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Hammertoes are a common pathology I see in my office.  Most patients with curled toes have pain with activities and a hard time fitting shoes.  They describe a progression of the toes where other forefoot pathologies can be present. 



The most common cause appears to be foot structure and genetics.  We see patients that have flatter feet require increased pressure from the tendons in their toes to stabilize.  This repetitive pressure can cause pain and discomfort.  Some people will inherit a foot structure that can predispose them to hammer toes.  These foot structures are ones that often develop bunions as well.


The symptoms can vary from patient to patient.  The most common symptoms include swelling and pain.  Some patients relate a significant stiffness or bending to the toes that pushes in their shoes.    All can be painful, especially with physical activities. 


We have many options available for hammer toes.  But it should be noted it is based on the degree of the hammer toe.  How significant is the bending and contracture of the digit.  It is important to have a good clinical evaluation and an x-ray.  If you would like a consultation for your hammer toe pain I can help.  Call to make an appointment with me at 425-391-8666 or make an online appointment.


Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Issaquah’s Top Podiatrist

Introduction: Midfoot arthritis can significantly impact one's quality of life, causing pain, stiffness, and limited mobility. While conservative treatments like medication and physical therapy can help manage symptoms, advanced cases may require surgical intervention. Adductoplasty, a surgical procedure aimed at addressing midfoot arthritis, has gained attention for its effectiveness in restoring function and reducing pain. In this blog, we'll delve into what adductoplasty entails, who can benefit from it, and what to expect during the recovery process. In addition it is helpful to know that the adductoplasty procedure in many ways is similar to the Lapiplasty procedure and in some cases the 2 procedures can be combined.


What is Adductoplasty? Adductoplasty is a surgical procedure designed to treat midfoot arthritis by realigning the bones in the midfoot region. It specifically targets the midfoot joints, such as the 2nd and 3rd metatarsal cuneiform joints (also known as the tarsometatarsal joints or TMT joints), which are commonly affected by arthritis. The goal of the adductoplasty procedure is to correct deformities, alleviate pain, and improve joint function and address arthritis joint pain.


Who Can Benefit from Adductoplasty? Adductoplasty is typically recommended for individuals with moderate to severe midfoot arthritis that hasn't responded adequately to conservative treatments. Common symptoms that may indicate the need for adductoplasty include persistent pain, stiffness, swelling, and difficulty walking or bearing weight on the affected foot.


The Procedure:


  1. Preoperative Assessment: Before undergoing adductoplasty, patients undergo a thorough preoperative assessment, including imaging studies like X-rays or MRI scans to evaluate the extent of arthritis and deformity.
  2. Anesthesia: Adductoplasty is performed under general anesthesia or IV sedation type anesthesia, depending on the patient's health and surgical preferences.
  3. Incision and Access: The surgeon makes an incision on the affected foot to access the midfoot joints. Minimally invasive techniques may be used to minimize tissue damage and promote faster recovery.
  4. Bone Realignment: Using specialized instruments, the surgeon realigns the bones in the midfoot to correct deformities and restore proper joint alignment. This will involve removing damaged cartilage or bone spurs.
  5. Stabilization: Additional procedures like joint fusion are necessary to stabilize the joint and promote healing.
  6. Closure and Recovery: Once the procedure is completed, the incision is closed, and the foot is bandaged. Patients are monitored in the recovery room before being transferred to a hospital room or discharged home, depending on the surgical plan.

Recovery and Rehabilitation: The recovery timeline for adductoplasty varies depending on the individual and the extent of the procedure. However, here are general guidelines:


  • Postoperative Care: Patients are advised to keep the foot elevated and apply ice to reduce swelling and discomfort.
  • Weight-Bearing: The surgeon will provide instructions on when and how much weight can be placed on the foot. Crutches or a walking boot may be recommended initially.
  • Physical Therapy: Rehabilitation typically involves physical therapy to improve strength, flexibility, and mobility. Patients learn exercises to restore function and prevent stiffness.
  • Follow-Up Visits: Regular follow-up visits with the surgeon are essential to monitor healing, address any concerns, and adjust the rehabilitation plan as needed.


