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Dr. Timothy Young a Board Certified Foot Surgeon, Talks About Surgical Treatment of Capsulitis of the Second Toe and a Bunion Deformity Combined

Surgical treatment for this condition involves correction of the bunion deformity, which often helps the second MTP joint capsulitis. The ideal procedure for this would be fusion of the first metatarsal-cuneiform joint in combination with the bunionectomy (lapidus bunionectomy or lapiplasty). The fusion of the first metatarsal stabilizes the first metatarsal and therefore able to bear the weight that it should be proportional to the rest of the foot.  Therefor this procedure takes some of the stress off of the next in line 2nd metatarsal.  So a lapidus bunionectomy is often a very effective treatment for both the bunion and capsulitis of the 2nd toe.
 
Sometimes the Lapidus Bunionectomy is not enough to correct or adequately deal with the second MTP joint stress load.  This is especially seen if there’s a very long second metatarsal or short first metatarsal.  In this case, the second metatarsal can be shortened for example with a weil osteotomy.  In addition if there’s a hammer toe of the second digit, this should be corrected at the same time.  If there is 2nd toe plantar plate damage, then it can be surgically repaired or a flexor tendon transfer of the second toe is often benefitial.
 
The xrays below show a lapidus bunion repair and a weil osteotomy to shorten the 2nd metatarsal.

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Capsulitis is an inflammation of a capsule or joint. Your joints are defined by where two bones come together and have cartilage on the opposing surfaces and a joint sac (capsule) that encircles the two ends of those bones. Additionally in the joint capsule is fluid which helps the joint to glide smoothly.

The human body has many joints, the human foot has the highest concentration of joints with 33. The foot is an extremely complex structure and small deviations in the alignment can cause significant problems.

Capsulitis can have many causes, one of the most common is abnormal wear of a joint. Abnormal wear of a joint is usually attributed to increase pressures in that joint and can ultimately lead to arthritis. In the foot instability of the big toe can increase pressure in the 2nd toe leading to inflammation of that joint, the 2nd metatarsal phalangeal joint or MTPJ. What is typically seen is a patient with a bunion or a flat foot that causes results in high pressures of the 2nd MTPJ and the net result is pain. The pain can present with swelling, numbness or tingling. The eventual progression of this can lead to dislocation of the toe or what we call a cross over toe.

If you have pain around the second toe, icing and stretching can be very helpful. However it is important to have your foot evaluated as this is usually a progressive deformity that can cause increasing discomfort and eventual structural changes. I recommend an x-ray and an overall foot exam. Often times there are great conservative options to help this condition and help patients return back to activities. If you have 2nd MTPJ pain give us a call at 425-391-8666 or make an appointment online today. 

austin bunionectomy

This is a common combination.

Capsulitis of the second toe is inflammation of the capsule and the structures of the second metatarsal phalangeal joint (or second MTP joint). This condition often occurs in combination with a bunion. When there’s a bunion deformity the whole first metatarsal and the first MTP joint are out of alignment.

When this happens in the first metatarsal does not carry its fair share of weight.  It is common, for the next in line 2nd metatarsal to develop a stress overload. We can evaluation both conditions with an x-ray.  We sometimes use an MRI to evaluation the extent of the 2nd toe capsulitis including for a capsular tear or plantar plate tear. Both the bunion and the 2nd toe capsulitis can be a difficult combination to treat. 

The best bunion treatment can involve shoes and orthotics can also help with non-invasive bunion treatment. Bunion treatment options may be limited in severe cases and often need surgical treatment.

injection

Neuromas
refer to a condition where the nerve in the foot often becomes intolerable secondary to pain and discomfort. The majority of people with neuromas will describe a burning or tingling sensation in their foot. This pain is often worse in shoes or after prolonged periods of walking. The majority of neuroma patients are female between the ages of 40 and 60.

Historically neuromas were treated with surgical excision and patients did well with this procedure. However, newer options are available. Alcohol injection therapy and shockwave therapy continue to show increasing success for neuroma patients. The alcohol therapy works by dehydrating the nerve and decreasing the pain signal conduction to the brain. Shockwave therapy works by applying acoustic sound waves to the scarred down nerve and breaking up the inflammatory cycle and increasing blood supply to the area.

The majority of patients we see for neuromas do extremely well with alcohol injections. These alcohol injections have a success rate in the literature up to 90%. The average person needs approximately 4-6 injections 1-2 weeks apart. We have seen incredible success for most of our patients and have had to remove far less neuromas.

Shockwave protocol typically takes between 3 and 5 and often times is done in conjunction with the alcohol injection therapy. Shockwave has no down time and no pain and is one of the most advanced techniques for chronic pain.

If you are currently suffering from nerve pain or neuromas please give us a call at 425-391-8666 or make an appointment online today.


Bunion xray

There are many different procedures that can be selected for bunion surgery. These can range from head procedures, midshaft procedures and base procedures and even joint fusions. The procedure selected can often be related to other conditions of the foot as well as how large the bunion itself is and how the patient is. The most important part about procedure selection is having an examination by a physician radiographically and clinically.

The Lapidus procedure has been around for an extremely long time and provides great bunion correction. The Lapidus bunion procedure itself inherently is a little more challenging than some of the other bunion options. Recently new instrumentation has been developed to make the Lapidus bunion procedure easier and more reproducible. This cuts down on recovery and operating room time for the patient and ultimately improves outcomes.

At Issaquah Foot and Ankle Specialists, we have been performing the Lapidus bunionectomy for years and on 100s of patients. The lapiplasty instrumentation has been extremely helpful we have seen increased patient satisfaction. If you are contemplating a bunionectomy I highly recommend an evaluation to see if the Lapiplasty is appropriate for your bunion.

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

Forefoot pain is a very common presenting symptom for patients at our office. We see a lot of people that have returned to activities or started a new exercise program that come in with forefoot discomfort. There are many different causes of forefoot pain. However, the most common are capsulitis and neuromas.

Capsulitis

Capsuilitis is an inflammation of the joint and, in the foot specifically, an inflammation of the metatarsal phalangeal joint. Capsulitis often can present with some swelling to the forefoot and the pain goes away with rest often times. Patients often describe it as a dual ache or throbbing like sensation, additionally there is usually underlying foot pathology that contributed to this. Where the most common other presenting pathology with forefoot capsulitis is a bunion deformity. We see a lot of people with large bunion deformities that are overloading the forefoot getting a considerable amount of discomfort daily. It is important to have an x-ray in order to rule out additional causes like stress fractures and arthritis.

Neuromas

Neuromas involve an inflammation of your nerves. Typically we see this pathology with, but not limited to, people between the ages of 40 and 60. Neuromas will typically present with burning or sharp shooting type pain. Most patients will relate that the pain is relieved by staying off of the foot or by taking off their shoe and rubbing the foot. The most common space for neuroma is the third interspace we typically will be able to isolate this pathology with palpation. However I do recommend an x-ray to rule out other causes as well.

Issaquah Foot and Ankle Specialists provides the most advanced care to all walks of life. We see pediatric patients all the way to geriatric patients. We treat all of our patients like family and look forward to helping you with your foot and ankle care.

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

Bunion xray

Bunions
can be very difficult for many patients. They can often be extremely uncomfortable and make walking unpleasant. Many people try going to larger shoes or wearing toe spacers or straps and padding. This can provide temporary relief however often make the bunion increase in size as larger shoes allow more room for the bunion to grow. The question I hear often is: “When do I have my bunion fixed?”.

When do I have my bunion fixed?

The answer for this is complex and is dependent on each patient and their lifestyle. I think the most important question is does the bunion impact the lifestyle you enjoy? If the answer is yes, it is time to fix it. If your bunion stops you from walking, hiking or even fitting in shoes the time has come.

How is my bunion fixed?

Bunion surgery has significantly progressed in recent years. The majority of bunions can be fixed with a simple procedure that takes less than 2 hours. Most often these can be done in our office and do not require any trips to the hospital. It is very common to be able to walk after surgery and maintain an exercise program with some modifications.

Is it painful?

