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Dr Brandon Nelson, A Board-Certified Physician & Surgeon Discusses Heel Pain
Heel pain can come on very suddenly. I remember when I first had heel pain and could hardly get out of bed. That first step in the morning was brutal. It would take hours for my heel to calm down. Then every time I sat down and got back up it would start. It was a terrible cycle that felt like it would never stop. Well, this really helped me to understand how patients were feeling. It also helped me come up with a treatment protocol that speeded recovery and permanently get rid of heel pain.
Most of all heel pain is plantar fasciitis. The plantar fascia is a thick fibrous tissue that is the main supporting structure of the foot. It helps with all phases of gait. It is chronically under load and tension and is the workhorse of the foot. This is why it can be so common to have heel pain. It is believed that something like 60% of all adults will experience heel pain at some point in their lives.
The treatment protocol I developed took me years to perfect and 1000s of patients. All heel pain is not the same just as all foot structures are not the same. If you are suffering from heel pain, I can help. I have seen how painful and debilitating it can be. Make an appointment at 425-391-8666 or contact us online.
Sincerely,
Dr Brandon Nelson, A Board-Certified Physician & Surgeon Discusses Neuromas
Do you have pain and or burning in one of your feet? Have you felt like maybe your sock is balled up in the front of your shoe or you are walking on a pebble? Do you find yourself taking off your shoe and sock to rub your forefoot? If these symptoms sound familiar you could have Morton’s Neuroma. This is a common condition that presents between the ages of 40-60.
A neuroma is a condition that occurs when a nerve is irritated in the foot and can swell. This normally occurs in the 3rd interspace of the foot. This is because the large nerve in the ankle that supplies the innervation to the foot divides into two branches. These two branches are the medial and lateral plantar nerves of the foot. These then come together in the 3rd interspace and create a spot of compression. Most physicians believe that this area lacks enough space and with ambulating the nerve can become irritated and a neuroma can develop.
Once a neuroma develops it can be very challenging to get the nerve to calm down. I have seen all sorts of creative solutions by patients but there are some tried and true methods. The first seems to be offloading of a nerve. Specifically, a prescription orthotic that is custom made for your anatomy works very well. This will need to be done by a physician, a shoe store or non-physician does not have access to the correct technology or laboratory equipment nor the training. Secondly, alcohol injections provide incredible relief to the irritated nerve. There is a great long-term study that shows this is effective up to 89% of the time.
If you are suffering from what you believe is a neuroma I can help. I have seen how painful and debilitating these can be. Make an appointment at 425-391-8666 or by filling out a contact form online.
Sincerely,
Dr Brandon Nelson
American College of Foot & Ankle Surgeons
Dr. Timothy Young Discusses Bunion Surgeries Part 3
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Dr. Timothy Young Discusses Bunion Surgeries Part 3
After the surgery Dr. Young likes to keep close tabs on his patients' and their recovery. It is important that any post procedure pain is well-controlled. It is also important that they have proper instructions beforehand, so they are prepared at home when all the anesthetic wears off. This is where being a couch potato pays off. Keeping the feet elevated, using ice, and taking medication as prescribed is critical. It is also critical to protect the surgical site either using a special boot, splint, crutches, or scooter. All the presurgical advice like getting a shower protector keeping the dressing intact to protect the surgical site comes into play. At each postoperative visit, the surgical site is checked to make certain it is healing properly and that there are no signs of infection.
Post acute recovery involves:
This involves bone remodeling and healing and soft tissue remodeling and healing. Sutures are removed. Post procedure x-rays are taken to verify the correction is maintained and that the bones are starting to bridge together properly. Our patients take special bone healing supplements also. We also often work with outside physical therapy clinics to help our patients heal faster and obtain proper range of motion and strength.
In conclusion, preparing for bunion surgery requires a comprehensive approach that considers the patient’s medical history, the extent of the deformity, and the type of surgery required. A skilled surgeon will carefully plan the surgery, provide detailed instructions for pre- and post-operative care, and closely monitor the patient’s recovery to ensure the best possible outcome.
If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online today.
