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surg neuroma

Morton’s neuroma
or inner metatarsal neuralgia is a common nerve entrapment of the foot. If left untreated, it can become extremely painful to exercise or wear shoes. There are quite a few nonsurgical approaches to do with the nerve, however not every patient can find relief from these. There are 2 categories of surgical procedures for Morton’s neuroma including decompression and neurectomy. A decompression refers to releasing the structures around the more given more space to decrease inflammation and pain. The neurectomy involves removing portion of the nerve so that the nerve this cannot cause long-term pain. The nerve that is removed is sometimes called is a nerve that provides sensory input, it does not control any motor movement of the toes or foot.

Nerve decompression has been around for quite a long period of time. It is most commonly used for carpal tunnel or tarsal tunnel and has shown good long-term success. This technique was applied to the nerve in the foot and revolves around releasing intermetatarsal ligament to create space for the nerve. The majority of patients to get relief from the nerve decompression have a fairly small neuroma and the long-term data as to whether or not this provides relief has not been ordered.

The traditional surgery or the neurectomy of the Morton’s neuroma involves an incision between the third and fourth metatarsals. Dissection is then carried out in the intermetatarsal ligament is released like with the compression however that a portion of the nerve is removed as well. Long-term success of this procedure has been well established this is considered to be the standard approach for most neuromas.

If you have a Morton’s neuroma and are interested in conservative measures or surgical measures we are here to help. Our on-site surgery center makes it convenient for our patients. Please call us at 425-391-8666 or make an appointment online today.

bunionsurgery

Complications from foot surgery are not common and many of them can be avoided with careful planning and following your doctor’s recommendations. Keeping your foot dry after surgery and until after your sutures are removed is recommended. During the first few days after surgery the incision site will still create a pathway for bacteria to get into the deeper tissue layers.

Sutures also penetrate a deeper layer and if they get wet or are contaminated they could create a direct pathway for bacteria to travel deep and cause an infection. We do not recommend allowing the incision site to get wet with bathing until after sutures are removed. Use a special cast protector for bathing and make sure that it is on correctly. A garbage bag with rubber bands may leak and fill with water-not good! Follow your doctor’s advice on wound care. At our clinic, after surgery we change our patient's dressings at our clinic to make sure it is done using sterile technique, for example a postop infection is certainly going to be more of a risk if you have an open wound or one that still has sutures and you get your foot wet such as bathing.

If you have questions about bunion surgery, and would like a consultation please let us know.

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

Bunion xray

Bunions
are painful enlargements around one’s big toe joint. They can be uncomfortable in shoes and with exercise. The majority of pain is usually associated with swelling, throbbing and sometimes redness. Most people with a bunion will have a family history of foot disorders and have a parent with a bunion. Commonly patients will have tried larger shoes or wider shoes and most will continue to have pain despite these measures. I get a lot of questions about the timing of bunion surgery and when to fix the bunion deformity. I will answer some of the most common questions to help others make this decision.

1. When should I have bunion surgery?

The majority of patients I see already have bunion pain and that is why they are in the office. I always have the discussion with patients about whether the bunion is causing pain daily or interfering with the activities they want to enjoy. If these are occurring it is time to fix the bunion. This deformity can make life challenging especially from a physical activity standpoint. If your bunion is preventing you from exercising, it is time to fix it.

2. How long is my recovery?

It depends on the bunion procedure that is utilized. The majority of bunion surgeries patients can begin to walk when they can tolerate it. Surgery will cause some pain and swelling. I like to have my patients aggressively treat the swelling as this will create a quicker return to activities. I also like my patients that are athletic to maintain some sort of activity, like riding a stationary bike. Runners will most likely need about 2-3 months before they can return.

If you are suffering from a bunion and need a consultation to discover what conservative or surgical options are available schedule an appointment online or give us a call at 425-391-8666 today.

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Don’t forget that if you take narcotic pain medication, it may have Tylenol in it. Medication such as Percocet and Vicodin may have Tylenol in it and there’s a maximum daily dose of Tylenol, approximately 3000 mg per day. This is why it’s important to keep a log of your medications. If you’re not comfortable with this then make sure to ask your doctor for narcotic pain medication that is a stand-alone item such as pure oxycodone instead of Percocet.

It’s recommended to have a family member help you keep track of these pain medications with a log. Set your clock or phone so that you have a schedule because you want to stay on top of the pain. 

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

pic heel pain 4

It is very common for our clinic to see patients that present with pain in the front of their foot. Often times patients have been dealing with this condition for months. Most patients will describe a burning or a feeling of walking on a bubble or that their sock feels balled up. There is usually no underlying injury and many patients will have a bunion with this foot type as well. The two most common diagnosis that encapsulate forefoot pain are 1. Capsulitis and 2. Neuromas.

Capsulitis refers to a general inflammation of a joint or a joint capsule. All joints are defined by where two bones come together, that share a common joint capsule with fluid inside and both bone ends are covered with cartilage. This joint capsule, fluid and cartilage allow gliding or motion to occur. Whether the joint is being overloaded or stressed can cause irritation, swelling, pain and sometimes stiffness. The most common spot for this to occur in the lower extremity is the second metatarsal phalangeal joint. This can be quite painful and make walking and exercise difficult. Most patients with this condition have an underlying unstable foot that causes the joint to be overloaded. It is important to see your foot and ankle doctor as this condition can lead to dislocation of the toe and chronic pain.

