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Tight calves and Achilles are a major factor in many foot problems.  That is why we use a night splint and calf stretching is helpful for many problems.  Problems in the front of the foot like 2nd toe capsulitis metatarsalgia often respond well to calf stretching.  We have discussed how during gait, early heel rising and transfer of weight to the front of the foot can increase the load and weight transfer to the forefoot (and midfoot).  This early transfer of weight and mechanical load can be destructive. 

With our example of capsulitis of the 2nd toe, we now have an extra load going through the 2nd metatarsal and toe joint.  Eventually the extra load can strain the 2nd metatarsal and capsule.  This can lead to capsulitis or even a stress fracture of the metatarsal.   So, to help with this, we have our patients stretch their calf and use a night splint.  We avoid shoes that further put more pressure on the front of the foot (like high heeled shoes).  We even recommend shoes with zero heel drop, like Altra shoes.  This is just one example of how equinus can factor into a foot problem, there are so many more examples where this happens.  So, this is just the “tip of the iceberg” as a major factor in many foot problems and pathology.  Keeping your calf stretched out is one of the single best exercises you can do to keep your feet healthy!

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


Dr Timothy Young Talks About Tight Calves and Foot Problems

Tight calves are a common finding and a common factor in many foot problems.  This can start in childhood with some children with calves so tight that the parents notice and call their kids “toe walkers”.  Later in life the mechanical force on the foot increases and if the calves are still tight, then tight calves can cause more problems.  We often call tight calves equinus.  The ankle joint moves down (plantarflexion) and up (dorsiflexion).  There are normal ranges for this upward and downward motion.  As a child we expect more flexibility compared to the adult range of motion.  A child might have 15 to 20 degrees of dorsiflexion and an adult range is less, more like 10-15 degrees.  The calf muscles attach to the Achilles tendon, and then to the foot at the heel (calcaneus bone).  

As mentioned, the mechanical load on the foot from the calf and ultimately the Achilles is tremendous.  So, with equinus ( a tight calve and or Achilles) there are many problems.  Think of a woman who wears high heel shoes every day for many years and over time the calf gets less flexible.  Now with that tight calf, her gait has changed.  As she walks, with each step going forward that tight calf pulls, and her heel comes off the ground early.  Early heel off with gait leads to early transfer of weight and force to the front of the foot.  Over time, this extra pressure on the front of the foot can cause problems.  This is like the childhood toewalker, but with adult body size and weight.

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


of the ankle is a fairly common procedure. The majority of ankle surgeries have to do with the outside of the ankle or the lateral ankle complex. The lateral ankle complex is composed of the lateral ankle ligaments and the peroneal tendons. The ligaments on the outside of the ankle are the most important ligaments for stability. These ligaments are often injured with an ankle sprain or ankle fracture. The peroneal tendons work to dynamically stabilize the ankle with activities. These tendons can also be injured with repetitive use or chronic ankle sprains. It is important for anybody that has more than 1 ankle sprain a year to have the structural integrity of their ankle evaluated.

Evaluation of the ankle usually involves and x-ray and a physical examination. In addition, I will often order and MRI to get a better appreciation of the structural components of the ankle. I like an MRI because one can see what the ligaments and tendons look like. This is extremely helpful for evaluation of what needs to be repaired for surgery and what the tissue consistency looks like for the repair.

The surgical procedure itself, or the repair, can be relatively straight forward as in just a ligament stabilization or more complex included bone work. The most common ankle procedure is the lateral ligament reconstruction or the Brostrum procedure. This is a great procedure for anybody with chronic ankle sprains. With this procedure there is a chance you may need the tendons repaired as well.

If you are experiencing frequent ankle sprains or have pain on the outside of the ankle I can help. Make an appointment today and we will get you back on the road to recovery. Give us a call at 425-391-8666. 


Again, I have had this problem before and as mentioned in prior blogs I did many of the appropriate initial treatments listed in my previous blogs.  The next step to consider is some of the other alternative treatments.  We used to do cortisone injections for this, and we do that very rarely now.  There is a non-cortisone anti-inflammatory called Injectable Sterile Traumeel that has much decreased potential risk for damaging the capsule (unlike cortisone).  There is also PRP–platelet rich plasma.  This can be very effective especially when combined with shockwave treatment.  Shockwave treatment can also be done as a stand-alone procedure.  The problem with some of these additional treatment options is that they often take several months to really be effective.  That's where it's hard to do this but one needs to have patience.  Again, that's where cross training can be helpful such as cycling or aqua jogging.  For my capsulitis as mentioned, I did the typical initial treatments.  I wore special orthotics modified for the capsulitis, I have shoes with a good rocker design, I don't go barefoot at home.  I work on stretching my calf and I have a night splint .  I stopped running for exercise and only did walking.
Finally, I had to have shockwave treatment.  I had a series of 5 treatments, and it did take several months but the symptoms have completely resolved. Because I have significant pronation I am vulnerable to reoccurrence of this problem.
If you have foot problems including capsulitis of the second toe or second MTP joint, please let us know.

