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

Introduction:

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

Location:

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

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

Associations:

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.

Conclusion:

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.

Bunions are an inherited foot deformity that can be exasperated by shoe gear and activities.  They are created when your first metatarsal begins to shift out of place to stabilize your foot.  They usually become worse with time and eventually cause pain and discomfort.  Many patients require surgical intervention. 

The surgical correction of a bunion can have great outcomes and provide long lasting benefits.  In the United States there are many different approaches to correction of a bunion.  I have been operating long enough to have had experience in most of these procedures.  That is why my bunion correction of choice is Lapidus or Lapiplasty.

The Lapidus or Lapiplasty is a procedure that dates back almost 100 years.  It was first described by Dr Lapidus and to date has stood the test of time for bunion correction.  It involves utilizing a fusion of 2 bones at the apex of the bunion or where the bunion starts.   This provides dynamic correction and great long-term stability.  I find patients are happy with their new foot structure and often want the other side fixed as well.

If you have been contemplating bunion surgery, give me a call.  I have an onsite surgery center that saves time and money.  IV sedation provides for a great experience.  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.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Bunions are present in many different sizes and shapes.  I see bunions on the inside of the foot, the outside of the foot and both.  It is important to remember that some small ones can be painful, and some large ones can be pain free.  It often seems to be dependent upon activity levels and shoe gear.  If they hurt or limit your lifestyle then maybe it is time to fix them. 

Fixing your bunion

Bunion surgery has two main procedures that are done.  One is what is called a head procedure.  This is basically cutting the bone and realigning it through transposition of the bone.  Usually fixated with one or two screws.  The other involves fusion of a joint, specifically the joint that is involved with the creation of the bunion.  This procedure is called a Lapidus bunionectomy. 

Bunion recovery

Recovery really depends on the procedure that is performed.  Head procedures recover faster and usually involve no periods of non-weight bearing.  The fusions often involve a period of crutches or knee scooters.  This can be as short as 3 weeks or as long as 10 weeks.  The weight bearing status can be dictated by other procedures that are done as well. 

Which bunion surgery is right for me?

This is a hard question to answer.  I believe this is where your consultation with your surgeon is extremely important.  Other factors like lifestyle, recovery support, expectations and experience can play a major role.  I think it is important to get an entire overview of the process and have a discussion with your surgeon.   

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.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Plantar fasciitis affects millions of people worldwide. It is often a debilitating condition that limits people’s activities. It is characterized by pain in one’s heel, pain when we get out of bed or can even be a bruised sensation to the bottom of the foot. Today I will discuss some of the causes, symptoms, diagnosis, and treatment. The plantar fascia itself is a thick ligament like tissue that runs on the bottom of the foot to provide support.

Causes:

The number one cause is overuse. This can be exercise or standing all day or a change in the amount of either of these. Other causes can be shoe gear, weight or even the foot structure one is born with.

Symptoms:

The most common symptom is sharp heel pain, especially when you first get up from a seated position. This usually improves as we walk but returns at the end of the day. Some people experience stiffness or even burning.

Diagnosis:

A good clinical examination can help identify plantar fasciitis for most people. The is usually pain with palpation of the heel, specifically at the heel bone where the fascia attaches. An x-ray can be useful to detect bone spurs.

Treatment:

The mainstay of treatment is to work on stretching of the foot and Achilles. Additionally, increasing support for the feet can be helpful. Often by the time I see patients an injection is needed to calm down the inflammation and help with recovery.

If you would like a consultation on your heel pain, I can help. Call to make an appointment with me at 425-391-8666 or schedule an appointment online.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Are you currently suffering with heel pain?  I can remember those days not long ago for me.  I would wake up in the morning and that first step pain was terrible.  It would take a couple minutes and it would finally loosen up only to return every time I sat down.  Does this sound familiar?  If so, you probably have plantar fasciitis.  The big question is when to see a foot and ankle specialist, the answer is now. 

