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Rolling your ankle and ankle sprains are common occurrences, especially for athletes. It is important to get an ankle sprain evaluated quickly as it can lead to long-term problems. These long-term problems include chronic rolling of the ankle or what we call chronic ankle instability as well as arthritis of the ankle joint. 

Oftentimes people will perform ice therapy which is rest, ice, compression and elevation. However this does not adequately address factors and ankle sprain. Rolling of the ankle can seem like a benign injury, but I will talk from experience: there are many long-term complications that result from the ankle sprain. It is important to have the ligaments evaluated and have the ankle sprain treated properly to mitigate these long-term issues. Most patients make a full recovery with proper treatment and are not usually sidelined for long period of time for physical activities.

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

Friday, 15 September 2017 17:09

What is a Pinched Nerve in the Foot

What is a pinched nerve in the foot?
There are a number of potential locations in the foot and ankle where nerves can become entrapped or pinched. In some situations it's truly a pinched nerve and others, the nerve becomes irritated and can develop scar tissue around it. That is the case with a Morton's neuroma. Often times there is enough irritation to the nerve in this area that the nerve sheath becomes thicker and all the more prone to irritation and compression.  
A Morton's neuroma involves branches of the plantar nerves between the third and fourth metatarsals in the forefoot area. Tarsal tunnel syndrome is similar to carpal tunnel syndrome and involved the posterior tibial nerve where the ankle meets the foot. This is on the inside or medial aspect. This is also directly adjacent to the primary artery and veins to the bottom of the foot. It also is part of the compartment that has the long flexor tendons to the toes and inside of the midfoot. Tarsal tunnel syndrome can be aggravated by other problems such as physical space-occupying conditions like a ganglion cyst or other soft tissue enlargements or growths. The top of the midfoot near the base of the second and third metatarsal is a common area to have nerve compression and a pinched nerve.
People with a high arch foot are more prone to these problems especially if they get into a tight fitting shoe or ski boot or similar device that could put non-forgiving pressure on the top of the midfoot. In this particular location there is not much subcutaneous tissue or fat pad to help the nerves in this location have adequate room. Instead there is very little subcutaneous layer and the nerve can get pin down directly against the top of the foot and press against the second metatarsal or second cuneiform midfoot bones. So these would be the 3 most common pinched nerves in the foot and ankle. In each case there can be nervelike symptoms from compression on the nerve in this area. These may be alleviated by changing shoes. But in some cases as time goes on they become hypersensitive and damaged with potential for permanent nerve damage and chronic pain. Each of these conditions involves specific examination and testing to help confirm diagnosis. They also had their own unique treatments. If you have any of these symptoms and are concerned and would like to come in to see either Dr. Nelson or myself. Please let us know.
Friday, 15 September 2017 17:06

Fall is Coming, Watch Out For Foot Problems!