I have had this condition myself.  We are talking about capsulitis of the second metatarsal phalangeal joint  (MTP joint) in the ball of the foot, near the base of the second toe.  There have been previous blogs about the potential cause of this problem.  Treatment has to address the underlying cause and foot structure as much as possible.  If the calves are tight, then they have to be stretched and use a night splint or even have a gastroc recession surgery.  If there is a bunion and the whole first metatarsal is not bearing is fair share weight then it can cause stress overload to the next in line second metatarsal.  Orthotics and foot taping often help this.  

Sometimes it's not enough and sometimes especially if there is damage to the capsule such as the plantar plate, we then have to correct the bunion and consider surgery on the second metatarsal.  But there are other cases that don't require surgery.  It still imperative to do all the other treatments. The correct shoes with a forefoot rocker, sometimes zero drop shoe such as Altra Shoes can also help.  Avoiding the activity that seems to aggravate this also can be critical.  For example, if you're runner or speed walker, you may have to put that on hold or do cross training until her symptoms have completely resolved.  For myself, this seemed to come on after I had resumed running after several months off.  I had to make sure my orthotics were still appropriate for this problem.  I wore correct shoes.  I had to stop running and cross train.  I worked on stretching my calf and I have a night splint also.  

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


woman pink dress holding heel

It is common for patients to come in the office and relate pain in the morning or right when they get out of bed. This can be a challenging way to start your day and can lead to chronic foot pain. Most patients describe the pain as a bruised feeling to the heel or a tightness with pins and needles. This can go on for months and become chronic. The most common cause of this type of pain is Plantar Fasciitis. Plantar Fasciitis is an inflammation of a supporting band of tissue on the bottom of the foot. The Plantar Fascia is essential for normal foot function and when it is inflamed daily tasks can be overwhelming.

Morning pain is one of the most common signs of Plantar Fasciitis. The reason behind this is while you sleep your Fascia and Achilles Tendon have a chance to relax. With this relaxation both structures begin to tighten up. This tightening up leads to stiffness when you first step on your foot. One can really help this by exercising their foot before getting out of bed. I recommend writing the alphabet with your foot and stretching with a theraband.

If your pain continues for more than a week an appointment is essential. Give us a call at 425-391-8666 or make an appointment online today. 

Wednesday, 30 June 2021 17:18

Dr. Brandon Nelson Discusses Heel Pain

heel pain in the morning

Heel pain can be extremely frustrating and challenging to treat. It is most often caused by plantar fasciitis, bursitis, or a stress fracture. It is important to find out the underlying cause before treatment and I highly recommend seeing a foot and ankle specialist before initiating and sort of treatment.

Bursitis, this is basically and inflammation of a sac that is used to cushion the foot. Typically, you will have similar symptoms to plantar fasciitis. Patients experience pain in the morning or with standing and after rest. It can be hard to differentiate from plantar fasciitis. However, at our clinic we have an ultrasound unit which we can use to visualize the bursa and help initiate treatment.

Stress fractures are usually seen after one begins to exercise. There can be accompanying swelling and stiffness. This pathology hurst constantly and can lead to a complete fracture. It is vital to get an x-ray and confirm the diagnonsis.

Heel pain or plantar fasciitis is the most common cause and can be variable in presentation. Classically, patients experience pain in the morning that gets better with a few steps. Most patients have increased activity levels and find pain returns whenever they rest and get us. There is a direct correlation with early intervention and a shorter duration of symptoms. I highly recommend getting in as early as possible to see your foot and ankle physician.

If you are suffering with heal pain I can help, come see me today. Give us a call at 425-391-8666 or make an appointment online today.  

Dr. Timothy Young, a board certified foot furgeon, discusses how to tell if a fracture is healing.  Also, when does your Doctor know when the bone has healed enough to get out of that boot or cast?
Bone healing occurs after a fracture or bone, or fusion.  In each case it is important to protect the bone and modify weightbearing or gait to allow the bones to heal in the appropriate alignment and position.  For example, if you have a fracture of your second, third or fourth metatarsal you don't want to put regular unprotected weight on it because the far end of the bone or distal aspect will tend to elevate and then heal out of alignment, causing a long-term problem with the structure of your foot.  Another exam would be after Lapidus or lapiplasty bunion surgery that requires a fusion of the joint.  Again, bone healing is critical and needs to evaluated during the postoperative course.
X-rays are one aspect of evaluation.  Your doctor will look at your x-rays and determine if there is signs of appropriate bone bridging.  One bone heals without excessive motion there is no bone callus and this is called primary bone healing.  This can be difficult to diagnose.  X-rays may show only incremental healing and filling at the fusion site or fracture site.  Initially this is quite subtle.  At times ultrasound imaging can be quite helpful and can show areas of bone bridging and areas that do not have any bridging.  CT scan can be useful.  
Timing is another key.  For younger patients for example those that are less than 20 years old one would expect bone healing to as fast as 4–6 weeks, for definitive stable bridging to be seen on x-rays.  But as we all age bone healing can take longer.  So for middle-aged patient it could take 8 weeks.  And as we get older for example passed 50 or 60 years old it can take 8–10 weeks.  Bone density and overall health can also be a factor, as well as other concerns such as smoking.  I'm not surprised for an older patient that I don't see definitive bone bridging and stability at 4 weeks postop.  But for the younger patients I do see this quite often.  Therefore, the age of the patient will be a factor in what my expectations are regarding the amount of time it takes for the bone to heal and have adequate stability.
Compliance can be another factor.  For example, some patients might initially stay off her foot and then pull weight onto soon and laterally cause a refracture and motion of the fracture or osteotomy site.  This can reset the clock.  One might expect to see bone callus and secondary bone healing in this case.

If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment onine today. 
Wednesday, 16 June 2021 14:53

Mid Foot Bone Spurs and Surgery Part Two


Mid foot bone spurs and surgery part two.

Surgery to treat a bony prominence in this area usually is very straightforward. It typically involves an incision directly adjacent to the prominence or bone spur. We surgically go down to the tissue layers and then expose the bony prominence. Then most commonly a power burr is used to smooth down the excessive bone in the area or sometimes a special surgical saw. The wound is cleaned up and flushed to remove any small bone fragments.

The remaining cut bony surface usually has an excellent blood supply and can cause swelling problems or even a small collection of blood like a hematoma. Therefore several different techniques can help deal with this. One is to use a small drain which allows for a path for the blood to escape the area, this is especially useful for the first several days postop.  Another strategy is to use bone wax to seal the bone.

Some Surgeons use topical fibrin to help clot exposed bleeding vessels that are small and embedded in the bone.  After the bone remodeling procedure is done, the soft tissue layers are closed and the procedure is then complete. Usually it’s a relatively quick recovery.  Remember that we are talking about a bony prominence without significant underlying midfoot arthritis.  The midfoot arthritis and surgical fusion of the involved joint can be a longer recovery.

If you have questions about spurs or bumps on the top of your feet forefoot surgery in general, and would like a consultation please let us know.  Give us a call at 425-391-8666 or make an appointment online. 


What is it?

Burning or tingling can be one of the most challenging symptoms to treat in the foot. The number one reason patients have burning of tingling in the foot is neuropathy. Neuropathy is a disfunction of the sensory nerves in the lower extremity. The most common cause for neuropathy is diabetes. High levels of glucose in the body can attack the nerves and lead to burning and tingling. There are other causes including medications, alcoholism and exposure to toxic metals. Additionally, about 60% of neuropathy is idiopathic, meaning we are unable to identify a cause. Neuropathy typically gets worse as time goes on and can become quite debilitating for patients.

How can we help?

We understand how frustrating neuropathy can be and how emotionally taxing it can become. Our goal is to help identify the cause and to help decrease the factors that make it worse. We have now established a protocol that significantly reduces the symptoms of neuropathy. Recently I had a patient tell me he felt his feet for the first time in 10 years. We have a combination approach that is extremely successful. We utilize an FDA approved laser for neuropathy in combination with some vitamin supplements that are specifically designed for nerve pain.

If you are suffering from neuropathy or fibromyalgia we can help, schedule an appointment today. Give us a call at 425-391-8666 or make an appointment online. 

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