We know that bunions are an inherited trait that can be exacerbated by activities and shoe gear.  Patients can have a bunion on the inside or outside of their foot.  The typical bunion is on the inside of the foot and involves the 1^st metatarsal while the bunion on the outside of the foot involves the 5^th metatarsal.  Either pathology can often require surgical intervention in order to provide long term relief and the primary surgery is usually the bunion on the 1^st metatarsal.  The bunion will usually dictate the recovery and the bunion on the 5^th metatarsal usually heals faster.

Bunions are typically fixed in a few ways, either a surgery at the head of the metatarsal or the base of the metatarsal.  It is important to get an x-ray to examine the overall foot structure to make sure there are no other driving forces that need to be fixed.  The typical foot structure we see with a bunion on both sides is a flat foot that has progressed with time.  The foot often widens when a flatfoot is present to try and create more stability.  The flatfoot may or may not need to be addressed.

Most bunion surgery patients will be walking the entire time after surgery and can continue with modified exercise.  I utilize techniques that allow my patients to be more active and recover faster.  It takes years and hundreds of patients to perfect these techniques and dealing with athletes has allowed an advantage to improve on outcomes.  If you are having bunion pain please make an appointment and I will see how we can best help you. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

Board Certified Surgeon & Physician

Heel pain is the most common presenting pathology at my practice.  In general, I would say 1 out of every 6 patients is for heel pain.  This can be common for both adults and children.  The adult usually has heel pain that is caused by plantar fasciitis and for children this is usually apophysitis or Sever’s disease. 

Adult heel pain is common as one starts an exercise program or as our mileage on our feet increases.  The symptoms usually begin with pain in the morning or after a walk.  The feeling is often described as a bruised sensation or a burning pain.  It is important to identify the underlying causes and address these.  I do think an x-ray is warranted and the earlier the treatment the better. 

Children usually seem to have heel pain between the ages of 10-14.  The typical child has been playing sports, especially cleated sports.  They usually describe a soreness that can result in limping.  It is again important to take an x-ray and for underlying foot conditions. 

Both plantar fasciitis and apophysitis seem to be most common in certain foot structures.  These include flatfeet and tight Achilles’ tendons.  I recommend stretching the calf for the tight achilles.  However, the flatfoot needs to be thoroughly evaluated to prevent long term issues.  I really enjoy treating both of these conditions and have great long-term protocols to eliminate this pain once and for all.

If you or your child is suffering from heel pain please call so I can help. Make an appointment online or give us a call at 425-391-8666. 

Sincerely,

Dr Brandon Nelson

Board-Certified Foot & Ankle Physician & Surgeon

Pediatric heel pain or kids with heel pain are a common presentation.  This heel pain is often correlated with the start of new activities or any sport season.  The most common sports that heel pain occurs with children are basketball and soccer.  Basketball seems to make sense as the hardwood floor can be tough and with soccer cleats seem to be an aggravating factor.  It is important to have your child properly evaluated for heel pain, however the most common cause is inflammation of the growth plate.  These growth plate issues are easy enough to diagnose based on clinical evaluation and radiographic findings.  It is important to have x-ray heel pain because there are other causes and the treatment is tailored towards the specific pathology.  Traditionally with proper implementation of a treatment plan, heel pain is usually amenable to conservative measures including clear fairly quickly.

Adult heel pain by far is most commonly caused from plantar fasciitis.  Plantar fasciitis usually involves an inflammation of the plantar fascia or the supporting network of the bottom of the foot.  There are many common clinical symptoms that we see each year including pain after rest or burning throbbing type sensation of the heel.  Typically for adults this heel pain starts in one heel and gets worse with activities and time.  Again it is important to have a thorough workup including radiographs or ultrasound examination of the heel.  I believe it’s important to get in and see a foot and ankle physician fairly early in this process as this makes treatment easier.  Again the majority of patients with this pathology clears up with conservative measures and returned activities.