Dr Timothy Young Discusses Bunion Surgeries, Part 2
Dr Timothy Young Discusses Bunion Surgeries, Part 2
Operating Room Preparation
Dr. Young and his staff will prepare the operating room by ensuring that the required equipment is sterilized and ready for use. This includes special surgical instruments that Dr. Young utilizes specifically for bunion correctionsurgery along with other standard surgical instruments. Also, surgical drapes, and other materialsrequired for the surgery. Dr. Young and the surgical team will also put on sterile clothing and gloves to reduce the risk of infection
Surgical Procedure
At the time of surgery, the correct surgical location is verified. IV antibiotics are administered by the anesthesia staff. The foot is prepped by a surgical scrub tech. Dr. Young will then do a final antibacterial scrub, in combination with sterile drapes placed around the foot isolated and protect the foot from infection.
Dr. Young will then start by making incisions on the foot to access the bunion. Dr. Young is careful and meticulous going down through the soft tissue layers over the bunion. Enlargement of the bunion itself (bone) is removed. Dr. Young then performs the bunion realignment surgery. You can think of this as resetting the bones like a surgical fracture. Just like a fracture, once the new position is exactly where Dr. Young wants it, he then uses any needed combination of pins screws and plates to maintain the correction. The hardware (screws plates and or pins) is used to hold the bones in place during the healing process.
This is also where the art of surgery comes in. For example, after realigning the first metatarsal, if the great toe is still out alignment, then additional correction is necessary. This needs to be done at the time of surgery. Additional release of lateral soft tissue structures can be done. An additional procedure called an Akin can be done. There are several options, and this is where it is critical to make sure that the foot is fully corrected before the dressings go on and the surgery is complete. Dr. Young will also use intraoperative fluoroscopy (which is a form of x-rays) to verify the bones and correction are exactly where he wants them. When our patients first see their bunion correction after surgery. We want to make sure that they are happy, and that the bunion is fully corrected. This also helps to minimize the risk of recurrence of a bunion.
If you are experiencing foor or ankle pain, give us a call at 425-391-8666 or make an appointment online.
Dr Timothy Young Discusses Bunion Surgeries
Dr Timothy Young Discusses Bunion Surgeries in Detail, Part 1
Bunion surgery is a common procedure performed by Dr Timothy Young and other Foot Surgeons to correct a bunion deformity. A bunion is usually combination of the first metatarsal being out of alignment and bony bump that forms on the joint at the base of the big toe. This can cause pain and discomfort when walking or wearing shoes. The bunion correction surgery itself usually takes 1-2 hours. The surgeon’s preparation for bunion surgery requires planning ahead and, requires attention to detail. In this blog, we will go over the steps that Dr. Young and other foot surgeons take to prepare for the best bunion treatment and the best bunion surgery.
Patient Evaluation
Before any bunion surgery, Dr. Young will evaluate the patient's medical history, medications, and overall health to make sure that our patients are good surgical candidates. Dr. Young will also examine the patient's foot to determine the severity of the bunion, the extent of the deformity, and the type of bunion surgery that would be most appropriate. For example, some patients have a severe bunion deformity and require a Lapidus or Lapiplasty procedure. Some patients have extreme adaptation of the great toe joint and require a procedure that realigns the joint. Some bunions are mild and yet the joint is not flexible and for this, decompressing the joint is an effective treatment. These evaluations come from both physically examining the foot, and imaging evaluation.
Imaging Tests
The surgeon will typically order imaging tests such as X-rays, CT scans, or MRI scans to get a better understanding of the bunion’s structure and position. This information will help the surgeon plan the surgery and determine the best approach to correcting the deformity. Dr. Young uses digital x-rays which allow for precise measurements and preoperative planning that can be done right on the computer.
Anesthesia Planning
Dr. Young will discuss the anesthesia options before surgery. Dr. Young often utilizes local anesthetic combined with MAC anesthesia (monitored anesthesia with conscious sedation). Other options include general anesthesia, regional anesthesia, or local anesthesia. The type of anesthesia can be discussed prior to surgery and will depend upon the patient's medical history and the type of foot surgery and the extent of bunion surgery. With MAC anesthesia combined with local anesthetic, the patient is still conscious and breathing on their own (not intubated). This is more like a twilight sleep and the patient's recovery extremely fast, and we can avoid the typical side effects that can be encountered with the general anesthetic.