The sooner you get in to seek treatment the faster your recovery will be.  With procrastination the inflammation gets worse, and you will take longer to recover.  I tell all my patients the sooner we initiate treatment the faster we can get you back to enjoying the things you like. 

Treatment of plantar fasciitis usually starts with a review of your activities.  What are you currently doing for exercise and how often?   Have there been any recent changes?  I like to get an x-ray to check for bone spurs and arthritis.  A good overall examination of the foot structure and lower leg can be helpful along with any treatments that have been tried.  If the diagnosis is still plantar fasciitis then the average patient I see will be about 50% better in less than a week with the first line of therapy. 

If you have heel pain, you know how uncomfortable it can be.  If you would like a consultation on your heel pain, I can help.  Call to make an appointment with me at 425-391-8666 or schedule an appointment online. 

Sincerely,

Dr Brandon Nelson

Dr. Timothy Young, a Board-certified Foot Surgeon discusses bone spurs in the foot: Osteophytes

Defining Osteophytes: Osteophytes, a subset of bone spurs, are characterized by the outgrowth of new bone on the margins of a synovial joint. They often develop in response to joint degeneration and are associated with conditions like osteoarthritis.

Locations of Foot Osteophytes:

1. Joints: Osteophytes often form on the margins of joints of the foot, impacting movement and causing pain.

2. Edges of Bones: They may also develop along the edges of bones, affecting the alignment of joints.

Causes and Risk Factors:

1. Joint Degeneration: Osteoarthritis, a common cause of bone spurs, leads to the breakdown of cartilage and prompts the body to form osteophytes.

2. Repetitive Stress: Continuous mechanical stress on specific areas of the foot, often due to poor biomechanics or ill-fitting footwear, can contribute to the development of bone spurs. This often involves the force of gravity on weight-bearing joints. A good example would be the ankle joint.

Symptoms and Diagnosis:

1. Pain: Persistent pain in the affected area, especially during movement or weight-bearing activities.

2. Reduced Range of Motion: Difficulty moving the affected joint due to the presence of bone spurs.

3. Visible Bumps: In some cases, visible or palpable bumps may be present, indicating the presence of bone spurs. A good example this would be a bump on the top the midfoot that is due to large osteophytes in this location.

4. X-rays and ultrasound: x-rays and ultrasound can show the osteophytes. It is usually not necessary to do an MRI or CT scan.

Treatment Options:

1. Conservative Measures:

• Rest, ice, compression, and elevation (R.I.C.E.).
• Orthotic inserts and supportive footwear.

2. Physical Therapy:

• Stretching and strengthening exercises.
• Therapeutic modalities to alleviate pain and inflammation.

3. Medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management.

4. Injections: injections can deliver medication such as Supartz which is a synthetic joint lubricant. This was originally FDA approved for the knee but is now used throughout the body. For the foot and ankle, it is most commonly used in the ankle joint and the great toe joint. Cortisone is not used as often, since repetitive use can weaken the existing Cartledge and adjacent joint capsule.

5. Surgical Intervention:

• In severe cases, surgical removal of the bone spur may be considered, or in some cases the joint can be stabilized by fusing it or placing an implant in the joint.

Conclusion:

Bone spurs and osteophytes in the foot can present challenges, but with proper understanding and timely intervention, individuals can manage their symptoms effectively. If you suspect the presence of bone spurs in your foot, please contact our clinic and we can review your options.

Bunion surgery is one of the most common surgeries performed in the United States.  It is something like 250,000 operations annually, that is a lot of bunions!  Well, how can you maximize your results, get back to activities early and heal faster?  I will give you some insight on these questions.    

Maximizing bunion results, when I think about what this question means I think it would pertain to how you get the best outcomes.  This means to me how you make the foot more functional and get a good cosmetic result.  This would be best done through appropriate procedure selection.  There are a lot of different bunion operations that are used to fix different sizes of bunions and different foot structures.  To me the most important thing here is to select a bunion surgeon that does a lot of bunions. 