Neuromas are an irritation of the digital nerves of the foot. Most commonly patients describe a burning or lump in the front of the foot. This pain is often worse in shoes. The neuroma is usually between the 3rd and 4th toes and more often in females than males. We do not often see an underlying condition that causes neuromas. This is usually the result of ones anatomy and not related to the overall structure of the foot. Your foot and ankle doctor can typically diagnosis this with a physical exam and an x-ray or ultrasound.

If you are suffering from ball of foot pain, capsulitis or neuromas we can help. We combine the most advanced treatment options available with recent literature and have seen great relief from conservative measures. Do not continue to suffer call us today and we can help.

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

anklesurgery1

We’ve discussed many of the things that need to be considered after foot surgery, including bunion surgery. One thing to think about is simple meal planning and getting groceries. 

There are options such as planning all your foods and meals ahead of time. Try getting premade meals such as at Costco and keep them in the freezer so you can just put them in the oven and not have to prepare a full meal. Other options could include Uber eats or having a family member pick up other food to go. You can always ask a family member to make a meal for you also. 

Don’t forget that many grocery stores have delivery options also. Amazon fresh is yet one more option. 

Planning your meals ahead of time will really pay off later when you are recuperating from foot surgery!

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

anklesurgery1

Regarding post-surgical home recommendations and ideas, don’t forget that there are things to do at home that we always forget or do not plan for. For example, taking your family members to appointments school or etc. This can be a tough one. If you’re the sole parent taking care of your children, then some people will wait until a relative or another family member can fly in to help out;  or they may live close enough where they can simply come over as needed. 

Foot surgery timing can sometimes work better with a college break - like Christmas break or summer break.   Sometimes it’s a good idea to wait to have surgery until you have enough help that all your family’s needs can be taken care of but there’s also the needs of the surgery patient themselves.  Discuss this with your surgeon, each different type of foot surgery and the recuperation and post op time off your feet or in a walking boot will be different.

If you are considering bunion surgery or other foot surgery, please let us know if you would like a surgical consultation.

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

Bunion (1)

People with a painful bunion often begin to contemplate bunion surgery. Bunion surgery is a great option for patients who are wish to relieve symptoms cause by bunions.

There are many different types of bunion surgeries. Bunion surgeries are based on the size of the bunion and the individual foot structure. The majority of bunion surgeries require and incision on the top of the big toe joint. The procedure then involves removing and realigning bone and soft tissue of the big toe joint. If any other foot issues are present, like a flatfoot, these should be fixed at the same time.

Scheduling an appointment to have your bunion evaluated is the first step. Dr. Nelson will discuss your x-rays and all of your options. He will present both conservative and surgical and help you determine what is best. Some common questions include:

-Surgery is done one foot at a time

-The majority of bunion surgeries are less than 2 hrs

-Patients are sedated during the procedure and this is done in the office

-Pain medication will be prescribed for when the nerve block wears off

-Walking without crutches is possible for most people

The recovery can vary from patient to patient. However, most people can bear weight after the procedure. It is important to follow all post-op instructions carefully. If you have a painful bunion and want to know what options are available and live in Issaquah, Sammamish, Snoqualmie, Bellevue, Seattle, Kirkland or Maple Valley give us a call so we can help.

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

From a medical standpoint, gout is one of the oldest recognized forms of arthritis dating back to the middle ages. This is often considered a disease of the well-off, because it's associated with over eating and drinking. Gout is an inflammatory disorder that often affects the big toe joint. What can occur is uric acid precipitated out of the body and builds up in joints and tissues causing pain and swelling. The primary source of uric acid is from the metabolism purines from foods we eat. Therefore we elected to focus on recognizing foods that are high in purines or can increase uric acid levels. One of the most common is sugar and all forms can increase gout reduction.

It is advisable to avoid especially sugary drinks and candies, however naturally occurring sugars found improvement but still usually have significant effect. In addition we know that processed foods as well can have an increased effect and uric acid production. Other foods that should be avoided include red meat, organs and wild game. In addition some fish like Salmon and Tuna should be limited as well. Alcohol consumption has a long-standing association with causing significant gouty attacks. Vegetables are generally considered safe. If you are suffering from big toe pain, swelling and redness we at Issaquah Foot and Ankle Specialists can help.

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

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We have discussed many things to consider after foot surgery in the previous post. There are several other things of course to think about with narcotic pain medication. Number one is to respect the potential for narcotic addiction. As soon as your pain is much reduced, you should stop taking your narcotic pain meds. You have to plan on meals and food. Remember to take narcotic pain meds with food. Make sure you drink plenty of water. It’s also good idea to plan on taking a stool softener so that you don’t get constipated with a narcotic pain medication such as docusate (Colace). A fiber laxative may also be helpful. Buy the stool softener before your surgery so you are prepared. If things get too far along don’t forget to take a suppository as another option. The most critical thing is that you need to make sure that you have bowel movements daily and you don’t get behind on this.  You should keep track of your bowel movements along with your narcotic and post op medication log.  ust add the info to your medication log.

 

If you have questions about hallux valgus bunion surgery or bunion correction, please let us know if you would like a consultation. Give us a call today at 425-391-8666 or make an appointment online.

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