation both physical exam and if necessary diagnostic ultrasound imaging.

 

A mucinous cyst is a fluid-filled space occupying lesion that occurs on the toes usually at the joint near the tip of the toe–distal interphalangeal joint and just behind the toenail on the top of the toe. It can look like a translucent lesion or like a blister. These cysts actually communicate with the underlying joint and therefore have joint fluid in them. It's important not to treat these on your own.  If they become infected they can communicate directly with the joint and cause a septic or infected joint.

 

There are several treatment options. One is you can have it drained at our clinic. They often come back again because the joint fluid that is connected to them has a ready supply to fill them up again. Therefore sometimes we have to excise them. But it's not always that simple. They often come back after excision because remember they communicate with the joint just deep to the lesion itself. Therefore sometimes it is necessary to remove a small portion of the joint directly adjacent to the lesion. Some people choose just to leave them alone or have them drained if or when a flareup. Either way its nice to know for certain exactly what you have.  These are similar but different to a ganglion cyst. If you have questions about a similar problem or like a consultation please let us know.

 

Myself Dr. Timothy Young, or my partner Dr. Brandon Nelson would be happy to provide a consultation.

Friday, 23 March 2018 05:30

Get Another Opinion!

 

Get another opinion!

 

Your Achilles will never get better, just stop exercising!

 

I recently saw a nice young woman who had several months of Achilles tendinitis pain and problems. She had gone to a local university clinic and saw a specialist there. She was told that she shouldn't do intense exercise anymore and there really wasn't much that could be done for her condition. It turns out that with diagnostic ultrasound imaging she has a small osteophyte or bone spur with calcific changes at the insertion of the Achilles tendon on the right side. There are multiple treatment options for this. 

 

The first most important step is accurate diagnosis which we did and provided for her with our in clinic high resolution ultrasound imaging. Then we were able to inform her that although Achilles tendinitis can be quite stubborn, we have very effective treatment protocols. She was treated with prescription orthotics to help eliminate side to side mechanical shear on the Achilles tendon during mid-stance. She was given a posterior night splint. She was given a special brace designed for Achilles tendinitis. 

 

If all these problems help but not enough we still have the options of shockwave therapy and injections of non-cortisone-based treatment such as injectable Traumeel. She was very grateful to know that there are effective treatments available to get her back to normal activity again. She said this was treatment will be life-changing. It's nice to be able to offer these options for patients.  It is surprising to me how some patients are just told to live with something or that there really aren't many options. We are always here for consultation and we are almost always an additional treatment options. Please let us know if you have problems or are frustrated with your current treatment or evaluation.

 

Either myself Dr. Timothy Young, or my partner Dr. Brandon Nelson are available for these consultations.

 

If you are experiencing any foot or ankle pain, do not hesitate to call us at 425-391-8666 or contact us online.

Friday, 16 March 2018 05:28

Stem Cell Therapy for the Foot and Ankle

Before you consider foot or ankle surgery, a stem cell therapy consultation is warranted. Stem cell therapy is the most advanced treatment option that we have available for chronic conditions of the foot and ankle. Patients with arthritis, tendinitis, plantar fasciitis and other conditions have found stem cell therapy to be extremely beneficial. Stem cells are harvested from your own bodies tissues and have the ability to differentiate into different types of cells.

Stem cell therapy involves injecting stem cells at the site of damage, using one's own cells heal. Stem cell therapy is usually more beneficial for people with arthritis or more chronic conditions. The procedure itself is relatively painless and can be performed on the same day. If you suffer from chronic foot or ankle conditions and would like last resort for considering surgical intervention try stem cell therapy.

If you are experiencing any foot or ankle pain, do not hesitate to call us at 425-391-8666 or contact us online.

 

The posterior tibial tendon, due to its anatomical structures, is prone to tearing and degeneration, which can cause increased pain and swelling. It is especially common for people with flatfeet and a tight Achilles tendon.  The disease process of the tendon can be called tendinitis or tendinopathy and with continuation of the pathology people can develop flatfoot which can lead arthritis of the joints. The most common area for this process disease to occur is right below the ankle bone due to the vascular supply in this region being tenuous.  Quite a few people that present with posterior tibial tendinitis, especially athletic people. There are many conservative and surgical options available. 

 

One of the most recent and advanced medical technology this platelet rich plasma and stem cell therapy. This process releases growth factors and bioactive molecules when the platelets are activated. Platelets are part of the normal repair process and injecting platelet rich plasma can accelerate the healing process. This is typically harvested from patient’s own blood and injected into the site of pain. Over the last few years there has been extensive discussion about platelet rich plasma and the results continue to be promising. For athletic patients this can be quicker than typical surgical repair and patients have no surgical scar. Regenerative medicine has emerged as an alternative approach to typical surgical repair and we're excited to offer platelet rich plasma and stem cell therapy at our practice. This is not only successful for posterior tibial tendinitis can be also applied other tendinitis including Achilles tendinitis and plantar fasciitis.

 

If you are experiencing any foot or heel pain, do not hesitate to give us a call at 425-391-8666 or contact us online.

Friday, 12 January 2018 17:48

Thoughts on Postoperative Wound Healing

Thoughts on Postoperative Wound Healing

 

From a surgical standpoint we close soft tissue layer by layer to help facilitate wound healing. The deeper layers have absorbable suture. The skin can have a combination of absorbable and nonabsorbable suture, I usually remove sutures between 2 and 3 weeks after surgery. Wounds on the top of the foot heal much faster than on the bottom. The skin is thicker on the bottom and it's not uncommon for wounds to take 3 or 4 weeks to heal on the bottom of the foot. Larger incisions take longer to heal. Some anatomical areas of the foot and ankle have more skin tension and require more protection and more time before the wound is fully closed, and the sutures are ready to come out. 

 

Sometimes Steri-Strips are helpful to maintain wound strength is the final healing is occurring. If there is tension on the incision site, then postoperative cast boot immobilization or other protection can help avoid excessive stress on the wound, and incision. In general the foot has less blood flow than other parts the body and that is a factor in why the wounds take longer to heal.

 

If you are experiencing any foot or heel pain, do not hesitate call us at 425-391-8666 or contact us online.

 

Speeding up and optimizing wound healing after foot surgery has always been a priority at our clinic. There are several aspects of wound healing. One is the soft tissue and skin healing component, and another is bone healing which is not being dealt with in this discussion. Regarding soft tissue and skin healing, some people seem to heal much quicker than others. It's not always clear why. One other aspect is nutrition. Supplements that are known to help with wound healing include vitamin C, collagen and zinc. An additional supplement that has recently had more attention is beta glucan. 

There are studies that show the diabetics wounds heal faster with this supplementation. Beta glucan is taken one half hour before meals or 2 hours after meals for best absorption.  Zinc can compete with calcium and magnesium absorption so it is best taken without other supplements, a typical dosage would be between 25 and 50 mg of zinc per day. Vitamin C 500 mg twice daily is also recommended. Collagen is available from various sources, it is best to talk to your health care provider regarding recommendations for this. If you have upcoming foot or ankle surgery you should discuss how to optimize her wound healing with your surgeon. Let us know if he would like to make an appointment at our clinic to speak to either myself or Dr. Timothy Young, or my partner Dr. Brandon Nelson to discuss these topics.

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