Benefits of Adductoplasty:


  • Pain Relief: Adductoplasty can significantly reduce pain and discomfort associated with midfoot arthritis, allowing patients to engage in daily activities more comfortably.
  • Improved Function: By correcting deformities and realigning the bones, adductoplasty improves joint function, enhancing overall quality of life.
  • Long-Term Results: Many patients experience long-lasting benefits from adductoplasty, especially when combined with postoperative rehabilitation and lifestyle modifications.


Conclusion: Adductoplasty is a valuable surgical option for individuals suffering from midfoot arthritis, offering pain relief, improved joint function, and enhanced quality of life. If you're considering adductoplasty or exploring treatment options for midfoot arthritis, consult with a qualified orthopedic surgeon to determine the best course of action based on your specific needs and goals. With proper care, rehabilitation, and follow-up, adductoplasty can pave the way for a more active and pain-free lifestyle.


If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young
Foot & Ankle Surgeon
Issaquah's Top Podiatrist

pic heel pain 4

I have to say that exercise for me helps with my mental health and overall wellbeing.  I typically workout 6/7 days a week and enjoy running, biking, rucking and walking the dog.  It is a great stress relief and helps me clear my head after a day of work.  I am sure many of you can relate and as the weather clears more of us are getting back into an exercise routine.

That being said, I always see a spike in heel pain patients this time of year.  It makes sense with the weather drying up and everyone wanted to get outside and ready for summer.  Heel pain can really sideline you as you return to activities.  It can come on suddenly and stick around for months.  As a side note, the earlier you get treatment the faster you can recover.  It is usually caused by inflammation of your plantar fascia. 

The plantar fascia is the main support network of the foot.  It is a soft tissue structure that runs from your heel to your toes.  It has the function of controlling the foot and helping with propulsion.  It can get worn out with time or tired from increased loads.  It is by far the most common condition I treat. 

Some patients wait quite a while before coming in and these cases are often what I call “stubborn heel pain” or “chronic fasiitis”.   This is because the inflammation has now become chronic, and the body has given up on trying to fix it and now coexists with this pathology.  These cases are harder to treat and usually require more extensive care.  I think it is important to understand that once it becomes chronic, part of the treatment usually requires a reactivation of the body’s ability to recognize this condition.  You must take the chronic state of inflammation and turn it back to an acute state. 

I really enjoy helping my patients get their life back and their feet pain free.  If you would like a consultation for your heel pain I can help.  Call to make an appointment with me at 425-391-8666 or make an appointment online.


Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Issaquah’s Top Podiatrist

bunion picture1

Bunions are one of the most common reasons people schedule an appointment with a foot and ankle surgeon.  It is by far the most common surgical procedure I do.  People of all ages and activity levels can have a bunion.  The primary reason people schedule an appointment is difficulty fitting the shoes they would like to wear.

I think there are quite a few reasons to fix your bunions these days and I will discuss a few of the most beneficial reasons.

1.     Foot Structure

Bunions are an inherited foot disorder and are more common in women.  They are usually the result of a foot that wants to flatten out too much or what we would call pronate.  A bunion results when the first metatarsal tries to stabilize the medial arch.  This results in the first metatarsal moving out of place and the bunion developing.  Fixing a bunion can result in stabilization of the medial arch.  This can have effects on the overall stability of the foot.  I see patients that have had plantar fasciitis or other stability issues that resolve once the bunion is fixed. 


2.     Shoe Fit

Another big issue with bunions becomes an inability to fit in normal shoes.  I see a lot of wide shoes and short extra depth shoes when people try to accommodate bunions and other toe deformities.  It is often a relief to be able to have shoes fit again and get back to wearing the shoes you once enjoyed or liked after your toe is straightened. 


3.     Your Bunion Will Get Larger

Many people believe they can use straps or tape or toe straighteners and change their bunion.  However, we know from long term data this is not true.  There is no way to reverse your bunion without surgery.  Everyone’s bunion with time and mileage will get bigger.  I recommend having it fixed before it causes the 2nd toe to become a hammer toe or begins to cross over or under the 2nd toe.

If you have a bunion and want an evaluation schedule an appointment with me, or make an appointment online, I will help you. 


Brandon Nelson

Board Certified Physician & Surgeon

Issaquah’s Top Podiatrist & Foot/Ankle Surgeon


Introduction: As winter settles in, along with its frosty bite, many of us bundle up in layers of clothing to protect ourselves from the cold. Despite our efforts, some may still find themselves facing an uncomfortable and sometimes painful condition known as chillblains. Chillblains, also spelled chilblains, are a common affliction during colder months, yet they remain relatively misunderstood. Chilblains is the common term used for this and Pernio is the medical term for chilblains. Very similar conditions include Raynaulds phenomenon and acral cyanosis. In this blog post, we discussed the details of chillblains, exploring their causes, symptoms, and effective treatments.

What are Chillblains? Chillblains, medically termed pernio, are a localized reaction of the skin to cold temperatures. They occur when the skin is exposed to cold but not freezing temperatures and then undergoes rapid warming, causing blood vessels to expand and leak. This leakage leads to inflammation and injury to the surrounding tissues.

Causes of Chillblains: Chillblains typically develop in response to repeated exposure to cold, damp conditions. Individuals living in cold climates or those who spend prolonged periods outdoors during winter are at higher risk. Certain factors may predispose individuals to chillblains, including poor circulation, hormonal changes, and medical conditions such as Raynaud's disease.

Discussion: Vasospasm of the smaller blood vessels in the digits are common in this case pulses in the feet may be intact but despite this the blood flow to the digits is essentially cut off. With a lack of oxygen there can be tissue damage and resultant inflammation even after the blood flow is reestablished. It also can be common for the individual’s foot to be moist from perspiration such that a “damp chill” on the feet occurs. This is why one of the strategies is to keep the feet dry and wool socks do a great job with this. In addition in the toes if there is a place where the toes often rub together that seems to be a common location to get purple/cyanotic nodular enlargement and irritation from the contact between the toes. Patient will come into the clinic with these purple painful nodules on their toes and states that they been to other clinics and owns quite certain what it is. They commonly think that they started out as a blisters.

Symptoms of Chillblains: The symptoms of chillblains can vary in severity but commonly include:

  1. Redness or purplish discoloration of the skin
  2. Swelling and tenderness with nodular enlargement
  3. Itching or burning sensation
  4. Blistering or ulceration in severe cases, often these are purple or cyanotic.
  5. Pain or discomfort, particularly upon warming the affected area

Chillblains most commonly affect the extremities, such as the toes, fingers, ears, and nose, but can also appear on other parts of the body exposed to the cold.

Treatment and Management: While chillblains can be uncomfortable, they typically resolve on their own within a few weeks once the affected individual is no longer exposed to cold temperatures. It’s not uncommon for these to last often on through the winter and then totally resolved each summer. But as the years go by sometimes the become progressively more of a challenge or problem. However, several measures can help alleviate symptoms and promote healing:

  1. Keep the affected area warm but avoid sudden temperature changes.
  2. Gently massage the area to improve circulation.
  3. Apply soothing lotions or creams to relieve itching and discomfort.
  4. Avoid scratching or rubbing the affected skin to prevent further irritation.
  5. Protect the skin from further exposure to cold and moisture by wearing appropriate clothing and using gloves, socks, or earmuffs.

In more severe cases or if complications arise, medical intervention may be necessary. This may include prescription medications to reduce inflammation, promote healing, or manage underlying conditions contributing to poor circulation.

