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austin bunionectomy

Bunion surgery
continues to be the most common foot and ankle surgery performed and there are many different procedures available. Not all of the procedures have equal outcomes.  The most common bunionectomy performed in the United States continues to be what is called an Austin bunionectomy or a head procedure.  This type of procedure is primarily used to correct mild to moderate bunions.  This procedure has great outcomes, as patients do well ambulatorily postoperatively.  Most patients will be back to activities fairly quickly and long-term results are good as long as there are no other foot deformities.  This type of bunion procedure is fairly straightforward and can be performed in 30-45 minutes.  Postoperative protocol is easy and pain level is generally mildly and well controlled with oral medications.

The second most common type of bunionectomies are for severe bunions or people with foot instability.  These procedures usually involve more in depth bunionectomy or stability type procedures.  The most common bunionectomy for this is what is called a Lapidus bunionectomy.  This procedure involves fusion of bones on the inside of the foot and provides great correction and increased stability for the foot itself.  This procedure can often involve a period of nonweightbearing or modified weightbearing and usually takes longer to heal from within the previously discusses bunion.  However it should be noted the recurrence rate with this type of bunionectomy is much less and the long-term outcomes are are great.  Again, it is important to address other foot structure issues as these can have effect on long-term results.

If you’re suffering from a bunion or foot pain, an evaluation is essential.  Call the office at 425-391-8666 or make an appointment online today so I can help.

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

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Dr. Timothy Young
, a board-certified foot surgeon discusses, Shockwave therapy for stubborn Achilles tendinitis and plantar fasciitis. (EPAT) 

Many of our plantar fasciitis and Achilles tendinitis patients respond well to traditional therapy.  This includes appropriate gym shoes, prescription orthotics, braces, a night splint and stretching.   

However, some patients have more stubborn cases.  In these cases shockwave therapy is highly effective.  In Dr Young's experience, this can be 80–90 percent effective for patients who have not had adequate relief with the traditional treatments.  There are some cases that are so severe that we also use PRP (platelet rich plasma).   

The shockwave therapy is typically done once a week for 5 treatments.  There is no down time with shockwave therapy and there are no injections.   

The Shockwave therapy protocol includes avoiding nonsteroidal anti-inflammatories like Aleve or Advil, avoiding icing, and taking supplemental boron - 3 mg per day and collagen.  The clinical improvement after shockwave can continue to progress over 3-4 months. 

Shockwave therapy is a form of regenerative medicine.  The shockwave therapy itself is a fairly intense treatment and the targeted tissue benefits from the shockwave therapy with increased blood flow and increased local healing factors much like other forms of regenerative medicine.  The body  responds to shockwave therapy such that the local tissues respond as though there is trauma and this triggers many of the bodies own natural healing.   

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

normalfoot

Capsulitis
refers to a large group of conditions that is associated with inflammation of the joint capsule.  It is important to have a little bit background of anatomy in order to understand this pathology.  The joint is where 2 bones come together and these 2 bones are covered with articular cartilage and then these 2 bones are encapsulated by the joint sac that is full of fluid or hyaluronic acid.  These all work in tandem to provide functional smooth gliding joint.  There are many causes of capsulitis, basically it is just inflammation of the joint capsule itself.

In the foot, one of the most common areas to have capsulitis is the second toe.  A lot of times there is an underlying foot deformity like a bunion or a tight calf muscle that is contributing to the development of this capsulitis.  Additionally we do see trauma can sometimes induce capsulitis.  This condition can be quite painful and cause a significant amount of discomfort and swelling with exercise or walking.  I always recommend beginning with an x-ray in a thorough evaluation of the foot.

Treatment of capsulitis depends on the cause.  There are quite a few different options that are highly successful for the treatment of capsulitis.  In general icing and anti-inflammatory can help as well as offloading the joint itself.  However in order to treat capsulitis, it is really important to understand the root cause of the capsulitis and this is where it’s helpful to have a physician evaluate the foot structure itself.  If you're suffering from capsulitis, make an appointment today and I can help. Give us a call at 425-391-8666 or make an appointment online. 

