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PRP

Again, I have had this problem before and as mentioned in prior blogs I did many of the appropriate initial treatments listed in my previous blogs.  The next step to consider is some of the other alternative treatments.  We used to do cortisone injections for this, and we do that very rarely now.  There is a non-cortisone anti-inflammatory called Injectable Sterile Traumeel that has much decreased potential risk for damaging the capsule (unlike cortisone).  There is also PRP–platelet rich plasma.  This can be very effective especially when combined with shockwave treatment.  Shockwave treatment can also be done as a stand-alone procedure.  The problem with some of these additional treatment options is that they often take several months to really be effective.  That's where it's hard to do this but one needs to have patience.  Again, that's where cross training can be helpful such as cycling or aqua jogging.  For my capsulitis as mentioned, I did the typical initial treatments.  I wore special orthotics modified for the capsulitis, I have shoes with a good rocker design, I don't go barefoot at home.  I work on stretching my calf and I have a night splint .  I stopped running for exercise and only did walking.
 
Finally, I had to have shockwave treatment.  I had a series of 5 treatments, and it did take several months but the symptoms have completely resolved. Because I have significant pronation I am vulnerable to reoccurrence of this problem.
 
If you have foot problems including capsulitis of the second toe or second MTP joint, please let us know.

xray 01

I try to let my patients know that I understand how scary or nervous it can feel to think about surgery. I think as surgeons sometimes we can forget that for us this is routine, however for the patient it can seem overwhelming. Bunion surgery itself is relatively straight forward and can provide great results. I have thought it could be helpful to have a few questions to ask your surgeon.

I think one of the most important questions to ask your surgeon is, “How many bunion surgeries you have done and how often you do them?”. I think most likely you are seeing a Podiatrist and we perform the most bunion surgeries out of any other specialty. I can tell you in residency alone I probably did over 500 and now into private practice for over 10 years I am sure the number is over 1000.

Another important question is, “What are some of the most common complications that occur?”. Every surgery has complications this is part of practicing medicine. The most important aspect of this is how they handle it and how quickly a surgeon responds to these. One of the most common is probably infection and this is rare, the literature state about 3% of all patients will experience this.

Additional question could include, “Why did you select this procedure?” There are numerous different bunion procedures and why we select a particular one is important. This is because they all have different correction abilities and time frames for healing. The majority of bunion procedures can be categorized as head or base procedures. Lastly, “What is my recovery time?”, be specific are you talking about back to exercising or just into a normal shoe.

I hope this was helpful, please feel free to schedule an appointment with me if you would like a consultation of second opinion. Give our office a call at 425-391-8666.

Orthotics

I have had this condition myself.  We are talking about capsulitis of the second metatarsal phalangeal joint  (MTP joint) in the ball of the foot, near the base of the second toe.  There have been previous blogs about the potential cause of this problem.  Treatment has to address the underlying cause and foot structure as much as possible.  If the calves are tight, then they have to be stretched and use a night splint or even have a gastroc recession surgery.  If there is a bunion and the whole first metatarsal is not bearing is fair share weight then it can cause stress overload to the next in line second metatarsal.  Orthotics and foot taping often help this.  

Sometimes it's not enough and sometimes especially if there is damage to the capsule such as the plantar plate, we then have to correct the bunion and consider surgery on the second metatarsal.  But there are other cases that don't require surgery.  It still imperative to do all the other treatments. The correct shoes with a forefoot rocker, sometimes zero drop shoe such as Altra Shoes can also help.  Avoiding the activity that seems to aggravate this also can be critical.  For example, if you're runner or speed walker, you may have to put that on hold or do cross training until her symptoms have completely resolved.  For myself, this seemed to come on after I had resumed running after several months off.  I had to make sure my orthotics were still appropriate for this problem.  I wore correct shoes.  I had to stop running and cross train.  I worked on stretching my calf and I have a night splint also.  

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

 
 

woman pink dress holding heel

It is common for patients to come in the office and relate pain in the morning or right when they get out of bed. This can be a challenging way to start your day and can lead to chronic foot pain. Most patients describe the pain as a bruised feeling to the heel or a tightness with pins and needles. This can go on for months and become chronic. The most common cause of this type of pain is Plantar Fasciitis. Plantar Fasciitis is an inflammation of a supporting band of tissue on the bottom of the foot. The Plantar Fascia is essential for normal foot function and when it is inflamed daily tasks can be overwhelming.

Morning pain is one of the most common signs of Plantar Fasciitis. The reason behind this is while you sleep your Fascia and Achilles Tendon have a chance to relax. With this relaxation both structures begin to tighten up. This tightening up leads to stiffness when you first step on your foot. One can really help this by exercising their foot before getting out of bed. I recommend writing the alphabet with your foot and stretching with a theraband.

If your pain continues for more than a week an appointment is essential. Give us a call at 425-391-8666 or make an appointment online today. 

Bunion xray

What is a bunion?

A bunion is a genetically inherited foot structure that leads to migration of your 1st metatarsal. The bunion itself is where the 1st metatarsal begins to protrude out the medial or inside of the foot. Nothing actually grows or forms new bone, but it is the deviation of the normal bone that creates the bunion. The bunion can continue to rotate and get larger until it creates hammer toes of the other digits. The bunion eventually causes pain and deformity that needs to be addressed surgically.

Bunion surgery:

One of the most common bunion surgeries is a head procedure. This involves cutting the metatarsal bunion and the end closest to the toe. The bone is then shifted back into place and held with a screw. This procedure works well for mild to moderate bunions and has a fairly quick recovery. The patient can walk the entire time and return to activities much sooner than other procedures.

Outcomes:

The typical bunion surgery has a 5% recurrence rate. The majority of the bunions that return are from not following post-op instructions or other foot factors. It is important to have your surgeon address all other components of your foot and procedure selection should be based on these findings. An x-ray is vital for procedure planning and an overall foot exam to help determine what other pathologies are present.

If you are suffering from bunion pain make an appointment today and I can help you get back to the activities you enjoy!

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

Bunion xray

What is a bunion?

A bunion is a genetically inherited foot structure that leads to migration of your 1st metatarsal. The bunion itself is where the 1st metatarsal begins to protrude out the medial or inside of the foot. Nothing actually grows or forms new bone, but it is the deviation of the normal bone that creates the bunion. The bunion can continue to rotate and get larger until it creates hammer toes of the other digits. The bunion eventually causes pain and deformity that needs to be addressed surgically.

Bunion surgery:

One of the most common bunion surgeries is a head procedure. This involves cutting the metatarsal bunion and the end closest to the toe. The bone is then shifted back into place and held with a screw. This procedure works well for mild to moderate bunions and has a fairly quick recovery. The patient can walk the entire time and return to activities much sooner than other procedures.

Outcomes:

The typical bunion surgery has a 5% recurrence rate. The majority of the bunions that return are from not following post-op instructions or other foot factors. It is important to have your surgeon address all other components of your foot and procedure selection should be based on these findings. An x-ray is vital for procedure planning and an overall foot exam to help determine what other pathologies are present.

If you are suffering from bunion pain make an appointment today and I can help you get back to the activities you enjoy!

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

Neuromas are a common presenting pathology in my office. I see quite a few in the typical week. The majority of patients with neuromas are female between the ages of 40-60. The patient will usually describe burning or tingling in the foot that is worse with shoes. Most of the time on exam one can feel the nerve moving, this is called a “Molder’s click”. I will usually get an x-ray and then help the patient with a long-term plan.

There are a few conservative modalities that work fairly well for a neuroma and I usually recommend trying these before proceeding to surgery. However, often times patients have tried these and are seeing me as a second opinion.

Surgery is relatively straight forward for a neuroma. The majority of us use a incision on the top of the foot that is about 3 inches long and provides great exposure to the nerve. The nerve is removed, and the entire procedure takes about 15 minutes. I let my patients walk after surgery and most are able to tolerate the discomfort from surgery with just an oral anti-inflammatory.

If you have burning or tingling in your foot or have been diagnosed with a neuroma I can help. Make an appointment today and we can review your options and get you back on your feet pain free.