I think it is important to realize all surgery can cause pain. The majority of our patients do very well with pain control. We have fixed 1000’s of bunions and have developed great post-operative pain control techniques.

Will my bunion come back?

The most important part of bunion surgery is procedure selection. Not all bunions are the same and therefore not all bunions can be fixed with the same procedure. It is vital to have and x-ray and a thorough evaluation of your foot. I also believe having somebody operate on your bunion that has vast experience with bunion surgery is something to consider as well.

I hope this was helpful and answered some common questions. You could be a candidate to have it fixed or even a candidate that we can employ some conservative measures. Please give us a call at 425-391-8666 or make an appointment online.

Foot drop

Capsulitis
is a generic term for inflammation of a joint or the joint capsule. A joint is where two bone come together and are covered with cartilage and surrounded by a joint sac filled with fluid. This allows the joint to glide smoothly and motion to occur. Joints can become painful, especially with abnormal movements or increased pressures. Capsulitis of the second metatarsal is a common condition in the foot.

Capsulitis of the second metatarsal or toe typically presents with pain or swelling under the second toe. Patients often describe a burning or tingling sensation that is worse with walking. The majority of people that experience this type of condition will have other foot and ankle pathologies that are contributing to the capsulitis.

Contributing factors for capsulitis can include a tight calf muscle or a bunion deformity. A tight calf muscle can cause increased pressure to the forefoot. A bunion can create instability and again overload the second metatarsal. Other factors that can play a role in the development are a flatfoot or even shoe gear and exercise patterns.

Second metatarsal capsulitis can be very challenging from a treatment standpoint. It is important to evaluate both feet and all presenting pathologies. An x-ray is a great place to start the evaluation and look at the generalized foot structure. If you believe you have capsulitis schedule and appointment today so we can help. Give us a call at 425-391-8666 or make an appointment online today. 

heelpain

Heel pain
has many causes, however the most common cause for adults is Plantar Fasciitis. Most of us have heard this term at some point in our lives because a friend or co-worker has talked about it. But what is it? The Plantar Fascia is the main supporting network of the foot. It runs from your heel bone all the way to your toes. It is active every time you stand or walk and is very important for normal gait cycles. Since this structure is under chronic strain it can become inflamed and over used. This will typically lead to pain in the morning or a bruised type sensation on the bottom of the heel. Patients will often state they feel like they are walking on a pebble. Plantar Fasciitis left untreated can become extremely painful and debilitating.

So when should you see a doctor. I cannot tell you how many patients I see that have had heel pain for greater than a year. The majority of patients will have tried icing and stretching and continue to have pain. I cannot stress enough that plantar fasciitis is much easier to treat with early intervention. I find it extremely valuable to get in to see your doctor early. This will lead to faster recovery and a better long term outcome. Additionally, they are other causes of heel pain and some of these can create serious long term damage. I think it is best if you have pain for greater than a week it is time to have it evaluated. Once evaluated my average patient has a 50-90% reduction in symptoms in less than 1 week.

If you are suffering from heel pain please give us a call at 425-391-8666 or make an appointment online.

anklesurgery2

Surgery
can be quite a bit to think about. Patients need to make work arrangements and plan with family and sometimes even friends. Especially if it is your first time having surgery it can feel like a lot. We at Issaquah Foot & Ankle Specialists have helped so many patients with surgery that our process makes it extremely easy and relaxing. We will help every step of the way. We provide a surgical binder that has everything you need and will make sure that you get all the assistance you need to make the process feel simple.

I think the most important part of planning when to have surgery is simply preparation. I tell most of my patients to think ahead and figure out when the slowest time of year is for you with both family and work. This is not always possible so the good news is we are here to help. The majority of procedures will allow patients to get back to activities in a few days. We have years of experience and can provide answers to any questions or concerns you may have.

The surgical process is easy as well. We have an onsite surgery center and most of the time you will be at the office for just a couple hours. We have dedicated rooms and staff that will assist you the entire time. If you are contemplating having your bunion fixed or having your neuroma or hammertoes corrected, we can help. Give us a call today at 425-391-8666 or make an appointment online.

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