Sincerely,

Board-Certified Foot and Ankle Surgeon and Physician

pic heel pain 4

Pediatric or child heel pain is a common condition that begins to affect most young girls between the ages of 10 and 14 and young boys between the ages of 12 and 14.  There seems to be a large correlation with previous family history where parents relate that they experienced heel pain as children.  Most kids will describe a throbbing-like sensation that is worse with activities and increases with the more they do and normally resolves with rest.  The #1 cause remains an inflammatory condition of the growth plate or what is called apophysitis or Sever’s disease.

Sever’s disease or apophysitis is very treatable condition and the early intervention easier is to recover.  Most kids that have apophysitis typically have a flatter foot or playing a sport in cleats.  I do recommend an x-ray and a thorough evaluation because there are other causes of heel pain including bone pathology like stress fractures or tumors.  Typically there will be less pain with shoes and icing can be helpful.  

If your child is having heel pain I can help.  Please make an appointment to have them evaluated and get them on the road to recovery.

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

Dr Timothy Young, a Board Certified Foot Surgeon, Talks About Supartz (Synthetic Joint Lubricant)

Dr. Timothy Young
has used this treatment for arthritis in the foot and ankle for over 10 years. This has been one the most effective nonsurgical options that we have. Supartz is synthetic joint lubricant Sodium Hyaluronate, and this is very joint and cartilage protective.

On the other hand, another common injection used by many clinics is cortisone. Cortisone can be very damaging to joints and cartilage especially with repetitive use. It can weaken the joint capsule and cartilage and over time accelerate the degenerative process. Supartz does not have these degenerative properties in fact quite the opposite, it is very protective.

Applications: Arthritis of the great toe joint is one the most common applications. But arthritis and joint pain from the ankle is another common treatment site along with other joints in the forefoot and midfoot. '

Duration: We have found that Supartz injections can provide relief and last between 6 and 12 months.

The local anesthetic is utilized initially so that there is no pain during the Supartz injection itself. Also during the Supartz injection Dr. Young utilizes ultrasound imaging to pinpoint the location and make certain that the Supartz goes directly into the joint as intended.

For a live video showing Dr. young doing a Supartz injection for great toe arthritis see youtube: https://www.youtube.com/watch?v=kZ9Rc6B8Fqc (Search: BestFootDoc Supartz YouTube)

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

Achilles Tendon

The Achilles tendon is the thickest strongest tendon in the human body.  There are more pounds per square inch going across the Achilles tendon than any other tendon.  It is important to realize that during an active gait cycle the Achilles tendon is under chronic mechanical load.  This tendon in general can become overused and is usually attributed to an increase in activity or change in activities.

The most common cause of Achilles tendon pain is what is described as watershed region Achilles tendinitis.  I encountered this in a lot of people that have begun to run or do plyometrics type activities like box jumping or jumping rope.  I encouraged people not to plunge into new activities to begin to train slowly.  With activities the changing and loading of the Achilles tendon can lead to Achilles tendinitis-type problems.  Typically this will present as pain and swelling in the Achilles tendon.  Oftentimes patients will experience increased pain that they try to push through this in addition they are at the risk of rupturing the Achilles tendon during this time.

It is extremely important that anytime a patient has Achilles tendon pain medicines evaluated by a physician.  Long-term wear and tear can delay the return to normal activities.  The longer patients have had these conditions there is a correlation with the longer it takes to recover.  Achilles tendinopathy is one of the most common pathologies that I see if with recent developments in treatment protocols patients can return to activities sooner.

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

Dr Timothy Young, a Board Certified Foot Surgeon Talks About Special Achilles Exercise Therapy

This is an extremely effective treatment for Achilles tendon problems. It's also very helpful for strengthening the calf muscle, and for improving balance. The premise of this is that you calf muscle is "firing" as it's getting longer - this is synonymous with deceleration as opposed to a normal muscle contracture where the muscle is getting shorter which is considered acceleration.