Give us a call at 425-391-8666.

pic heel pain 4

The shockwave therapy is part of what we call regenerative medicine. Typically, 5 treatments of shockwave are done at weekly intervals.  This actually helps the damaged tissue and fascia heal rather than just masking the problem.  There are a number of pathways with this treatment works including improving the local blood flow to the damaged plantar fascia.  The treatment also activates the local It is always critical to continue the other mechanical and supportive measures (Prescription orthotics night splint hoka shoes).

The majority of patients do very well with this protocol.  A small number of patients will need an additional limited series of (3) additional shockwave treatments 4–6 months later into the treatment plan.

If for any reason there is not dramatic and 90% plus improvement then an MRI evaluation is recommended.

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

Wednesday, 30 June 2021 17:18

Dr. Brandon Nelson Discusses Heel Pain

heel pain in the morning

Heel pain can be extremely frustrating and challenging to treat. It is most often caused by plantar fasciitis, bursitis, or a stress fracture. It is important to find out the underlying cause before treatment and I highly recommend seeing a foot and ankle specialist before initiating and sort of treatment.

Bursitis, this is basically and inflammation of a sac that is used to cushion the foot. Typically, you will have similar symptoms to plantar fasciitis. Patients experience pain in the morning or with standing and after rest. It can be hard to differentiate from plantar fasciitis. However, at our clinic we have an ultrasound unit which we can use to visualize the bursa and help initiate treatment.

Stress fractures are usually seen after one begins to exercise. There can be accompanying swelling and stiffness. This pathology hurst constantly and can lead to a complete fracture. It is vital to get an x-ray and confirm the diagnonsis.

Heel pain or plantar fasciitis is the most common cause and can be variable in presentation. Classically, patients experience pain in the morning that gets better with a few steps. Most patients have increased activity levels and find pain returns whenever they rest and get us. There is a direct correlation with early intervention and a shorter duration of symptoms. I highly recommend getting in as early as possible to see your foot and ankle physician.

If you are suffering with heal pain I can help, come see me today. Give us a call at 425-391-8666 or make an appointment online today.  

Dr. Timothy Young, a board certified foot furgeon, discusses how to tell if a fracture is healing.  Also, when does your Doctor know when the bone has healed enough to get out of that boot or cast?
 
Bone healing occurs after a fracture or bone, or fusion.  In each case it is important to protect the bone and modify weightbearing or gait to allow the bones to heal in the appropriate alignment and position.  For example, if you have a fracture of your second, third or fourth metatarsal you don't want to put regular unprotected weight on it because the far end of the bone or distal aspect will tend to elevate and then heal out of alignment, causing a long-term problem with the structure of your foot.  Another exam would be after Lapidus or lapiplasty bunion surgery that requires a fusion of the joint.  Again, bone healing is critical and needs to evaluated during the postoperative course.
 
X-rays are one aspect of evaluation.  Your doctor will look at your x-rays and determine if there is signs of appropriate bone bridging.  One bone heals without excessive motion there is no bone callus and this is called primary bone healing.  This can be difficult to diagnose.  X-rays may show only incremental healing and filling at the fusion site or fracture site.  Initially this is quite subtle.  At times ultrasound imaging can be quite helpful and can show areas of bone bridging and areas that do not have any bridging.  CT scan can be useful.  
 
Timing is another key.  For younger patients for example those that are less than 20 years old one would expect bone healing to as fast as 4–6 weeks, for definitive stable bridging to be seen on x-rays.  But as we all age bone healing can take longer.  So for middle-aged patient it could take 8 weeks.  And as we get older for example passed 50 or 60 years old it can take 8–10 weeks.  Bone density and overall health can also be a factor, as well as other concerns such as smoking.  I'm not surprised for an older patient that I don't see definitive bone bridging and stability at 4 weeks postop.  But for the younger patients I do see this quite often.  Therefore, the age of the patient will be a factor in what my expectations are regarding the amount of time it takes for the bone to heal and have adequate stability.
 
Compliance can be another factor.  For example, some patients might initially stay off her foot and then pull weight onto soon and laterally cause a refracture and motion of the fracture or osteotomy site.  This can reset the clock.  One might expect to see bone callus and secondary bone healing in this case.

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