Achilles Tendon

Dr. Timothy Young
, a Board-Certified Foot Surgeon, Discusses Insertional Achilles Tendon Problems
Achilles insertional calcific tendinosis. This is a common problem at the insertion point of the Achilles tendon. This very often has chronic degenerative changes within the tendon which are therefore considered tendinosis. And often times there are also calcific changes or even radiographic appearing bone at the insertion of the tendon. This is a process where the Achilles tendon becomes degenerative and over time calcified is and over a longer period of time the calcification here becomes larger and can become essentially bone, that is seen on x-ray. Regarding the cause of this condition, some of it is due to overuse, it may be due to mechanical shearing and the individuals biomechanics or sport specific. A large muscular calf and/or a tight calf definitely plays into all Achilles problems. Men seem to be more prone to this than women.

Especially very large areas of calcification with men. Although women can get a condition that similar but different called a Haglund deformity. In this case it is the bone on the posterior aspect of the calcaneus that protrudes and can be aggravated by the adjacent Achilles tendon and not intratendon calcification. In the early stages this is very treatable. As time goes on and there are large areas of calcification, they can cause chronic problems. As I mentioned, in the early stages this response to some of the classic treatments for Achilles problems. That means a special brace, orthotics to decrease the workload and side to side mechanical shearing of the tendon at the insertion point, calf stretching and related treatments, and shockwave therapy. The later stages the same treatments are often still helpful, but they may not offer full relief. These are the individuals that often require surgery. The surgery involves access to the back of the Achilles insertion point with removal of the calcific portions and then reattachment of the tendon itself. The healing process for this can be similar to an Achilles rupture. There are new anchors that help to give more reliable surgical reattachment of the Achilles to the underlying bone.

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

Dr. Timothy Young
, a Board-Certified Foot Surgeon Discusses Tendinosis

Tendonosis. A classic example of this would be Achilles tendon problems. Achilles tendon problems within what we call the watershed region which is several centimeters above the back of the heel. This is also the region that the Achilles is prone to rupture. With Achilles tendinosis there are degenerative changes within the tendon itself and thickening of the tendon. This may or may not be painful. This may or may not have involvement of the paratendon component. This does seem to be aggravated by a tight calf muscle or large muscular calf. It can also be aggravated by mechanical shearing within the tendon in this location. It can be due to overtraining or sport specific.

The most effective treatments for this include prescription orthotics to address the mechanics and to reduce the mechanical shearing within the tendon. Calf stretching and a night splint can be very effective. KT tape is a useful adjunct for this problem. Shockwave therapy is extremely helpful for this condition. Some individuals will require surgery for this. This can involve removing some of the damaged portion of the tendon, and it can also involve lengthening the tight calf muscle with the gastrocnemius recession.

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

Dr. Timothy Young, a Board-Certified Foot Surgeon Discusses Achilles Tendon Problems

Achilles tendon problems can be quite different from other tendon conditions or pathology. There can be an acute inflammation or an acute strain, or there may be a chronic condition. Sometimes there is a low-grade condition smoldering along that the individual is not aware of and finally it passes a threshold of involvement that creates symptoms and pain. There is the main central portion of the Achilles tendon which is considered the watershed region of the tendon primarily because there is not as much blood supply to this area.

Then there is the outer synovial sheath adjacent to the tendon or the paratendon. There is no typical tendon sheath with the Achilles tendon but rather a paratenon which is a lining around the tendon. This can become inflamed. This would be considered paratendinitis or paratendinosis. And finally, there is the insertion of the tendon that can become degenerative and calcified. In addition, there can be a partial tear of the tendon or a total rupture. Therefore, there can be different approaches to treatment based upon which problem is encountered with the Achilles tendon.

There may be different causes of the specific condition which can help to dictate which treatments to focus on. In general, addressing a tight calf muscle is appropriate whether it is stretching the use of a night splint or even a gastroc recession or lengthening. Other general treatments include home physical therapy, prescription orthotics and addressing biomechanics, KT tape and icing, shockwave therapy. For some individuals' surgical treatment is appropriate.

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

Dr. Timothy Young
, a Board-Certified Foot Surgeon Discusses Common Tendon Problems

Many of our patients have heard of tendon problems such as tendinitis. Over the last few years there has been some clarification of some of these tendon pathologies and conditions.
-Tendinitis is a still useful term, this typically involves the acute injury of the tendon with inflammation.
-Tendinosis is different where there is not so much inflammation as there is damage and degenerative changes within the tendon to thickening and abnormality of both the tendon and the collagen organization within the tendon itself. This can be due to chronic overuse and natural aging also.
-Tenosynovitis. This often involves the outer tendon sheath which has a synovial lining. When this lining becomes inflamed there is synovitis with tenderness. There also may be changes with the tendon itself
-Paratendonosis, there is the outer synovial sheath adjacent to the tendon or the paratendon.  There is no typical tendon sheath with the Achilles tendon but rather a paratenon which is a lining around the tendon. This can become inflamed. This would be considered paratendinitis or paratendinosis (if there is associated thickening of the tendon and degenerative changes within the tendon).
Each of these conditions can be somewhat different and can require a slightly different treatment approach. In general, we want to address the biomechanics of the individual to help decrease the workload on the tendon. Sometimes complete resting is necessary, and a cast boot may be helpful. Cross training may be possible with mild cases. Icing and anti-inflammatories can also be helpful for these conditions. There are special braces and KT tape. Many of these tendon conditions respond very favorably to shockwave therapy. PRP can be another treatment. The whole goal is to restore normal pain free activity and tendon function.

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

Bunion xray

The bunion deformity is an inherited foot structure issue.  Most people that develop a bunion have a family history of bunions.  They usually have a parent or grandparent that has a similar type of foot or foot problem.  The foot structure that predisposes one to a bunion can be inherited.  Usually this type of foot is more prone to flattening or pronating and this over time can result in a bunion. There are other factors that can accelerate the development of a bunion as well.

Wearing high heel shoes has been shown to put more pressure on the forefoot and therefore speed up the process of developing a bunion.  Additionally any exercise that puts increased force on the foot can technically speed up the growth of a bunion i.e. running, jumping or similar exercises.  The bunion develops as the body tries to stabilize the foot with these activities.

The bunion is a shifting of the 1st metatarsal bone to try and control abnormal flattening of the arch.  This is one of the first adaptations the body utilizes.  Patients often think there is a growth of bone at the site but technically it is the bone shifting out of place that occurs and creates the illusion of something growing.  This is why there are no conservative measures that can move the bone back into correct alignment and why surgery is the only long term fix.

Surgery for bunion surgeries has really changed in the last couple decades.  New techniques allow for a much faster recovery and healing times.  If you have a painful bunion or would just like a consultation on bunions in general I can help. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,Dr Brandon Nelson

heel pain out of bed in the morning

Waking up in the morning is hard enough.  It becomes even harder when you have pain with putting your feet down.  Morning pain or first step pain is usually an indicator of plantar fasciitis.  I am going to briefly describe why we get it and what we can do to relieve it.

When we sleep at night our foot and ankle are in a plantar flexed position.  This means our foot is bending forwards as well as our ankle.  Positioning like this creates soft tissue relaxation.  Specifically our Achilles tendon and plantar fascia have decreased tension on them.  This allows tightening of our tissues and as we sleep the inflammation from the previous day settles in.  Then as we place our foot on the ground to step out of bed we stretch and place load on the plantar fascia and the Achilles tendon.  This causes pain and discomfort immediately and leads to a cycle of inflammation.  There are a few tricks you can do to help this.

Morning pain can be alleviated and here are a few ideas to help;

1.     Before you get out of bed, write the alphabet with your toes.  This will help loosen up your tissue and stimulate blood supply and lubrication of those tendons and fascia.

2.     Stretch, start with stretching in bed work on your posterior chain.  It can be quite helpful to stretch your Achilles and your fascia.

I do think it is important to seek a physician before starting any of these options.  It is essential to get a proper diagnosis and treatment plan.  If you are having heel pain I can help. If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online today. 


Dr Brandon Nelson

Bunion xray

Bunion surgery
for me is a very exciting procedure to perform.  I really enjoy fixing a large bunion and seeing the satisfaction on a patient's face.  Bunions can be debilitating and really interfere with life.  They make activities painful and are frustrating when buying shoe gear.  I have now been fixing bunions for 15 years and have truly begun to love the Lapiplasty.

The Lapiplasty is an exceptional procedure for patients that have large bunions.  It really has helped to create better outcomes and improved techniques for bunion repair.  The Lapiplasty is based on the Lapidus procedure first described by Dr. Paul Lapidus.  The procedure was popularized by Dr. Sigvard Hansen who was a local physician in Seattle.  Some of us had the pleasure of meeting Dr. Hansen and spending time with him.  He was truly an amazing physician that helped all of us foot and ankle surgeons.

If you are contemplating bunion surgery I would love to discuss your options with you.  It is important to get an x-ray and to see a surgeon that performs a lot of bunion procedures.  It is also convenient that at my practice we have an on-site surgery center.  Having our own surgery center is extremely valuable to patients as it is not affiliated with a hospital or an ASC and therefore saves each patient thousands of dollars in comparison to having it done at one of the above locations.  If you have a bunion I can help get you back to normal shoe gear and activities. Give us a call at 425-391-8666 or make an appointment online today


Dr. Brandon Nelson

austin bunionectomy

Bunion surgery is one of the most common surgical procedures in the United States.  It is usually performed in an outpatient setting and no overnight stay is required.  The majority of bunion surgeries take less than 2 hours and have great long term outcomes.  The most common bunion surgery is an Austin bunionectomy as it is called. It has been utilized for almost 100 years and is a powerful tool in bunion correction. 

The Austin bunionectomy traditionally involved a cut in the 1st metatarsal head.  It was cut from medial to lateral in a chevron type fashion.  This allows for correction of the abnormally aligned joint and removal of the bunion.  It usually involves some sort of fixation to hold the bone in place like a screw or a pin.  Some surgeons require a period of non-weight bearing and typically 3 months before back to normal activities.`

I personally have performed this type of bunion surgery 1000’s of times.  I like to make a longer arm with my but on the bottom of the bone as opposed to a chevron style cut.  This allows for a more rigid fixation and faster recovery.  The typical patient can return to activities at 6 weeks. 

If you have a bunion that is causing pain and want to have minimal downtime give me a call and I can review all your options.  Remember I have an onsite surgery center that saves thousands as compared to having your procedure at a hospital or ASC.


Dr Brandon Nelson

Achilles Tendon

Heel pain
is by far the most common pathology I see in the office.  It is so common among adults it is estimated that 1 out of every 4 currently are experiencing heel pain.  It is also postulated that 60% of all adults will have heel pain at some point in their lives.  It is important to understand the causes of heel pain and when to seek professional help.  The most common causes are plantar fasciitis, Achilles tendon issues and nerve entrapments or irritation.

Plantar fasciitis is by far the most common cause.  It often is described as a dull ache or bruised sensation.  This is usually on the bottom of the heel.  Plantar fasciitis can be painful in the morning, first step pain, or after activities.  One of the most common presenting symptoms is pain after any period of rest.  Plantar fasciitis is an overuse injury and I recommend always seeking physician input on this one as you may develop tearing in the fascia with increased symptoms.

Achilles tendon issues can also present with pain in the heel or around the heel.  The Achilles tendon is the thickest strongest tendon in the human body and it is constantly under load.  It is therefore prone to developing issues especially in physically active individuals.  The Achilles tendon type pathologies often have swelling or sharp shooting pains near the heel.  Again this is one to seek help early as the average recovery of Achilles tendon issues can take 4-6 months. 

Nerve entrapments of the heel or Baxter’s neuritis or tarsal tunnel syndrome often have burning or electrical type symptoms.  There is a correlation with other nerve issues in the body like neuropathy or carpal tunnel or fibromyalgia.  Nerve issues are an urgent matter and early intervention is key so do not wait on these ones.  I recommend immediately making an appointment.  The nerves usually require testing to identify and prevent long term damage. 

If you are having heel pain I can help call and schedule an appointment today. Give us a call at 425-391-8666 or make an appointment online


Dr. Brandon Nelson  

ankle knee pain

Dr. Brandon Nelson
, A Board Certified Physician & Surgeon, Discusses Ankle Pain

Ankle pain is a large topic to discuss in a blog but I will focus on two of the most common causes.  The vast majority of ankle pain follows an injury like an ankle sprain or an ankle fracture.  When looking at an ankle sprain the most likely long term causes of pain are soft tissue issues.  When looking at ankle fractures with time bone or joint pathologies can occur.  Let us take a look at a common ankle sprain and what can be the long term results of untreated sprains.

Ankle sprains are one of the most common injuries that occur in the lower extremity.   The vast majority of sprain occurs in an inversion type fashion or a rolling in of one’s foot.  This puts a lot of strain on the ligaments and tendons on the outside of the ankle or the fibular side.  We often see ligament tears or tendon tears that develop. These can lead to pain with activities or with certain movements.  It is important to seek the help of a foot and ankle physician early with ankle sprains.  It is amazing the amount of issues I see that could have been avoided by seeing a physician when the sprain occurred.  It seems that the adage of “PRICE” or protect, rest, ice, compress and elevate just does not provide enough healing for athletes or active patients.

Ankle fracture on the other hand usually does seek medical intervention.  It really depends on the type of fracture some patients will require surgery to realign the bones and some will do find with just a period of non-weight bearing.  Ankle fractures usually have higher trauma velocities and therefore can cause more damage to the bones.  One of the most common long term effects of a fracture can be arthritis.  With fractures you can change the weight distribution in joints and over time this can wear away cartilage.  Having all fractures evaluated by a medical professional with experience in that area is key.

I cannot express the importance of early intervention and seeking the advice of a foot and ankle physician will improve outcomes and long term functionality.  If you have had an injury or are currently injured I can help.

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


Dr Brandon Nelson

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