Prevention: Prevention is key to avoiding the discomfort of chillblains. Some tips to prevent chillblains include:

  1. Dress warmly in layers, paying particular attention to extremities.
  2. Keep indoor environments warm and dry, especially during colder months.
  3. Limit exposure to cold and damp conditions, and take breaks to warm up if spending extended periods outdoors.
  4. Wear moisture-wicking socks and breathable footwear to prevent moisture buildup.
  5. Maintain good circulation through regular exercise and avoiding tight-fitting clothing or accessories that may restrict blood flow.

Conclusion: Chillblains are a common but often misunderstood condition that can cause discomfort during colder months. By understanding the causes, symptoms, and effective treatment options, individuals can better manage and prevent chillblains, ensuring a more comfortable and enjoyable winter season. If symptoms persist or worsen, it's essential to seek medical advice for proper evaluation and treatment. Remember, staying warm and dry is key to keeping chillblains at bay.

If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young

Foot & Ankle Surgeon

Issaquah’s Top Podiatrist

austin bunionectomy

Bunions are painful deformities that are common and can cause pain and discomfort daily.  Surgery for bunions has been around for over 100 years but recent advancements have made bunion surgery easier than ever.  Today we will discuss the Lapiplasty bunion procedure, its advantages and how it has changed the way we correct bunions. 

What is a bunion?

A bunion is an inherited foot issue that involves the deviation of a bone in your foot.  Specifically the 1st metatarsal begins to drift in the wrong direction making it difficult to fit shoes and can be quite painful.  Genetics play a big role in the development of a bunion and things like shoe gear can contribute to the bunion. 

Lapiplasty procedure

Convention bunion surgery often involves cutting the bone and realigning a joint.  This type of procedure has been utilized for years and is still the most popular bunion surgery in the world.  It has its applications and is appropriate for certain individuals.  The Lapidus or Lapiplasty focuses on larger bunions and people that have a more unstable foot.  It aims to correct the bunion in a more comprehensive approach and provides the best long term results.

It involves correcting the bunion in 3 planes, realigning the metatarsal, correcting the bunion at the root cause.  The joint where the bunion originates is cut and realigned and fixated to heal in the proper position.  Recovery can vary by patient and bone quality same with healing times.  I do recommend physical therapy and follow up is essential.

In conclusion Lapiplasty has revolutionized bunion correction and provides excellent long term results and is by far the best procedure for many patients.    

If you would like a consultation for your bunion I can help.  Call to make an appointment with me at 425-391-8666 or make an appointment online.


Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Bunion xray

I have been practicing medicine now for about 15 years and like to look back from time to time on how it has changed.  Currently there is a lot of talk about the Lapiplasty bunion and bunion surgery in general.  I thought I would take a few minutes and discuss this topic. 

Bunion surgery continues to be one of the most common foot surgeries in the United States if not the most common.  I believe the last statistic I read was something like almost 350,000 operations per year.  It is hard to believe there are that many bunions out there!

The most utilized bunion surgery is the Austin bunionectomy.  This is for a couple reasons.  One can correct the vast majority of bunions whether small or large.  It has a much faster recovery and is technically not as challenging as other operations.  It involves the cutting of the metatarsal head in a chevron pattern and shifting that bone medially.  It is usually fixated in place with a few screws.  Patients can bear weight immediately and are typically in a walking boot for 4-8 weeks.  It has good long term results and will probably continue to be the most common bunionectomy for that reason. 

The other most talked about bunion procedure is the Lapidus bunionectomy or the Lapiplasty.  This procedure is the choice for very large bunions or juvenile bunions.  It is technically more challenging but provides for excellent correction.  This involves fusion of the metatarsal cuneiform joint to realign the metatarsal.  It  usually involves a period of non weight bearing from 3-8 weeks.  The long term results are excellent. 

That begs the question: which procedure is best for bunion patients?  Well the answer is not simple.  It really involves a couple key considerations.  First being how does the rest of the foot look and how much motion do we have through the 1st metatarsal?  Second is patient age and activity level.  Third would be overall general health of the patient and bone quality.  I recommend seeing a surgeon that performs a lot of bunion surgeries as their outcomes will be better.

If you have a bunion and would like to know your options and have it evaluated schedule, make an appointment with me and I will help you. 


Brandon Nelson

Board Certified Physician & Surgeon

Issaquah’s Top Podiatrist & Foot/Ankle Surgeon

woman pink dress holding heel

Heel pain can affect people of all ages, lifestyles and activity levels.  You can be an avid exerciser, a home body or just spend all day working on your feet.  I will discuss some of the causes of heel pain, the symptoms and when to seek medical attention.  I have been a practicing podiatrist in Issaquah for over 25 years and have treated and helped 1000’s of patients. 

There are many common causes of heel pain.  However a few are the most common and these include; plantar fasciitis, Achilles tendonitis, stress fractures and Baxter’s neuritis


Plantar fasciitis is caused from an inflammation of a band of tissue running on the bottom of the foot.  The job of the fascia is to support the arch of the foot and control 3 dimensional movement.  It often occurs with repetitive stress like standing all day or running. 

Achilles tendonitis is usually located more towards the back of the heel.  The Achilles tendon helps to push off the foot during the gait cycle.  Often any activity that increases load like jumping rope can cause the Achilles to become inflamed.  People often feel swelling or a thickening of this tendon in the ankle.


Stress fractures are usually related to overtraining and time.  They occur with repetitive loading of a bone.  The bone I am speaking of in this case is the calcaneus.  These can be tricky to diagnose. 


Baxter’s neuritis is rare but is often confused for plantar fasciitis.  There is usually more of a burning or tingling that occurs.  Often there is not an increase in activities and no correlation with time spent on your feet and pain. 

I recommend seeking early treatment for heel pain.  I see that patients that wait longer have a harder time recovering and often need more therapeutic interventions.  This is especially true for athletes, get in early and get a head of the pathology. 


If you have heel pain and would like an appointment with Issaquah’s top Podiatrist at 425-391-8666 or make an appointment online.


Dr Brandon Nelson

Board Certified Foot & Ankle Surgeon


Bunion surgery is the most common foot surgery done in the United States.  There are many different techniques to correct a bunion.  Most involve either cutting of a bone or fusion of a bone.  All involve realignment of a joint in order to improve the function and appearance of the foot. 

I have now been practicing medicine and surgery for over 15 years.  I am a podiatrist in Issaquah and have had the opportunity to help 1000’s of patients with bunions.  Bunions can be extremely painful and the majority of people will require them to be fixed at some point. This experience has led me to utilize Lapiplasty on the majority of my patients.

Why the Lapiplasty?

1.      It provides correction at the center of a bunion deformity

2.     It has been proven to have the best long term outcomes

3.     It stabilizes the foot structure

4.     It does an excellent job for large bunions

5.     It has been utilized for over 100 years

I encourage anybody with a bunion to get evaluated by a surgeon that performs a significant amount of bunion corrections annually.  Experience can make a big difference in outcomes and the Lapiplasty is a technically difficult procedure to execute.  If you have a bunion and would like to discuss the Lapiplasty make an appointment with Issaquah’s top Podiatrist at 425-391-8666 or make an online appointment.


Dr Brandon Nelson

Board Certified Foot & Ankle Surgeon

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Dr. Timothy Young discusses a different kind of bone spur in the foot: Enthesophytes, not your typical bone spur.


There can be confusion when talking about bone spurs in the foot. In general, when one thinks of an arthritic bone spur, that is often an osteophyte. However, there is a different kind of bone spur; this is an enthesophyte. The best way to think of an enthesophyte is calcification of the tendon or ligament at its attachment to the bone. A common example would be a heel spur related to plantar fasciitis or calcification of the Achilles tendon where it attaches to the back of the heel bone. It is important to know, however, that calcification of the Achilles tendon or a plantar calcaneal heel spur, in either case, may not cause any pain or symptoms at all. On the other hand, if there is associated inflammation or degenerative changes, there may be symptoms and pain.

