Monday, 10 February 2020 02:20

Are your feet killing you?


Every one seems to like the new TV show: My Feet Are Killing Me.

What are you waiting for? Your feet should not hurt! Many of our patients come in, asking if their foot pain is something they will just have to live with. The answer for the vast majority of people is NO! You should not have to live with foot pain (there are very few exceptions). There are so many new great treatment options. Sometimes it's worth it to just come in to have evaluation and if needed x-rays or ultrasound imaging, and then an examination and definitive diagnosis. Then we can give you treatment options.

Don't just live with it, on in and lets figure out what's going on and what your options are.
Either myself Dr. Timothy Young, or my partner Dr. Brandon Nelson would be happy to do your evaluation and give you treatment options. Give our office a call at 425-391-8666 or make an appointment online today!

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After foot surgery, it’s not uncommon to have edema that can last from just 2 or 3 weeks, up until 2 or 3 months or even longer. It is always advantageous to try to reduce swelling when possible. There are multiple strategies for reducing swelling. Reducing swelling very often helps reduce postoperative discomfort and reduces the need for post procedure pain medications. Note postoperative swelling can be persistent. Once one or several techniques are done to reduce it, an effort has been made to maintain this because the swelling tends to want to keep coming back. This will happen until several weeks or longer have gone by and additional soft tissue and/or bone healing has occurred.

Outside physical therapy: We often wait for outside physical therapy until least 3 weeks postoperatively because this gives the incision to get a chance to have some initial healing to "seal up" the wound so to speak and to therefore minimize the risk of a postoperative infection.

Home treatments:

RICE: Rest Ice Compression and Elevation - this is always helpful. But our patients often forget.

Rest: Avoid going back to work or doing activities too soon. After initially being a couch potato for the first 3-5 days, some people just get too busy, and some people start to resume full weightbearing activities (too soon) with one's feet dependent or hanging down allowing gravity to pull more fluid down to the feet and ankles. This is often a time when initially you are feeling great, and then you start to overdo it and all of a sudden it starts hurting again and it may start swelling also. Remember, if you have to go back to work and your feet start to swell, you may have to compensate by really pampering yourself at home. Often it is helpful to go back to work for reduced hours during the first few weeks of returning to work. For example for major foot surgery, working just 4 hours per day 3 days a week the first week, than 4 hours per day 5 days a for several weeks, and then returning to work 6 hours 5 days a week, and finally a full 8 hour shift.

Ice: Whenever there is swelling, ice can be of some help. It's usually the most helpful during the first 48 hours of an injury but with surgery this can be more like the first 7 days.

Elevation: In particular, whenever possible if you're just sitting, try to keep your feet elevated above heart level.

Compression: An Ace wrap office compression. Sometimes it's helpful to do fairly intense compression with the Ace wrap leave it on for 20 minutes and then loosening the Ace wrap to more moderate pressure.

Remember to never remove the dressing including Ace wrap and last unit if the doctor is okay during the first 3-4 days. Remember, Ace wraps can lose some of their compression over time.

There are special forefoot compression sleeves that we can order or may be available through our clinic.

Contrast baths: After the first 1 to 2 weeks, there can be a benefit to doing contrast baths. Ask Dr. Nelson or Dr. Young before doing this. But, one technique is to have a very light sterile dressing on the foot, and then use a brand-new garbage bag and have the foot go into one top of warm water for 3-4 minutes at one top of his water for 1-2 minutes. This is a 5 minute cycling total, the 5 minutes cycled is repeated for 20-30 minutes.

Home interferential electrical stimulation (IF 4000 unit). These units are often available to check out from our clinic. These use a set of 4 gel electrodes that are placed per your doctors’ recommendations. Typically these are done for 20-30 minutes 1-2 times a day. Also typically icing is done during this treatment and/or immediately after this treatment. The units are usually used for 2-3 weeks duration. This helps reduce swelling and pain both.

Massage and ROM (range of motion): Gentle massage away from the surgical site can be very beneficial. One technique is for example, if bunion surgery was done then the side of the foot adjacent to the great toe is avoided. But the outside of the foot that may still have some swelling and/or edema is gently massage well the foot is elevated above heart level. This massage is worked from the toes back toward the midfoot toward the ankle and then up towards the leg. Most of the time is concentrating on the foot and ankle. The goal is to physically work some as swelling out by gently manually "moving" the fluid. After this can be very beneficial to place a compressive sleeve and/or Ace wrap over the foot to help avoid the swelling from immediately returning.ROM can be very helpful especially well the foot is elevated above heart level.

Supplements: It is always helpful to take supplements the help of bone healing such as calcium, magnesium, vitamin D 3 and vitamin K 2.

But in addition, it can help to take other supplements such as Omega essential fatty acids (fish oil), some people swear by tumeric and Arnica.

Rx Oral anti-inflammatories: Some anti-inflammatories may have properties that inhibit and/or slow bone healing. Taking Advil or Aleve once in a while should not be a problem, but taking it consistently or taking prescription anti-inflammatories can be a concern.

Sunday, 19 January 2020 20:52

What Does a Partial Matricectomy Look Like?

This is one of the more common procedures that we do. Typically a patient will have a history of recurrent painful ingrown toenails. They may have had procedures done previously to help treat the problem but not permanently. The partial matricectomy involves removing a small ingrown border of the nail and then applying medication that "kills the root of the nail". The root of the nail is technically called the matrix or lunula. Therefore a partial matrixectomy would be partial permanent removal of the nail root.
Many of our patients especially are concerned about the cosmetic appearance of the toenail once the ingrown border is gone. Actually it is very difficult to even see this and be able to tell what side has been done permanently. Here is a photograph of a patient who had ingrown toenails removed (partial matricectomy procedures) from both the medial (inside) and lateral (outside borders) of the right great toenail and the medial or inside border of the left great toenail. See if you can tell the difference, most patients really can't tell the difference. Or they have to look very close to be able to tell the difference.
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If you have questions about these treatments please let us know. We treat problems like this daily. Sometimes we see and treat 5 or more patients with this procedure on a given day. Give us a call at 425-391-8666 or make an appointment online today. 
Monday, 13 January 2020 03:08

Neuromas - How To Treat Them

Mortons Toe

Neuromas can be unbearable for patients. It is common to see patients who are avid cyclists experiencing burning and tingling in one or both of their feet. Often we relate this to the tight fitting cycling shoes or the increased forefoot pressure with pedaling. Typically patients have tried a wider cycling shoe or see a bike fitter and still have not received much relief. It is important to get a correct diagnosis established and then a proper treatment protocol can be initiated. Neuromas are most often described as a burning, tingling or electrical pain to the 3rd and 4th digit.

Patients additionally will often relay a balled up sock or feeling like they are walking on a marble. The 3rd interspace is the most common area to develop a neuroma and diagnosis can be confirmed with a “positive mulder’s click” and an ultrasound or x-ray. One of my favorite treatment options is sclerosing therapy to stop the nerve from transmitting a pain signal. Sclerosing therapy has proved to be highly successful even for patients that have tried multiple other treatment options. I see patients that are ready to have the neuroma surgically removed and I recommend trying the sclerosing therapy first. The majority of patients go on not to need surgery and resolve their neuroma pain.

If you are experiencing this type of pain, give us a call at 425-391-8666 or contact us online for an appointment.
Sunday, 05 January 2020 23:24

Minimally Invasive Bunion Procedures

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I get quite a few questions from patients each week pertaining to minimally invasive bunion procedures. The idea of minimally invasive surgery is attractive to patients as it usually means less healing time and smaller scars. The concept of a minimally invasive bunion has been around for decades and continues to come in and out of favor. The major problem I see is that patients often can find a physician willing to do this procedure when it is not an appropriate procedure to select i.e. the patient has a very large bunion or other complicating factors like a flatfoot.

I find the minimally invasive bunion procedure to be reliable and easily producible but proper patient selection is of the utmost importance. I see hundreds of patients a year and am happy to provided consultations or second opinions on bunions and bunion surgery. Our practice has an onsite surgery center which is a huge time savings and cost savings for patients. We see the average patient save tens of thousands of dollars as compared to having the surgery performed at a hospital.

Give our Issaquah Podiatrists a call today at 425-391-8666 or make an appointment online today.