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1600px Toes

The big toe or 1st metatarsal phalangeal joint is one of the major weight bearing joints in the foot.  It is utilized in the normal gait cycle and normal supports approximately 80% of the body weight with each step.  With the average person walking 110,000 miles in a lifetime this can be quite a challenge if you are experiencing toe pain.  There are a few major causes of toe pain and we will discuss a couple today, arthritis and bunions.

Arthritis of the big toe is caused from normal wear and tear of the joint or from a sustained injury.  This can result in losing cartilage in the joint and a person begins to experience pain and swelling.  The toe joint can often enlarge and every step can become painful.  An x-ray is extremely helpful in establishing a diagnosis and a treatment plan.  This is a common pathology of the 1st MTPJ that causes arthritis called Hallux Limitus.  This is a result of abnormal pressures in the joint and can progress with time.  There are quite a few options available to help this condition.

Bunions are another common reason a big toe can be painful.  With a bunion you will see the toe is deviated and often appears to have a large bump.  Most people will have a family history of bunions.  Bunions as well become larger with time and increasingly painful.  Again, an x-ray can be helpful for coming up with a treatment plan.  A large majority of bunions end up requiring surgery to fix.

If you are having big toe pain, I can help. Give us a call at 425-391-866 or make an appointment online today. 

Sincerely,

Dr Brandon Nelson

Bunion (1)

We know that bunions are an inherited trait that can be exacerbated by activities and shoe gear.  Patients can have a bunion on the inside or outside of their foot.  The typical bunion is on the inside of the foot and involves the 1st metatarsal while the bunion on the outside of the foot involves the 5th metatarsal.  Either pathology can often require surgical intervention in order to provide long term relief and the primary surgery is usually the bunion on the 1st metatarsal.  The bunion will usually dictate the recovery and the bunion on the 5th metatarsal usually heals faster.

Bunions are typically fixed in a few ways, either a surgery at the head of the metatarsal or the base of the metatarsal.  It is important to get an x-ray to examine the overall foot structure to make sure there are no other driving forces that need to be fixed.  The typical foot structure we see with a bunion on both sides is a flat foot that has progressed with time.  The foot often widens when a flatfoot is present to try and create more stability.  The flatfoot may or may not need to be addressed.

Most bunion surgery patients will be walking the entire time after surgery and can continue with modified exercise.  I utilize techniques that allow my patients to be more active and recover faster.  It takes years and hundreds of patients to perfect these techniques and dealing with athletes has allowed an advantage to improve on outcomes.  If you are having bunion pain please make an appointment and I will see how we can best help you. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

Board Certified Surgeon & Physician

heel pain out of bed in the morning

Heel pain
is the most common presenting pathology at my practice.  In general, I would say 1 out of every 6 patients is for heel pain.  This can be common for both adults and children.  The adult usually has heel pain that is caused by plantar fasciitis and for children this is usually apophysitis or Sever’s disease

Adult heel pain is common as one starts an exercise program or as our mileage on our feet increases.  The symptoms usually begin with pain in the morning or after a walk.  The feeling is often described as a bruised sensation or a burning pain.  It is important to identify the underlying causes and address these.  I do think an x-ray is warranted and the earlier the treatment the better. 

Children usually seem to have heel pain between the ages of 10-14.  The typical child has been playing sports, especially cleated sports.  They usually describe a soreness that can result in limping.  It is again important to take an x-ray and for underlying foot conditions. 

Both plantar fasciitis and apophysitis seem to be most common in certain foot structures.  These include flatfeet and tight Achilles’ tendons.  I recommend stretching the calf for the tight achilles.  However, the flatfoot needs to be thoroughly evaluated to prevent long term issues.  I really enjoy treating both of these conditions and have great long-term protocols to eliminate this pain once and for all.

If you or your child is suffering from heel pain please call so I can help. Make an appointment online or give us a call at 425-391-8666. 

Sincerely,

Dr Brandon Nelson

Board-Certified Foot & Ankle Physician & Surgeon

austin bunionectomy

Bunions
can be quite painful for many people.  They can begin to interfere with activities and make exercising difficult.  Additionally, it can become difficult to find shoe gear that fits properly.  Most bunions are a genetic condition that is inherited and develops with time and loading of the foot.  Many bunions get bigger as time goes on and eventually require surgical repair.  Surgery for a bunion can be broken down into two categories what are called head procedures and base procedures.  Today I will only discuss a base procedure as this seems to be the most common question lately.

Base procedures are often used for large bunions and can be a powerful tool to correct the foot.  The base procedure is usually further divided into joint sparing procedures and joint destructive procedures.  The most asked about procedure currently is the Lapiplasty.  The Lapiplasty is a procedure based off a technique described by Paul Lapidus.  It involves removing a joint in the foot that is the apex of the bunion deformity.  The reason this procedure is so effective is it eliminates the primary cause of the bunion, the hypermobile joint that initiated the development of the bunion.

Lapiplasty is a tool set that is provided to make the Lapidus bunion surgery easier.  This is a technique that has been utilized for years however this instrument set is the first of its kind and has helped make this procedure more reproducible.  This is the most common bunion procedure I execute as it has great correction and great long-term outcomes.  If you have a bunion and would like a consultation, make an appointment today and I can help.

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

Sincerely,

Brandon Nelson

Board Certified Physician and Surgeon

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Dr. Timothy Young, board certified foot and ankle surgeon, talks about hallux limitus surgery for arthritic bone spur removal of the great toe.

Arthritis of the great toe is very common. Usually there is excessive compression on the top of the joint, and over months to years, painful bone spurs or osteophytes can develop. These create even more pressure and pain, and there is often bone on bone contact between these bone spurs. Removal of the bone spur is a very effective treatment for this problem. This surgery is called a cheilectomy. Cheilectomy surgery for arthritis of the great toe is quite straightforward and has a rapid recovery. Cheilectomy surgery is the most basic and simple procedure, from a surgical perspective for this condition.

There are more and fall procedures that can be done such as a decompression osteotomy of the bone, or fusion of the joint. These procedures usually require significant additional protection and recovery time. The surgical procedure itself involves access to the joint with an incision through the tissue layers including the joint capsule. The bone spurs are then exposed and removed surgically. This also involves using a surgical bur to smooth down the top of the joint. It is quite common to fine small loose fragments of bone, which are also removed during the procedure. If there are loose flaps of cartilage, and failure removed and the exposed bone can be drilled to create a fibrocartilage patch.

The joint and wound is flushed and then the layers are repaired and sutured. Recovery involves using a surgical shoe or cast boot. Initially putting weight on the heel for the first few days, and after that for weight with a surgical shoe or cast boot works well. Sutures are typically removed 2 weeks after the surgery. Most of our patients stay in the boot for 3 weeks.

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

hammertoe


Hammer toes
are a condition that affects usually multiple toes in the foot.  This condition can occur on one foot or both.  It is often part of an overall deformity of the foot for example a bunion with hammer toes is common.  There tends to be a family history of hammer toes and pain can begin as the condition worsens.  Often patients will present with pain from shoe gear rubbing or pain with activities like running.  The hammer toes are a progressive deformity and I encourage early intervention to manage the deformity.

The most common cause of hammer toes is the foot trying to stabilize itself.  Often the long flexor tendons of the foot are working to create an arch or support the arch.  Patients often have a flatfoot associated with this pathology and the hammer toes start to progress as the foot becomes flatter.  The foot works hard to try and stop the flattening and the flexor tendons begin to overpower the digits.  The digits begin to curt and hammering is the result. 

The only long-term fix of hammer toes is surgical.  The procedure itself is relatively straightforward and quick.  It involves removing a piece of bone and often lengthening a tendon or releasing some soft tissues.  It is a stepwise approach to the hammer toe that provides the best long-term outcomes.  I have patients that choose to have it done with just some local anesthetic and the recovery is uneventful.

If you are suffering from curling digits and need an evaluation I can help.  Please contact the office at 425-391-8666 or make an appointment online today.

Sincerely,

Dr Brandon Nelson

Board Certified Physician and Surgeon

achilles20tendonitis20pain

If you are an athlete at some point you have probably experienced Achilles tendon pain.  Most people will have this type of ankle pathology after starting a new program or ramping up their current workout schedule.  I personally have dealt with some insertional Achilles tendon pain and will give some insight as to what can be done to get you back to full speed.