Key points:
-Use your upper body strength to raise your heal and then use your calf muscle to lower slowly. The best way to do this is with your hands supported on a high countertop and your feet on the floor with a raised forefoot
· Mild discomfort is okay.
· It is important to build up with this exercise and not do too much too soon.
· Some individuals add additional weight using a backpack
· Lower your heel slowly and it should be lower relative to your forefoot. Therefore some people would use a 1 inch block/book under the ball of the foot
· Start off with both feet simultaneously then add each foot individually.

The traditional Repetitions:
3 x 15 straight knee, then 3 x 15 with bent knee.
Frequency: Twice daily for 12 weeks

The toned down version:
Initially doing a set of 30 using both right and left simultaneously
After several weeks doing more:
An additional set of 30 on the right side
An additional set of 30 on the left side

Example below would be even better if the hands were on a high countertop
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If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online today.

Bunion
Bunion surgery continues to be the most common foot surgery United States.  Tens of thousands are performed annually.  The vast majority of these are performed in an outpatient setting less than a couple hours.  A large percentage of these patients can begin weightbearing shortly after the procedure.

Currently there is a lot of literature around the Lapiplasty which is the device to help improve bunion correction.  The idea behind the device is a 3 plane correction of the bunion this been utilized for over 6 years and on over 35,000 patients.  Lateral last he device helps to correct, cut, compress and fixate the bunion procedure.

First component of the laminoplasty is correct.  The device is utilized to correct the bunion in all 3 cardinal planes by allowing and alignment correction or making any cuts in the bone.  A second component for contact performed via sisal J which allows an average cut between 2.4 and 3.1 mm average shortening.  Third component or compresses utilized to achieve compression of the joint while maintaining the 3-D correction.  The fourth and final fixate is plate system that has been biomechanically tested for multiple complaints stability and rapid return to weightbearing.

I have had experience using the lapiplasty system.  The Lapidus bunionectomy remains one of my most commonly performed surgical procedures.  It has great power of correction for large bunion deformities and patients with significant instability.  If you currently are experiencing bunion pain and are interested in the laminoplasty I am happy to help.

Sincerely,

Dr. Brandon Nelson

Board-certified American College of Foot and Ankle Surgeons

Board-certified American College of Podiatric Medicine

heelpain

There are quite a few causes of heel pain of heel pain and it can vary by age.  We tend to break it up by pediatric meaning anybody less than 18 and adult heel pain anybody over 18.  Regardless of the age and the patient heel pain can be extremely challenging and very painful.  We see quite a few adults and children that are highly athletic and struggling with resolving their heel pain.

Heel pain and children is typically sourced to a disorder called calcaneal apophysitis.  This is a condition where the growth plate of the heel is affected.  Often times with young man this occurs between the ages of 14 and 16 and for young limited between the ages of 12 and 14.  We see a high correlation with sport activities especially cleated sports.  It is important to have an x-ray and follow-up with the foot and ankle physician in order to evaluate the other underlying causes.

Adults tend to have pain that occurs in the morning especially when getting out of bed or after activities.  We see the majority of people have often increased their exercise routine or started a new activity.  The #1 cause of heel pain and adults remains plantar fasciitis.  The plantar fascia is the main supporting network of the foot and can become tired and worn out with age.  Again it is important to seek help from a foot and ankle physician to determine whether or not this is the underlying cause.

Heel pain in both pediatrics and adults is highly treatable and early intervention is better.  The majority of these causes can be distinguished of the first visit and felt can be implemented immediately.  If you’re having heel pain please make an appointment today and I can help.

Sincerely Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

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One of the essential tools for evaluation of heel pain is ultrasound high definition imaging. With this diagnostic tool,  we can see if the planter fascia is excessively thickened and to what extent.  For example typical thickness would be 3- 4 mm. But in severe cases it can be 7 mm or even up to 11 mm thick.  This can be especially helpful when comparing to baseline or the non-symptomatic side.

In some cases there has been plantar fasciitis in the past on the non-symptomatic side or some individuals have plantar fasciitis affect on the both the right and left foot which does make baseline comparison a challenge.  So when we see a severe case of plantar fasciitis with severe thickening of the fascia then we know it will be even more resistant than typical.  That means that we have to consider some some of the treatment options for resisting cases such as shockwave therapy or PRP.  We still have to do all of the other traditional treatments for plantar fasciitis.   

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

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