The preoperative visit:
Dr. Young's patients come in the week prior to surgery to help them prepare for surgery. We will discuss details of the surgery itself and how to care for the foot after bunion surgery and if crutches or a special boot will be required. Also, the patient's medical history and medications are reviewed. Some medications will be avoided prior to surgery. Usually, the patient will be required to fast prior to surgery and need to make driving arrangements after the procedure. Our patients are given a special antibacterial scrub to do at home prior to surgery.
If you are experiencing foor or ankle pain, give us a call at 425-391-8666 or make an appointment online.
Dr Brandon Nelson, A Board-Certified Physician & Surgeon Discusses Heel Pain That Will Not Go Away
Heel pain is by far the most common thing I see in the office. The number one cause is still being plantar fasciitis. Most patients with heel pain will have resolution of their pain within a month of seeing me. However, there is a small percentage of patients that do not get better and further work up is warranted. We call these patients the outliers or red herrings. There are about 2 main causes of outliers or red herrings. These are nerve issues, i.e., Baxter’s neuritis or a stress fracture.
Baxter’s neuritis is not as common as plantar fasciitis. It is basically an entrapment of a nerve near the heel. The nerve becomes irritated and compressed. The symptoms can be similar to plantar fasciitis. The most common symptom seems to be burning in the heel. Burning or tingling are often associated with nerve pain. Usually, a nerve conduction study is required to diagnose this entrapment. Once it is diagnosed sometimes a local injection of the nerve can help or a prescription orthotic to offload the area can be quite helpful. Baxter’s neuritis differs from a stress fracture in presentation usually.
A stress fracture of the heel bone or calcaneus both can cause heel pain however usually in different areas. With the stress fracture it is usually a constant pain that is a dull ache or throb. Additionally, there is often an increase in training that has resulted in a stress fracture. Usually, a stress fracture will require an MRI and most resolve with time and protected weight bearing. If you are suffering from heel pain, especially if it has been going on for more than a couple weeks I can help. If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online.
Sincerely,
Dr Brandon Nelson, A Board-Certified Physician & Surgeon Discusses the Best Time to Have Bunion Surgery
Bunion surgery can be highly rewarding for patients. When you have a bunion that causes pain daily or pressure in the shoe it is a great time to think about having it fixed. Having a bunion fixed these days is easy and it is done in an outpatient setting.
Timing for some patients is critical. Many patients want to plan around a certain time of year or holiday. I personally believe that timing plays a big role and when it is easier in one’s life is a great idea. What I mean is we can all be busy and certain times of the year are less busy. Or for some certain times or the year are more important to patients. If you are a big skier and winter sports are important, do it in the summer or vice versa. Timing can be crucial but planning I feel is just as important.
Planning can also be extremely important. I recommend thinking about being a couch potato for the 1st week and making sure you are prepared for that. I think it is best to have food prepared, a place set up downstairs if that is appropriate, basically a command center you can live and work in. A place with a bathroom nearby and any way you can minimize having to get up and move around. Recovery is probably the next item we should talk about after planning.
Recovery varies by procedure and what other procedures were done. It can be as quick as walking in a normal shoe in 6 weeks or more like 19 weeks. Some procedures you will need to be on crutches as needed for pain others you may need them for 6 weeks. One could be running around 3 months but others it may be longer. It is important to be patient and allow adequate healing to occur and know it can often take up to 1 year. If you are suffering from heel pain, especially if it has been going on for more than a couple weeks I can help. If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online.
Sincerely,
Dr Brandon Nelson, A Board-Certified Physician & Surgeon Discusses Conservative Care For Your Bunion
I get a lot of questions about what measures are helpful for conservative care of bunions. I think it is important to know that although there are no conservative measures that will ever reverse, fix or change the size or appearance of your bunion there are a few things you can do to help slow the progression of it. The only effective measure to ever fix or remove your bunion is surgical. There are a few things you can do to make your bunion more comfortable.
The first thing I always recommend is stretching your calf muscles. Your calf muscles impart force on your feet and lengthening them can help reduce this force. Google a couple calf stretching exercises and perform them a few times a day.
Secondly, no bare feet can be helpful. Most people that develop a bunion have a mechanically unstable foot. Wearing a sandal or slipper around the house can help slow the deforming forces creating the bunion. I like a good recovery sandal or a nice pair of slippers with arch support. Socks do not count, they do nothing to support your foot.
A prescription orthotic is your biggest help in slowing down the progression of your bunion. We are not talking about something you buy online, buy from a shoe store or some other venue. A prescription orthotic is made by a physician. This is a medical device that is often covered by insurance. This is made after a biomechanical examination of the lower extremity and gait. This is often done with a 3-D image of the foot to capture the foot structure.
Things that absolutely do not work and are a waste of money. Toe correction devices you see online. If a bunion could be fixed this way, there would never be another bunion surgery ever. Toe spacers can be helpful in reducing rubbing but again these will not fix your bunion. If you are suffering from bunion pain I can help. Give us a call at 425-391-8666 or make an appointment online today.
Sincerely,
Dr Brandon Nelson
Dr Brandon Nelson, A Board-Certified Physician & Surgeon Discusses Everything You Need To Know About Your Bunion
Bunions are primarily a genetic foot structure that is inherited from mom or dad. We see that it can skip generations as well. There seems to be a misconception that the bunion is just a growth on the side of the foot. However, this is not true. The bunion is a misalignment of the first metatarsal. It occurs when the first metatarsal separates or begins to deviate from the second metatarsal towards the other foot. This in turn causes the big toe to deviate or point towards the second digit. The growth or bump that one sees is the first metatarsal pointing out of the joint. This concept is important to understand as it will make sense when I discuss bunion correction.
Bunion correction refers to removal or reversal of the bunion. Well now that you understand it is a deviation, more correctly a progressive deviation of the first metatarsal, you can see why certain things will not correct a bunion. I have seen all sorts of strapping, taping and splinting techniques to correct a bunion. Now that it is clear this is a movement of a bone you can clearly see why none of this works. It is not possible to move the first metatarsal back into place once it has deviated via any sort of appliance or device you apply to the outside of the foot. Once the bone has moved the only option to correct the bunion is surgical.
Surgical correction of the bunion is the only way to reverse this misalignment. This is the only avenue we have to bring the big toe back into the correct orientation. There are many different techniques based on the size of the bunion and the rest of the foot structure. If you have a bunion and need help please schedule an appointment. Give us a call at 425-391-8666 or make an appointment online today.
Sincerely,
Dr Brandon Nelson, A Board Certified Physician & Surgeon, Discusses How to Heal Quickly Following Bunion Surgery
There are a few things patients can do to heal faster from bunion surgery. I will review some ideas that patients can utilize that may decrease healing time frames. Most importantly one must follow the postoperative course as directed by your surgeon. It is important to realize that 2 things need to heal following surgery: soft tissues and bone.
Soft tissues consist of skin, subcutaneous tissues and capsular tissue around the joint. These structures are primarily sutured closed and will typically have sutures in for 10-14 days depending on the site. There are a few supplements that can help to improve healing. I like to have my patients take collagen and zinc and hydrate as these can influence skin healing. Once the wound is closed I encourage the use of silicone and moisturization of the wound. Additionally it is important to start the range of motion of the toe to free up and adhesions.
Bone is the other structure that must heal after bunion surgery. Usually, a bone cut, or fusion is performed. This is dependent on the procedure but there are a few things you can do to speed bone healing. The first being additional calcium and other bone healing nutrients. I like to have my patients take a bone healing supplement and increase the consumption of green leafy vegetables. Additionally, if a bone stimulator is available this can be helpful.
Regardless of the bunion procedure these tips can be helpful in your recovery process. Take care and wish you a speedy recovery. If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online.