Enthesopathy is another similar term describing this condition. Note that Enthesopathy often occurs in response to a mechanical condition, but there can be more of a systemic inflammatory condition also, such as ankylosing spondylitis or psoriatic arthritis. Some of the autoimmune arthritic conditions may potentially be related to this condition.

Enthesophytes vs. Osteophytes: An Overview

Enthesophytes Defined: Enthesophytes are abnormal bony projections that occur at the attachment points of tendons or ligaments to the bone. These bony outgrowths are the result of the body's response to chronic stress and irritation in these connective tissues.

Osteophytes in Contrast: We have previously discussed osteophytes in our prior blog. Osteophytes are abnormal bony projections that form within joint spaces. Unlike enthesophytes, which are associated with the insertion points of tendons and ligaments, osteophytes develop as a response to joint degeneration and inflammation, often associated with conditions like osteoarthritis. The most common osteophytes in the foot and ankle could include the great toe joint, where bone spurs limit motion and cause an enlargement on the top of the joint. In the ankle, it is often the front of the ankle joint that develops osteophytes that can also limit ankle joint motion.

The Stress Response: Understanding Enthesophyte Formation

Chronic Tendon or Ligament Stress: Enthesophytes are born out of the repetitive stress and strain on tendons and ligaments. This stress can result from various factors, including overuse, improper biomechanics, or inflammatory conditions affecting the connective tissues.

Microtrauma and Inflammation: Microscopic damage to the tendon or ligament can lead to localized inflammation. As the body attempts to repair this damage, the bone responds by forming additional bony tissue at the insertion point – thus, an enthesophyte is born.

Common Locations: Enthesophytes can occur at multiple sites throughout the body. Common examples in the foot include the heel, with two common examples being Achilles enthesophyte and an enthesophyte associated with plantar fasciitis or the most typical heel spur.

Distinguishing Features: Enthesophytes vs. Osteophytes


Enthesophytes: Develop at the attachment sites of tendons or ligaments to bones.

Osteophytes: Form within joint spaces in response to joint degeneration.


Enthesophytes: Linked to chronic tendon or ligament stress and inflammation.

Osteophytes: Associated with joint degeneration and conditions like osteoarthritis.

Clinical Manifestations:

Enthesophytes: May cause localized pain at the attachment sites, especially during movement.

Osteophytes: Can impact joint movement, causing pain, stiffness, and reduced range of motion.

Managing Enthesophytes: It is important to understand that in many cases, it is really because of the enthesopathy that we are treating so for calcification of the Achilles tendon, we often are treating Achilles tendon problems. And for treating a plantar calcaneal spur, we often are treating plantar fasciitis as the primary problem, and the enthesopathy may be a secondary problem.

Conservative Measures:

Rest, activity modification, and gradual return to exercise.

Physical Therapy: Stretching and strengthening exercises.

Anti-Inflammatory Medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage inflammation and pain.

Orthotic Support:

Proper footwear and orthotic devices to alleviate stress on affected areas.

Shockwave Therapy: This is extremely effective at treating Achilles tendon problems and calcific Achilles insertional tendinosis and plantar fasciitis.

Platelet Treatments: Concentrated platelets are injected into the damaged tendon or plantar fascia.

Surgical Procedure Interventions:

Tenex: This is a less invasive type of procedure that can remove damaged tendon and remove some of the calcified portions.

Traditional Surgery: In resistant cases, surgical direct treatment may be considered.


Enthesophytes may relate to the body's adaptation to the demands placed on tendons and ligaments. This condition may (or may not) cause discomfort, especially in the presence of chronic stress, and may limit exercise. Understanding their distinct nature and differentiating them from osteophytes is crucial for accurate diagnosis and effective management. If you suspect the presence of enthesophytes and experience persistent pain or discomfort, please contact our office for consultation or make an appointment online.
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