How do you get back to activities earlier?  The main point here is to follow your surgeon's protocol.  Do not listen to your neighbor or friend, they might have had a different operation than you.  Your surgeon really knows best in this case.  Most of us have taken years to perfect our post-op protocol and do not deviate from following them to the letter.  But if you have questions or concerns ask to let us know.

Healing faster can mean a lot of things, the skin, the bone, when one can walk.    The skin is the first thing to heal. I always recommend collagen and zinc supplements.  These seem to speed things along and once the incision is closed there are some great products to minimize scar appearance.  Next is the bone, a good bone healing supplement is essential and if available a bone stimulator can shave weeks off healing.  Weight bearing is a different story, often this depends on other procedures that were done.  I try to get all my patients moving and bearing weight within a couple days if appropriate.  The minimum is to start a range of motion exercises.    

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

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Bunion surgery is the most common surgical procedure I perform at my ambulatory surgery center.  I have a few tips I would like to share that can make things much easier.

Get ready a week before surgery.  Start thinking about where you will set up.  I always recommend being a couch potato for about a week.  This home base spot should be conveniently located.  This spot should be downstairs and near a restroom.  Make sure you have access to anything that might pass the time, a computer, tv, etc. 

Meals are another thing to think about.  I like to advise my patients to make a weeks’ worth of food.  You can freeze them or refrigerate them but not having to cook can be a game changer.  This can really help you focus on your recovery, and nobody wants to cook with a sore foot.

Supplements are another thing to consider.  I think talking to your surgeon about this one is important.  Calcium or some sort of bone healing supplement if you are having bone work done.  Collagen and zinc can help wound healing.  Once the wound closes, start topical scar care.

The bathroom situation can need some thought as well.  How will you shower or use the toilet?  I always if you are going to be non-weight bearing to have a trial run of both.  It can be difficult executing these tasks with one foot.  Options for these include a shower chair or stool and for the toilet they make elevated seats that are helpful.

Medications are the last thing I will touch on.  Get these before the day of your procedure.  Think about making a log or schedule so you can track what and when you take them.  Make sure you understand what each is and that you have no interactions with other medications you are taking. 

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

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

I remember performing my first bunion surgery over 15 years ago and was so excited to help my patient.  I also remember learning all the different types of bunion surgeries and how each one was slightly different.  It made me ponder why there were so many different types of bunion surgeries for one pathology.  It was about this time I was introduced to the Lapidus bunionectomy by an attending physician.  He discussed how this was his favorite procedure, how it provided great outcomes but was difficult to execute.

Well fast forward 15 years and now the Lapidus is one of the most common bunion surgeries in the United States.  Things have really changed with the Lapiplasty system.  A group of doctors worked with a medical device company to develop a series of gigs and clamps to make the Lapidus reproducible and easier to perform.  This has really revolutionized bunion surgery and I anticipate Lapidus will eventually be the most common surgery worldwide.

I feel lucky having trained in the Northwest as I am very familiar with the Lapidus procedure and even before the Lapiplasty system it was one of my go to bunion corrections. 

If you have a bunion, you know how uncomfortable they can be.  If you would like a consultation on your bunion I can help.  Call to make an appointment with me at 425-391-8666 or schedule an appointment online. 

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Hammer toes refer to a curling downward of the toes.  This can occur in one or more toes and can be a stand-alone pathology or with another type of foot condition like a bunion.  The hammer toe is often caused by shoe gear choices, trauma or inherited from mom and dad.  It typically gets worse with time and makes it hard to exercise or fit in shoes properly.

 The conservative options for hammer toes can sometimes relieve pain.  These options are such things as wearing larger or wider shoes, taping the toes, or using pads or spacers.  It is important to note that this does not fix the hammer toe.  Additionally, with time it usually gets worse and the toe curls more.

Long term or surgical correction is the usuals course for most patients.  This involves addressing the underlying causes of the hammertoe or toes.  It is important to look at the overall foot structure and any contributing factors.  The surgical procedure to correct a hammer toe can be removal of a bone or removal of a bone and soft tissue balancing.  Sometimes it requires pinning of the hammer toe to allow the new position to heal and correct itself. 

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

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons