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Dr. Timothy Young
, a Board-Certified Foot Surgeon, Discusses Children's Foot Problems

Today we are discussing a lump or bone that sticks out on the inside of the foot near the ankle joint. This is the navicular bone. The navicular bone can be enlarged or have an extra bone (accessory navicular). In both these cases, there can be a significant firm bony protrusion in this part of the foot. This can be painful just from direct pressure. This can also be painful because there is an important tendon that attaches to this bone to help support the foot. This is the posterior tibial tendon. Its job is to help provide support both medial and vertical support to the inside of the arch to keep it from collapsing and to help stabilize the entire foot.

This attachment point can be overstressed with a pronated low arch foot structure. Basically the tendon has to work too hard and there can be pain and inflammation with the tendon attaches to the navicular. In other cases the tendon attaches to the accessory navicular bone which then attaches to the main navicular bone. This weakens the attachment point and creates more potential problems. In some cases, the accessory navicular has to be removed. This foot surgery procedure is called a Kidner procedure and is done at approximate 13 years of age with a range of 9 to 16 years of age for children. This is sometimes done in adults also. When the accessory bone is removed and the tendon is repaired it often improves the mechanical function of the tendon at this point. It also eliminates the inflamed and symptomatic accessory bone. The accessory navicular very common and is present in approximately 5-10% of the population. For milder cases, ankle braces orthotics and athletic taping can all offer some symptomatic and functional improvement with the painful accessory navicular.

If you or your children are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online today. 
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Dr. Timothy Young
, Board-Certified Foot Surgeon, Discusses Painful Bumps and Bones That Stick Out on Children's Feet

We see a lot of children at our clinic. There are a number of different problems that they come in for. A common complaint is a painful bone that sticks out on the inside of the foot or sometimes the outside of the foot. On the inside of the foot or medial aspect it may be that they have the beginning of a bunion or juvenile bunion. This is similar but often more aggressive than the adult form of a bunion involving prominence of the first metatarsal head. Further back on the foot on the inside (medial) aspect the navicular bone often has an accessory bone or accessory navicular.

Up to 10% of the population may have this. Also the navicular bone itself even without the extra or accessory bone may be quite prominent. This is much more of a problem in children that have low arches/hyperpronation or flat feet. The posterior tibial tendon that attaches this location is at a strong mechanical disadvantage. On the outside or lateral aspect of the foot there may be a tailors bunion or bunionnette. And a smaller percentage of the pediatric population will have a growth plate or and apophysis of the 5th metatarsal base. This is called Iselin's disease. We will go over each of these more detail in some of our following blogs and discussion.

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

Bunion xray

I have been operating on bunions now for over 15 years and have seen all sizes and shapes of bunions.  It is interesting to see the techniques that have come in and out of favor.  I have had an opportunity to watch as the Lapiplasty has moved to the forefront of surgical procedures for bunion correction.  I believe this is a great option for bunion repair and am excited to see what the future holds in regard to the Lapiplasty.

I find the Lapiplasy highly successful for large bunions or patients with flatfeet.  The Lapiplasty provides great correction and faster recovery.  It is an easily reproducible procedure with gigs and guides to help with correction.  It provides for stable fixation and allows for early weight bearing.  It can be used at all ages and helps to maintain long term correction.  The system is revolutionary for surgeons and has taken years to develop.

I can say I am excited to continue using this system and to help my patients with bunions.  It is wonderful to have a tool set like the Lapiplasty at my surgery center and to help so many patients walk normally again.  If you have been contemplating bunion correction I would love to share this exciting new technology with you. Give us a call today at 425-391-8666 or make an appointment online today.

Sincerely,

Dr Brandon Nelson

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When I created the Washington Heel Pain Center I was excited to bring my years of treating heel pain to patients.  I had seen and even experienced heel pain from all types of pathology and was ready to provide the best possible care for heel pain.  Heel pain continues to be the most common reason for a patient to visit our clinic and we still provide the best care in Washington, Issaquah, Bellevue and Seattle.  There are even offices now that have tried to imitate our heel pain center.

However, being the first heel pain center in Washington and the longest running heel pain center in Washington we continue to provide the best possible care.  We have the most advanced technology to diagnose and cure heel pain.  Our center provides the latest treatment options available to get patients pain free quickly and back to their favorite activities.  Patients come to us from all over the Northwest including Alaska, Canada, Oregon and Idaho.

If you suffer from heel pain I can help.  I see the average patient improve their symptoms by 50-70% in a week with my protocol.  If you are in pain with every step or have pain when getting out of bed or after rest I can help.  If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online today.

Sincerely,

Dr Brandon Nelson

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. 

Sincerely,

Dr Brandon Nelson

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