Heel pain can have many causes and can be extremely challenging for all patients.  Not all sore heels are caused by plantar fasciitis and it is important to understand the underlying cause.  Identifying the underlying cause will help to assure patients get the best treatment options.  Even with many other causes of a severe heel pain, the number one cause continues to be plantar fasciitis.

Plantar fasciitis is basically an inflammatory process of the main supporting network of the foot.  The primary cause of inflammation seems to be overuse and repetitive stress.  The plantar fascia in general has a relatively poor blood supply and this can lead to chronic inflammation.  Once we see chronic inflammation set in it can become extremely difficult to reduce pain and resolve one's heel pain. 

Heel pain treatment options are vast.  It really boils down to what the primary cause of the heel pain was and the activity level of the patient.  I like to break it down to foot structure and rear foot pathologies.  What I mean by foot structure is does the patient have a high arched foot or a low arched foot.  Is there a lot of pronation that occurs with ambulating or overloading of the foot?  Rear foot pathology can have a large effect on heel pain.  Is there a tight calf muscle or is there a dysfunctional supporting tendon?  The best long term outcome and shortest course to a pain free heel is to appreciate the deforming forces.

If you have severe heel pain or pain under your heel or even pain with running I can help! Give us a call at 425-391-8666 or make an appointment online today.

Sincerely,

Dr. Brandon Nelson

Hammer toes are quite common and can continue to get worse as time progresses.  They are often associated with other foot deformities like bunions or flat feet but can be a standalone pathology.  There is usually a family history associated with them or an underlying trauma that caused the development of the hammer toe or toes.  Additionally, they can occur with over powering of certain tendons in the foot.  The majority of hammer toes will require surgical care but some can be managed with padding and strapping.

Conservative care of hammer toes can be helpful especially during the initial development.  There are several techniques for tapping hammer toes and even straps and splints that can be purchased to help control the toes.  It is also advisable to stretch the calf and not go barefoot.  However the vast majority of hammer toes will get worse and eventually require surgical intervention.

Surgical care for hammertoes can be divided into two types of procedures, soft tissue and bone.  The determining factor for which procedure is appropriate is based on the clinical exam of the toe and the patient.  Release of the long flexor tendon can be helpful in controlling the hammering digit as long as it is a flexible deformity.  We often see this in the pediatric or geriatric patient as the hammer toes first develop.  The longer the hammer toe is present the more likely bone work will need to be done.  The most common procedure is a resection of the phalangeal head of the affected digit.  Hammer toe surgery done in isolation allows for full ambulation after the procedure.

If you have hammer toes or other digital deformities I can help. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

A Porokeratosis is not caused by a viral infection, and it does not have the additional blood vessel growth that is classically seen with a plantar verruca. Often, these lesions will be on a weightbearing portion of the foot such as underneath one of the five metatarsal heads.  In the case of lesions with a weight bearing location, prescription orthotics can help.   When a pathologist looks at a sample of the plantar verruca there are distinct differences compared to a porokeratosis.

These lesions also can be in a non weightbearing portion of the foot such as the heel. These lesions can be challenging to treat.  There is some preliminary data that the Swift treatment (Microwave Verrucae treatment) can help reduce the pain from these lesions and in some cases, there can be reduction or resolution of the lesions.  Surgical excision of the porokeratosis lesions is another treatment option.  Larger lesions can be surgically removed, and a plastic surgical technique called a rotational flap is utilized to repair the deficit left after removal of the larger lesions.

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, a board-certified foot surgeon, discusses Plantar verruca and porokeratosis

Pain in the forefoot can range from tingling and burning to a dull ache or throb.  The majority of forefoot pain can be broken down into nerve pain ie a neuroma or mechanical pain ie capsulitis.  Both can cause similar type symptoms and differentiating between the two can be difficult. 

Capsulitis is the most common forefoot type of pain.  It is basically an overloading of the metatarsal phalangeal joints.   Most patients will experience a combination of burning and aching.  There are many causes of forefoot capsulitis or overloading.  This can be from tight muscle groups or abnormal anatomy.  The majority of patients will find conservative therapies successful and will completely recover.

