New cartilage implants for first metatarsal phalangeal joint arthritis is promising. The Cartiva synthetic cartilage implants is used for the treatment of arthritis of the great toe joint. The implant is highly effective on people with good bone stock and mild bunion deformities. Recent study reviews the five-year follow-up as approximately at 96% chance of retaining the implant and no changes were noted in the positioning of the implant.  

Patients report high satisfaction rates and have found a considerable reduction in pain.  In addition there has been a low reoperation rate and improved functional outcomes. The Cartiva is a great alternatives to fusion of the great toe joint for patients all remain active and have increased motion. The recovery time is much less as compared to the traditional outcome in most patients are reporting improved satisfaction. The Cartiva implant is available at our surgery Center where excited to offer this new cutting edge procedure. 

If you are experiencing any foot or heel pain, do not hesitate to call us at 425-391-866 or contact us online.

Peritenolysis is the quickest Achilles tendon surgery to heal from. This is a great surgical technique for patients that are active runners or high-level athletes. This procedure has been around for over 30 years and basically involves freeing up the covering around the Achilles tendon to increase the gliding mechanism and gets patients to return to activities more quickly.

Patients return to normal activities in approximately 7-10 weeks -- this includes activities like running and jumping. It is common practice today for surgeons to remove part of the Achilles tendon or transfer adjacent tendon to help with this chronic tendinopathies. However the above described procedure is highly effective for managing patients with Achilles tendon pain. At Issaquah Foot & Ankle Specialists we have an on-site surgery that allows for significant time and cost savings. This procedure can be performed in less than an hour and has great long-term success rates.

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

I think everybody is still disheartened after Richard Sherman’s Achilles tendon rupture. An Achilles tendon rupture can take a significant amount of time to recover from. We see quite a few people on an annual basis that rupture their Achilles tendon often times playing basketball or football. The majority of people relate a popping sensation or pulling in the back of the leg. It is extremely difficult to walk afterwards and a weakness is usually present. The majority of people are surgical candidates for Achilles tendon ruptures as the outcomes are better with this type of repair.

Achilles tendon ruptures are usually preceded by pain and swelling in the Achilles, that often times if left untreated can lead to rupture. There are a lot of great stretching and strengthening exercises that can be beneficial for an Achilles tendon. The Achilles tendon is the thickest strongest tendon in the human body and it’s important to take proper care of it. If you suffer from pain in your Achilles tendon we have a lot of great modalities to help relieve these symptoms and get keep you active.

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

The most basic and simple procedure to do from a surgical perspective is a cheilectomy. This is basically a joint cleaner procedure that it also involves aggressive removal of bone from the top of the first metatarsal. During this procedure, we also release soft tissue contracture of the capsule, especially on the bottom of the joint near the sesamoid bones. If there are big defects in the cartilage then any loose flaps of cartilage are removed and the exposed bone is drilled. The goal is to develop a fibrocartilage patch over the damage bone.  If it's a larger section of damage bone and then a osteochondral or bone and cartilage graft can be taken from other joints and placed in the defect surgically. Another newer procedure is a joint implant called Cartiva.  My partner, Dr. Nelson has discussed Cartiva joint implant procedures on our website.  Another approach to this whole problem is to improve the mechanical function of the great toe and the first metatarsal. 

This would involve realigning the entire first metatarsal to more functional position and essentially tilting it downward or dropping it. It is difficult to gain significant improvement in the alignment by doing a procedure at the head of the first metatarsal. However the first metatarsal cuneiform joint that often has hypermobility and elevation of the entire metatarsal is a great joint to utilize to improve function of the entire foot and the first metatarsal phalangeal joint. This is a midfoot fusion also known as a Lapidus procedure. 

The first metatarsal is plantar flexed and the fusion was done at the joint and augmented with bone graft material and hardware or screws or plates are used to maintain the alignment until the bone fusion is complete. Another fusion would be for severe cases arthritis in the great toe joint where the entire joint itself is fused. This is another very effective procedure and totally eliminates any joint pain here. The downside is that there is no motion whatsoever at the big toe joint. It is surprising how well people function after this is done. If you have questions about some of these treatment options please let us know.  Both Dr. Nelson and myself–Dr. Young,  have extensive experience treating these problems.

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

The poor Seahawks and Richard Sherman. This Achilles tendon rupture is a difficult injury to heal from. It is not uncommon for a weak or symptomatic Achilles tendon to be vulnerable to injury or even rupture. Certainly with a pro athlete with the extreme forces and performance that his professional football job requires.

Treatment for this would normally be surgical repair of the ruptured tendon. Additional treatments that may enhances healing could include bathing the surgical site with PRP (or platelet rich plasma) . Taking supplemental collagen can help with tendon healing postoperatively. It's always a good idea to take supplemental zinc and vitamin C also for wound healing.

Once initial healing is done, in addition to physical therapy there are special braces for achilles tendon problems and injuries. In addition shockwave therapy can be very beneficial for Achilles tendon injuries and postprocedure healing.

Richard Sherman has a long road ahead of him, but it's very likely that we'll utilize some of these cutting edge treatments to help speed up the healing process for him. 

At Issaquah foot and ankle specialists (Dr. Brandon Nelson, and Dr. Timothy Young), we see and treat Achilles tendon ruptures at our own clinic.  If you have Achilles tendon issues please contact us, we will treat you like a pro athlete.

For those individuals that have structural hallux limitus with bone spurs or osteophytes, this can be a difficult problem.  At the early stages they can be quite difficult to see from an x-ray.  But surprisingly they can be seen quite clearly with diagnostic ultrasound imaging.  It's also helpful to try to bend the great toe upward and do a live manipulation of this joint under ultrasound guidance and visualization.  You can then see the definitive block to the upward range of motion. 

Over time the small bone spurs become larger and larger and more painful.  In addition the joint itself can become more inflamed and the inner joint lining becomes thicker–synovitis.  For some patients eventually the cartilage becomes thinner also and eventually the joint can become bone-on-bone and extremely painful.

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

Function of the great toe joint is one of the subtle critical components of gait.  Normally as the heel starts to rise off the ground and the first metatarsal is plantar flexed with good full weightbearing purchase and grip on the ground to great toe starts to glide upward or effectively the metatarsal rises as the great toe is planted on the ground.  From a nonweightbearing perspective we just see the big toe move upward or dorsiflexion.  During a full weightbearing scenario the great toe remains planted on the ground and the metatarsal tilts upward.  However, there are some individuals where mechanical jamming at this joint occurs.  It's actually quite common.  Sometimes this starts from an old injury in the joint just doesn't glide like it should. 

When this happens there is a lack of smooth gliding upward of the great toe or tilting of the metatarsal.  Something has to give, there is then compression on the top of the joint line itself of the first MTP joint (metatarsal phalangeal joint).  Over time with inflammation and damage to the bone on the top of the joint line bone spurs–osteophytes develop.  These can then backfire and actually cause even more of a rigid block to smooth gliding of this joint.  Eventually the joint can be's quite stiff even when it's not on the ground.  So functional hallux limitus occurs from mechanical jamming of the joint without a definitive block and also occurs primarily when the joint jams from the entire joint being elevated rather than down bearing weight on the ground.  Structural hallux limitus occurs when even in a nonweightbearing position the great toe joint is not able to bend upward to the normal range of motion–this usually occurs with adaptive changes around the joint often including bone spurs.

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

Achilles tendinitis is a very common problem. It is one of the problems that I really like to see at our clinic. This is for a number of reasons. The biggest reason is that we have developed some protocols that are extremely effective. Surprisingly, most clinics have great difficulty treating this and are not aware of all the treatment options. Achilles tendinitis is due to a number of different problems. From a biomechanical standpoint, the Achilles tendon is subject to tremendous force as you're walking or running and your heel comes up off the ground. In addition there are additional forces from side to side. It is the side to side forces that seem to cause additional mechanical shearing and stress to the Achilles tendon. It is important to address both the inflammatory component of the problem and the mechanical component. 

From a mechanical standpoint it's important to have prescription orthotics that help address the side to side stress that occurs during weightbearing phase of gait. This includes controlling both excessive pronation and supination. In addition there are special braces made just for Achilles tendinitis. Again it is surprising how he clinics have never heard of these braces and are not aware of how effective they can help complement our treatments. From a mechanical standpoint, eccentric loading of the Achilles tendon and calf muscle is extremely effective. 

Eccentric Achilles strengthening exercises are part of our treatment protocol. General calf stretching is always helpful and a night splint can help complement this. The icing on the cake especially for resistant cases is shockwave therapy. This is available at our clinic and is extremely effective. There is no down time with this and no injection is required or anesthetic. 

Finally for the most resistant cases sometime surgery is necessary. This may involve procedures with Achilles tendon and it may also involve procedures for the gastroc tendon such a gastrocnemius recession especially for those individuals with extremely tight limited ankle joint range of motion. It is extremely rare to have a case have to go onto surgery at our clinic. If you have Achilles tendinitis or Achilles symptoms please let us know and we will be happy to help. Both Dr. Nelson and Dr. Young utilize these treatment protocols. 

As basketball season and football season starts up, we continue to see a lot of ankle sprains. It is essential to have your ankle sprain evaluated, as not all can be treated by ice therapy. Some of the best recommendations we can give you are to immediately get on crutches and apply some compression to the site and get in to see your Foot and Ankle Specialists early.

Ankle sprains have a lot of long-term complications including continued instability and damage to the joint. Proper rehabilitation and a thorough evaluation are essential to return to activities. We see quite a few patients months after ankle sprain that have long-term complications that could’ve been prevented. If you suffer from an ankle sprain, come in for an evaluation to prevent these long-term complications.

One of the most frustrating conditions we see at Issaquah Foot and Ankle Specialists are neuromas. Patients often come in with an extreme amount of pain. This pain can be described as a burning pain or stabbing pain. Patients often relate an inability to exercise or walk due to increased discomfort from the neuroma. The neuroma itself is basically an inflammatory process around the nerve. There are some new exciting treatment options available one of the most successful is sclerosing or alcohol injection therapy. The literature reports a success rate of up to 88% utilizing this technique. In addition shockwave therapy has recently shown increasing success for neuroma type pain. This can be done in the office usually requiring 3-5 treatments. Issaquah foot and ankle specialists have the most advanced treatment protocols to cure neuromas nonsurgically.