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Dr. Timothy Young
, board certified foot surgeon discusses maximal recovery after an ankle sprain  

How does a runner know when they’re fully recovered from an ankle injury? 

Ankle sprains often in result in total or partial tearing of the ankle ligaments. 

Most commonly this is the anterior talofibular ligament or ATF ligament. 

For third degree sprain remaining off the ankle for 3-4 weeks is ideal.  What about after that timeframe. Wearing a brace initially to protect the ankle from repeat injury is helpful and physical therapy can be helpful.  Other rehabilitation options include using a stationary bike or aqua jogging.  Balancing exercises or proprioceptive exercises are also helpful. 

But when do you know when you can return to running such as trail running 

Sometimes it is knowing when you have a confidence than your ankle will hold up over uneven terrain.  A very good benchmark for knowing when you can return to running and especially trail running, is when you can run up and downstairs without grabbing the handrail.  Your body unconsciously is giving you a " go ahead". This is a crude but actually very accurate indicator of when you have adequate strength and recovery in the ankle and confidence in your proprioceptive - balance reflex. 

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

heel pain out of bed in the morning

Pediatric heel pain
or kids with heel pain are a common presentation.  This heel pain is often correlated with the start of new activities or any sport season.  The most common sports that heel pain occurs with children are basketball and soccer.  Basketball seems to make sense as the hardwood floor can be tough and with soccer cleats seem to be an aggravating factor.  It is important to have your child properly evaluated for heel pain, however the most common cause is inflammation of the growth plate.  These growth plate issues are easy enough to diagnose based on clinical evaluation and radiographic findings.  It is important to have x-ray heel pain because there are other causes and the treatment is tailored towards the specific pathology.  Traditionally with proper implementation of a treatment plan, heel pain is usually amenable to conservative measures including clear fairly quickly.

Adult heel pain by far is most commonly caused from plantar fasciitis.  Plantar fasciitis usually involves an inflammation of the plantar fascia or the supporting network of the bottom of the foot.  There are many common clinical symptoms that we see each year including pain after rest or burning throbbing type sensation of the heel.  Typically for adults this heel pain starts in one heel and gets worse with activities and time.  Again it is important to have a thorough workup including radiographs or ultrasound examination of the heel.  I believe it’s important to get in and see a foot and ankle physician fairly early in this process as this makes treatment easier.  Again the majority of patients with this pathology clears up with conservative measures and returned activities.

If you suffer from heel pain or trauma suffering from heel pain I can help.  Please feel free to contact the office and we will get you back on your feet pain-free. Give us a call today at 425-391-8666 or make an appointment online today. 

heelpain

Important distinction should be made between both acute and chronic heel pain.  Most physicians consider acute heel pain something that is 4-6 weeks old in nature and still has the ability to resolve on its own and often doesn’t take a lot of intervention.  These are the typical patients I can ice and stretch and find a fair amount of relief.  However there is a different category of patients ones where the heel pain becomes chronic and these are much harder to treat.

Chronic heel pain is usually described as anything over 6 weeks in nature and oftentimes fairly debilitating.  I see quite a few patients that often times have heel pain that has been around for more than a year and regardless of stretching and icing.  Chronic heel pain is a different animal and normally requires some sort of biological intervention.  I think it is important to address the nature of the chronic heel pain and an MRI to evaluate whether or not a tear is present can be highly beneficial.

If you are suffering from heel pain and this has been going on for months to years I can help.  First it is important to identify the underlying causes and at this point implementing a treatment plan that can be curative. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician

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Dr. Timothy Young, a board-certified foot surgeon, discusses the latest treatment for painful plantar warts.
Plantar verruca or plantar warts are one of the more common problems that we see at our clinic.  The are a number of different treatments for plantar warts. This ranges from some home treatments and home remedies to more consistent medical procedures.  Some of the more common medical treatments would be topical freezing or liquid nitrogen, Cantharone treatment  (beetle juice) and surgical removal.  

Our clinic has acquired a Swift laser device specifically for persistent plantar  verruca.  We have over 12 months experience with this and has been very effective for verruca treatment.  This is one of the fastest treatments and does not require injections or surgery.  There is no open wound.  Typical treatments are done at 3–4 week intervals.  Now that we have this treatment option it is rare to need more aggressive treatment such as surgical excision.  We do have one more treatment option at our clinic and that is bleomycin injections.  Plantar warts have their own blood supply through a process called angioneogenesis.  The bleomycin targets the additional vascular network that verruca have and therefore the verruca are not able to continue being viable and a blood blister forms and the verruca resolves.  If you have are resistant plantar wart please let us know.

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

Mortons Toe

Morton’s neuromas
or interdigital neuromas are usually from a compression of the nerves in the front of the foot.  Oftentimes characterized as burning or pain that’s exacerbated by walking or tight shoes.  A number of different etiologies have been described to decrease blood supply progression to irritation from bursa or the intermetatarsal ligament.  The majority of these neuromas occurr in the third interspace, about 70% of the time and in the second interspace about 30% of the time.  It is most common to have a single neuroma however some patients have multiple neuromas.  There are multiple studies on the best conservative measures.

Conservative measures range from orthotics, footwear adjustments, corticosteroid injections, alcohol injections, radiofrequency or even cryoablation.  Conservative management continues to be the mainstay of neuroma therapy.  Oftentimes it can take months before your neuroma feels better depending on the size and location.  There are a few people that have multiple Morton’s neuroma and an MRI can be highly valuable.

Surgical management usually consists of removal of the nerve.  This is generally done to the top of the foot and has a fairly short recovery as compared to other foot and ankle surgeries.  Sound physicians go to the bottom of their feet just depending on experience and discomfort levels.  The overall success rate with surgical management is high, if conservative measures have failed, it is the appropriate next step.

If you’re suffering from neuroma pain make an appointment today and I can help. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

heel pain out of bed in the morning

Capsulitis
and metatarsalgia are generic terms for pain in the front of the foot or what we call forefoot pain.  This pain is often described as burning tingling or numbness or stabbing pain that increases with activity or ambulation.  There doesn’t have to be a history of any trauma or previous injury however there usually are other foot problems that are present.  These other problems can include a bunion or a tight calf muscle or deviated toes.  These can contribute to forefoot overloading which ultimately lead to capsulitis or metatarsalgia.

Capsulitis typically refers to inflammation of the joint for multiple joints in the front of the foot.  Often times this joint is the second toe and can begin to swell increasing irritation around the joint.  As the swelling gets worse it can begin to push on the nerves in the front of the foot and present with increased numbness and tingling that can often mimick neuroma.  Neuromas are not typically in this location are more common in the third, however it is important to differentiate between the 2 as the treatment is different.

Metatarsalgia is more of a generic term for pain in the metatarsal bones.  There are 5 metatarsal bones in the foot and typically the first metatarsal can cause pain and irritation.  It is not uncommon to have arthritis in these joints that can also cause a great deal of pain.

I recommend anybody with forefoot pain make an appointment to decrease the likelihood of continued or progressive pain. Give us a call today at 425-391-8666 or make an appointment online.

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician

1600px Toes

Arthritis of the big toe
or sometimes called hallux limitus or hallux rigidus involves degenerative arthritis of the big toe.  It often presents as pain and swelling in the big toe and even limited range of motion.  Patients often have a history of any injury like a turf toe type incision where the majority of the time this is genetic in origin.  This typically starts from an anatomical misalignment or elevated first metatarsal where long-term jamming of the joint and pain and swelling begins.

The treatment options from a surgical aspect involves joint preserving procedures.  Joint sparing procedures involve trying to increase the life of the joint.

Joint sparing procedures typically have consisted of cleaning up the joint which is very commonly called a cheilectomy. This can be done for early type arthritis.  This has all been considered were course of early intervention and has had great outcomes.

Joint destructive procedures typically involve the use of implants or fusion.  Implants of the big toe joint have fallen out of favor and are not utilized by many physicians. The stays and fusion continues to be the mainstay.  However there are other options that become available, depending on the patient's needs.  There are some physicians that advocate what is called an interpositional arthroplasty which seems to work well and provides some space in the joint to provide cushioning.

If you have big toe pain I am happy to help make an appointment at our office and we can see whether conservative or surgical options are warranted. Give us a call today at 425-391-8666 or make an appointment online today

Sincerely,

Brandon Nelson 
Board-Certified Foot and Ankle Physician and Surgeon

bunion1

Bunion surgery
has progressed significantly since its inception. Years ago, it was not uncommon for patients to stay overnight in the hospital if they had bunion surgery.  Often times patients would spend days in the hospital and be in a cast and nonweightbearing for months.  However this is a very rare occurrence these days and the majority of procedures are performed in an outpatient setting and very rarely is there an extended period of nonweightbearing.  This evolution of bunion surgery has allowed for minimally invasive surgeries to become more commonplace.

Minimally invasive refers to making significantly smaller incisions than we’ll we typically do for bunion surgery.  The average bunion can now be performed with minimally invasive surgery through an approximate 2 cm incision.  The advantages of minimally invasive surgery is it allows for a quicker recovery and increased healing capacity.  The majority of people will heal more quickly than the traditional open bunion procedure and will have less pain.

It is important to note that not every patient is a candidate for minimally invasive bunion surgery as it depends on other factors including overall foot structure and size of the bunion.  It is important to have a thorough evaluation and workup for considering bunion surgery, any type of bunion surgery including minimally invasive.  If you’re having bunion pain please contact my office and we will be able to get to an appointment and have your bunion evaluated. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

Board-certified Foot and Ankle Physician and Surgeon

Bunion xray

A bunion is a common forefoot condition that can be characterized by mild, moderate or severe and defined as a deviation of the big toe in the lateral direction.  This condition is progressive and can lead to pain and discomfort with walking and exercise. Conservative measures are not usually successful. The traditional approach consists of an open incision and dissection of the foot that involves balancing of soft tissues and bony deformities.  The procedure itself is highly successful but there is question as to whether more minimally invasive type accessible.

Minimally invasive bunion surgery has been around for years and as this technique is getting better, this becomes more of a promising type procedure.  The literature is full of different types of minimally invasive bunion surgeries that can be used correct the foot.  Some of the most promising new or techniques utilize screw or pin fixation and has become highly successful.

All done under direct live x-ray and results have been extremely positive.  Majority of patients are weightbearing immediately after surgery and can return to normal shoes in 3-4 weeks.  This is because of the soft tissues had minimal interruption and vascularity preserved.  Minimally invasive bunion surgery shows promising results and can provide a fast return to activities.

If you’re suffering from bunion deformity and would like to discuss minimally invasive bunion procedure, call 425- 391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson
Board-certified Foot and Ankle Physician and Surgeon

Ingrown Toenail

Ingrown nails
can be extremely uncomfortable.  They are caused from a bacterial infection typically in the big toe.  Often times patients will have a history of ingrown toenails or family history of ingrown toenails.  It is important to not try and treat ingrown toenails at home as this typically will make the infection worse.  Ingrown nails themselves typically present as pain and swelling along the border of the toenail where the skin, patients will experience some drainage from the site and is often painful at times.

I recommend patients are evaluated when their nails are sore, red, thickened or painful with walking.  There are many different options for treating an ingrown nail however typically the offending nail border has to be removed.  Once removal is performed the procedure of choice is really dictated by the number of ingrown toenails the patient has experienced.  The two options are an incision and drainage or what is called a matrixectomy.

Option one or incision and drainage involves removal of the offending nail border.  This is typically done on just the side that is painful.  Prior to removal the toe is anesthetized, cleaned and sterile prep.  Nail is then removed with the hemostat appendicitis, flushed and covered with a sterile compressive dressing.  Typical recovery from something like this is patients can return to activities the next day or so once a day for 1 week.

A matrixectomy involves a similar technique as described above.  However once the nail is removed the nail cells are cauterized to prevent them from growing back.  Matrixectomy is a procedure specifically designed for someone that has a history of recurrent ingrown toenails or long family history of ingrown nails.  The patient’s toe will be red and sore often times for 2-3 weeks after the procedure.

If you’re experiencing painful swollen digit please give me a call today and I can help 425-391-8666, or make an appointment online. 

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

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