Neuromas usually occur in a specific anatomical location, the 3^rd interspace.  This pain is almost exclusively a burning or tingling.  It is almost always worse with shoes and primarily affects females.  Neuromas occur from irritation to the nerve that is mechanical or anatomical in nature.  Again the conservative success rate for this is high.

If you are experiencing burning or tingling in the foot I can help.  I have an exceptional protocol for both capsulitis and neuritis.  If you have foot pain, call today.

Sincerely,

Dr. Brandon Nelson

Bunion surgery is one of the most common procedures performed in the United States.  It is almost exclusively done in an outpatient setting and the majority of procedures can be completed in less than 2 hours.  Most patients will experience pain that lasts a few days and can begin weight bearing fairly soon.  There are many different types of bunion surgery and not all are equally effective. 

There are a few things that will help patients get a better outcome with bunion surgery.  I will discuss these tips that can be helpful along with selection of the surgeon.

#1. The most important thing after having any type of surgery is to follow postoperative protocol.  There are many tips that can improve your outcome after bunion surgery and careful adherence to postoperative protocols is essential.

#2. Bone healing supplementation, there are many different types of bone healing supplementation that are not all created equal however some of them can be highly effective in decreasing healing times.  I have a brand that I recommend for all my patients that often shaves weeks off of healing time.

#3. Couch potato for your first week, set yourself up for success.  During that first week just really take it easy, take your medications as prescribed, ice and elevate your foot.

#4. Surgeon selection, the majority of us have very similar training and most foot and ankle physicians are highly trained in this procedure.  One question I would ask any surgeon is how many bunion surgeries they perform annually.

I hope this is helpful and can be utilized by you in the future.

Sincerely,

Dr. Brandon Nelson

For some individuals with extremely large calf muscles and extremely tight calves and Achilles they may need to have a protective procedure done call a gastroc recessi. This is primarily for patients with chronic symptoms or who are at very high risk of reinjure of the Achilles tendon.

Give us a call today at 425-391-8666 or make an appointment online for an evaluation. 

Heel pain can be very challenging no matter when it occurs.  It can be common in the morning or after exercise.  There are many causes of heel pain and the most common is plantar fasciitis.  Plantar Fasciitis is a condition in which the plantar fascia in your foot becomes inflamed. 

An inflamed plantar fascia is often characterized by burning or a bruised type sensation one's heel.  Many patients describe the fact they feel like they are walking on a marble or pebble.  This can get worse as time and activity levels go on and can become quite debilitating.  This can be brought on by many causes but most notable is overuse.

Overuse is by far the most common cause.  Patients often relate the start of a new exercise program or a new activity.  This new activity can put new stresses on your fascia which ultimately leads to inflammation and pain.  It is always best to ease into activities as this can help minimize fascial pain.  Another key characteristic of facial pain is morning stiffness or irritation.

Morning pain is a hallmark of fasciitis.  This is very common and one of the most challenging parts of having plantar fasciitis.  This is often because when you sleep and then step down on your foot your fascia instantly becomes irritated.  This can be extremely difficult to get rid of and often sticks around for months.  This is when it is time to make an appointment with a heel pain specialist.  I have been treating heel pain for 15 years and can help you get rid of it quickly.  Give us a call today at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr Brandon Nelson

Dr. Timothy Young Discusses Achilles Tendon Injuries and Rupture

Part 1

We see a number of Achilles injuries in our clinic. For most active individuals with a complete rupture the Achilles tendon we advocate surgical repair. During the surgical repair any of the significant internal bleeding or hematoma is removed to facilitate the repair itself. After the repair has been done during the surgery we often augment this with other treatment. The original injury blood clot itself does have components that may be beneficial but some of those components also can become excessive scar tissue. Eventual augmentation with shockwave therapy can also benefit these patients who have had open surgical repair of an Achilles rupture.

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

If you have tendinitis-like symptoms, please schedule a consultation at our clinic. Give us a call at 425-391-8666 or make an appointment online today.