It is important to know that the Achilles tendon is the biggest, thickest and strongest tendon in the human body.  It has more pressure per square inch than any other tendon and is constantly under load and tension.  Every time you step the Achilles tendon fires so it rarely has an opportunity to relax.  This is the primary reason it is common to have tendonitis in this location.

Other factors contributing to this can be related to training issues or foot structure issues.  Training issues are usually related to plunging into new techniques or training to hard.  It is important to build up to new levels and allow adequate recovery to prevent tendonitis.  I also am a big proponent of stretching and icing as this can speed recovery.  Foot structure or anatomical design can also have a role in this pathology.  Oftentimes patients will have a tight calf that they were born with.  It is important to establish a stretching protocol that encourages at a minimum of 3 times a day.  Other foot structures that cause Achilles issues are high arched feet or the cavus foot.  These type of feet tend to overload the Achilles. 

If you are suffering from Achilles tendon pain I can help get you back to full speed.  Give us a call today at 425-391-8666 or make an appointment online

Sincerely,

Dr Brandon Nelson

Board Certified Foot & Ankle Physician and Surgeon

austin bunionectomy

Bunions
can become quite painful and make walking or exercising difficult.   Additionally, shoe gear can become increasingly hard to find as the foot begins to widen.  Most bunions are genetic in origin, however shoe gear and increased pressure can cause an acceleration of their growth.  It will usually get to a point where one needs to consult a bunion expert and come up with a management plan.  I normally consult on more than a few bunions per week and can help patients make decisions with what would be best with there current situation. 

Conservative care may be an option for some people.  I have taken over 10 years and developed a protocol that can provide significant pain relief and help slow the progression of a bunion.  I typically will start with an x-ray and then go through all the options available for an individual patient.  Even if you have seen another physician, it can be quite helpful to have a second opinion.

Surgery is also an option that can work very well for some people.  I believe the most important step in this process is what a patient’s goals are.  It is important to note the only way a bunion can be reduced in size is surgical.  There are many different surgical options, and I will always take you through what is most appropriate in your circumstances. 

If you have a bunion and would like a consultation, please call and schedule one today.  I look forward to helping you.

Sincerely,

Dr Brandon Nelson

Board Certified Foot & Ankle Surgeon and Physician

Bunion xray

Bunions
are by far the most common surgical procedure I perform.  At this point in my career after practicing more than 10 years, I have performed thousands of bunion procedures.  Bunion surgery itself is a highly successful procedure that has great outcomes and patient satisfaction.

The 3-D bunion correction or lapiplasty is a great tool that has accelerated the bunion surgery techniques.  I find the procedure itself can be easily reproducible and has great long-term success.  This is a great tool for large bunions and for patients that have had long-standing bunion deformities.  It is important to see somebody but has experience performing this technique, because there are some technical challenges.

The Lapidus or lapiplasty is a most common bunion procedure I perform and I have found it to be extremely powerful surgical tool.  If you have a long-standing bunion deformity and have had pain and irritation and are contemplating surgical reconstruction please make an appointment.  I will happily review your x-rays and possible surgical options.

Sincerely,

Brandon Nelson

Board-certified Foot and Ankle Physician and Surgeon

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Dr. Timothy Young
, a board-certified foot surgeon, discusses evaluation of bone healing status

How does your surgeon know when bone healing is adequate for unprotected weight-bearing for example if you have had bunion surgery and the bones were cut (osteotomy), then it’s important to stay in a protected boot or surgical shoe until there’s adequate bone healing. Typical bone healing takes approximately eight weeks for a healthy adult that can be less for young adult or teenager.  X-rays can be helpful.  A CT scan also can be helpful but can be quite expensive and often has artifact due to retained hardware causing magnetic interference with the imaging.  One additional tool that I like to utilize is ultrasound imaging. 

Ultrasound imaging can show subtle areas of bone bridging that you cannot see with a conventional radiograph.  X-ray findings often lag behind the actual bone healing status.  So, determining bone healing is always a challenge and based on a number of different indications such as age and health of the patient, appearance of x-rays, and post operative time frames.  Oftentimes I can get a better assessment of the actual bone healing by utilizing ultrasound imaging.  This often allows me to have our patients get out of their boot or cast earlier and then if I had to rely on x-rays alone.

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

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