Regarding your feet, there are many advantages of summertime.  People often wear good running shoes.  And even though sandals aren't always the best support fot your feet, they allow a lot of room. So when the fall comes people are going out of roomy comfortable sandals into snug fitting shoes. Sometimes even a slight change can cause a problem.
For example, ingrown toenails are often much more noticeable when you wear closed shoes and your toes are tight together and overlapping each other.  The second toe can then abut the adjacent great toe all along the side of the toenail causing pressure here not just at the tip of the nail.  Other problems related to shoe fit will start becoming a problem also such as bunions and hammertoes and calluses, when the shoe pressure and fit cause problems.
So what can you do?  Wearing shoes that are much wider in the toebox will solve a lot of these problems.  Some patients really go all the way with shoes like Birkenstock or Keene Shoes that have a nice squared off toebox.  Other options include shoes they come in a wider width such as New Balance.  You can get gel or foam spacers to go between your toes.  Sometimes no matter what you do with the roomier shoes, there are still problems.  If you have any of these symptoms and are concerned and would like to come in to see either Dr. Nelson or myself, please let us know.
The Journal of Foot and Ankle Surgery recently published a great article on radiofrequency micro-debridement. This article discussed the use of a Topaz micro-debrider as opposed to open surgical repair of the Achilles tendon. The micro-debrider allows for a tiny incision that can be considered a minimally invasive type of surgery. The study shows micro-debridement technique is just as effective as the open repair of the Achilles tendon. The micro-debridmemt is a quicker recovery and has less pain and swelling then the traditional open repair. We have been using the micro-debridement technique at Issaquah foot and ankle specialist for years and have been extremely happy with the results. Achilles tendinitis can be extremely challenging and frustrating for the patient. If you are experiencing foot and ankle pain in the Issaquah, Bellevue, Seattle, Redmond, Mercer Island, or any neighboring areas, do not hesitate to give us a call at 425-391-8666 or contact us online.
There is a great alternative to cortisone injections.  Traumeel is a non-cortisone treatment for inflammation and pain.  It is a sterile injectable solution that we utilize at our clinic under ultrasound guidance.  Traumeel can effectively reduce inflammation and pain after an injury. 
This is a great tool to have for problems such as Achilles tendinitis, peroneal tendinitis or posterior tibial tendinitis.  In these situations our first goal is to treat the mechanical component of the problem.
But there is also the inflammatory component of the problem that we need to address.  In that case we cannot use cortisone for example with Achilles tendon because it could make it more prone to rupture and further damage.  It also may delay healing long-term.  But Traumeel is a blend of mineral extracts and botanical's with the ability to reduce inflammation and pain.
Typically we would do a minimum of 2 or 3 injections spaced one or 2 weeks apart.  Often there is pain relief within 24 hours after the first injection.  It may be helpful to combine this with the use of a brace or cast boot if there is a lot of inflammation.  This can be discussed and determined at our clinic.  The injection  of the Traumeel itself should be painless.  Prior to the injection of the Traumeel we would use lidocaine or Marcaine which is a local anesthetic–and we have special techniques to help minimize any discomfort from local anesthetic injection.  Many of our patients are able to resume normal activities within 24 hours.
If you have questions about treatments with Traumeel please contact myself Dr. Timothy Young, or my partner Dr. Brandon Nelson at Issaquah Foot and Ankle Specialists –
Friday, 28 July 2017 16:59

Bunion Surgery With Faster Healing

Bunion Surgery With Faster Healing
There are different types of bunion surgeries.  The majority involves soft tissue and bone healing. In general the more corrective bunion surgeries would either involve repositioning of the bone at the head of the first metatarsal or the base of the first metatarsal in the midfoot.  Either way we want to maximize bone healing and soft tissue healing.
So here are some of our strategies and treatments.
Prior to surgery, blood is drawn for PRP or platelet rich plasma. During the surgery itself, before closing the incision the platelet rich plasma is irrigated throughout the entire wound to maximize healing of the soft tissue and bone.
During the surgery itself, if there is major bone healing or a fusion is required then autogenous (using yourself as the donor and not cadaver bone) bone graft Is harvested and implanted during the surgery itself at the fusion site.  
After the surgery patients take special nutrients to maximize healing.  This includes Ortho Pro Bono which is a bone healing super nutrient available at our clinic. After the surgery bone stimulation therapy can also be done.  This can be one of several different technologies that maximize bone healing and enhance bone healing.  These are not always covered by insurance.
Physical therapy including electrical stimulation also can enhance soft tissue healing and maximize postprocedure range of motion.A special cast can be made out of fiberglass and then split and a special walking heel applied to allow for those patients that have a midfoot fusion to put weight on the heel which helps reduce atrophy compared to non weight bearing status.
If you would like to find out more information about this advanced treatment approach.  Please contact our office, either myself Dr. Timothy Young, or my partner Dr. Brandon Nelson.

Recently I am seeing a lot of patients with big toe pain and swelling. I believe it is probably the nice weather and we are all getting outside and enjoying the Pacific Northwest. The summer is short-lived around here! The majority of these patients have arthritis of the big toe or great toe and are experiencing difficulty exercising. It is fairly easy to diagnosis this condition with testing the range of motion of the toe and x-ray.

Typically I am able to offer some great conservative measures that provide significant pain relief. However, a few people will be better candidates for surgical intervention. There are two types of surgical intervention what we call joint sparing and joint destructive procedures. When possible I prefer to preform joint sparing so patients retain motion of that toe. But, some patients possess pathology that is too far gone and require a fusion of that joint. I am excited to be able to offer an alternative to fusion.

This is a new implant that acts as a joint spacer that has great results and I am one of the only surgeons in the Pacific Northwest to offer this advanced technique. The implant is called Cartiva and acts as a joint spacer to provide pain relief and preserve motion of the arthritic joint. It is a great alternative to anybody contemplating fusion. If you live in Seattle, Bellevue, Redmond, Issaquah, Tacoma, Everett, Alaska, Oregon give us a call at 425-391-8666 or visit us online.

There is a lot of discussion lately about minimally invasive keyhole bunionectomies. These are great procedures that can have good functional outcomes. It is important to note that not every person is a candidate for keyhole style bunionectomy. The most important piece of advice I can give somebody is to be properly evaluated for the type of surgical procedure that provides the best long-term outcomes. The keyhole minimally invasive bunionectomy can have a quicker recovery because the incisions are smaller and there is not as much disruption of the soft tissues.

However, this should not be the determining factor in whether or not to have bunion surgery. The determining factor should be based on proper procedure selection which decreases complications and maximize long-term results. At Issaquah Foot and Ankle Specialist we have an on-site surgery center and typically perform bunionectomies every Monday. It is important to see a physician that performs a lot of bunions and an on-site surgery Center can save you thousand dollars. If you live in Issaquah, Seattle, Bellevue, Kirkland, Redmond, Maple Valley, Tacoma or the greater Puget Sound area, come visit us at our office or online.

We've had a request recently to discuss the advantages/disadvantages of having surgery on both feet at the same time (for bunions).

Bunion surgery often requires realigning the first metatarsal.  This means that there is bone healing.  This is very similar to fracture healing, and this involves the first metatarsal or possibly bone healing involving the base of the first metatarsal.  Whenever there is fracture healing or bone healing, there are several different considerations.  These are often time-dependent.  Typical bone healing takes 8–10 weeks. 
It can be shorter the younger you are (for example a teenager) and it can be longer the older you are (for example those patients who are over 50 or 60 years old).  Typically for fracture to heal we would recommend a cast boot or a regular fiberglass cast.  The good news is that there is often full weightbearing allowed with either the cast boot or the fiberglass cast.  The time spent in the cast allows for protection and bone healing with proper immobilization.  This means that it may be hard to drive with the right foot until there is at least some initial bone healing.  It also means that for longer distances it may be helpful to use either a scooter or crutches. 
When surgery is just done on 1 foot at a time, the opposite foot can compensate and help protect the surgical side.  This can make it easier to drive and get around.  It also means if there is any discomfort from the surgery it's just surgery from 1 foot instead of 2.  When you have physical therapy you can really concentrate and focus on regaining normal range of motion on 1 foot instead of doubling the time and effort spent on two feet.  It is nice to have 1 good foot and leg for best possible balance instability.  You don't want to have an injury or fall during her initial postoperative healing.
So to summarize: The advantage for 1 foot at a time:

-Allows for postoperative driving
-Allows for better balance
-Allows for 100% attention to postprocedure rehabilitation on 1 foot at a time
Considerations of having both feet at the same time:

-You're combining the postoperative timeframe.
-High risk of falling or compromising one or both surgical sites from injury
-Bone healing postoperative nutrition supplements are only taken one suspended twice.
-The need for outside help (family or close friend) is only needed one time instead of 2. 
Most patients who have 1 foot done like to wait approximately 6 months or even a year before the have the next foot done.
It is our general recommendation that only 1 foot be done at a time.  There have been a few exceptions over the years were we have done both feet at once.  We would be happy to further discuss these options.  If you would like a consultation with either Dr. Nelson or myself please contact our office.  It would make most sense to review this in person and especially with x-rays available.
Saturday, 24 June 2017 15:33

Platelet Rich Plasma Injections

There continues to be a lot of discussion around platelet rich plasma therapy. We have been utilizing this technology for years and find it highly successful in certain application. PRP utilizes the body's own ability to heal and repair itself by harvesting the patient’s blood and spinning it down to cells that have the potential to heal inflammatory conditions.

We find it highly successful in tendonitis like Achilles tendinitis, posterior tibial tendinitis as well as other conditions like plantar fasciitis and arthritis. The procedure itself, including harvesting the blood and spinning it down and then reinjecting into the site, takes approximately 30 minutes. At our practice we can do it on site for a huge cost savings as compared to the majority of facilities offering this procedure.

We are able to keep cost down because we do a high-volume and are not employed by a hospital or organization. People with tendonitits, plantar fasciitis or arthritis that have continued pain and have tried other treatments are great candidates for platelet rich plasma and we can often get them scheduled in less than a week. If you suffer from foot or ankle tendinitis, arthritis or plantar fasciitis and live-in Bellevue, Seattle, Redmond, Kirkland, Issaquah were Maple Valley call 425–880-9552 or vist us online.

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