If you suffer from heel pain or trauma suffering from heel pain I can help.  Please feel free to contact the office and we will get you back on your feet pain-free. Give us a call today at 425-391-8666 or make an appointment online today. 

Morton’s neuromas or interdigital neuromas are usually from a compression of the nerves in the front of the foot.  Oftentimes characterized as burning or pain that’s exacerbated by walking or tight shoes.  A number of different etiologies have been described to decrease blood supply progression to irritation from bursa or the intermetatarsal ligament.  The majority of these neuromas occurr in the third interspace, about 70% of the time and in the second interspace about 30% of the time.  It is most common to have a single neuroma however some patients have multiple neuromas.  There are multiple studies on the best conservative measures.

Conservative measures range from orthotics, footwear adjustments, corticosteroid injections, alcohol injections, radiofrequency or even cryoablation.  Conservative management continues to be the mainstay of neuroma therapy.  Oftentimes it can take months before your neuroma feels better depending on the size and location.  There are a few people that have multiple Morton’s neuroma and an MRI can be highly valuable.

Surgical management usually consists of removal of the nerve.  This is generally done to the top of the foot and has a fairly short recovery as compared to other foot and ankle surgeries.  Sound physicians go to the bottom of their feet just depending on experience and discomfort levels.  The overall success rate with surgical management is high, if conservative measures have failed, it is the appropriate next step.

If you’re suffering from neuroma pain make an appointment today and I can help. Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

The Achilles tendon is the thickest strongest tendon in the human body.  There are more pounds per square inch going across the Achilles tendon than any other tendon.  It is important to realize that during an active gait cycle the Achilles tendon is under chronic mechanical load.  This tendon in general can become overused and is usually attributed to an increase in activity or change in activities.

The most common cause of Achilles tendon pain is what is described as watershed region Achilles tendinitis.  I encountered this in a lot of people that have begun to run or do plyometrics type activities like box jumping or jumping rope.  I encouraged people not to plunge into new activities to begin to train slowly.  With activities the changing and loading of the Achilles tendon can lead to Achilles tendinitis-type problems.  Typically this will present as pain and swelling in the Achilles tendon.  Oftentimes patients will experience increased pain that they try to push through this in addition they are at the risk of rupturing the Achilles tendon during this time.

It is extremely important that anytime a patient has Achilles tendon pain medicines evaluated by a physician.  Long-term wear and tear can delay the return to normal activities.  The longer patients have had these conditions there is a correlation with the longer it takes to recover.  Achilles tendinopathy is one of the most common pathologies that I see if with recent developments in treatment protocols patients can return to activities sooner.

Sincerely,

Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

There are quite a few causes of heel pain of heel pain and it can vary by age.  We tend to break it up by pediatric meaning anybody less than 18 and adult heel pain anybody over 18.  Regardless of the age and the patient heel pain can be extremely challenging and very painful.  We see quite a few adults and children that are highly athletic and struggling with resolving their heel pain.

Heel pain and children is typically sourced to a disorder called calcaneal apophysitis.  This is a condition where the growth plate of the heel is affected.  Often times with young man this occurs between the ages of 14 and 16 and for young limited between the ages of 12 and 14.  We see a high correlation with sport activities especially cleated sports.  It is important to have an x-ray and follow-up with the foot and ankle physician in order to evaluate the other underlying causes.

Adults tend to have pain that occurs in the morning especially when getting out of bed or after activities.  We see the majority of people have often increased their exercise routine or started a new activity.  The #1 cause of heel pain and adults remains plantar fasciitis.  The plantar fascia is the main supporting network of the foot and can become tired and worn out with age.  Again it is important to seek help from a foot and ankle physician to determine whether or not this is the underlying cause.

Heel pain in both pediatrics and adults is highly treatable and early intervention is better.  The majority of these causes can be distinguished of the first visit and felt can be implemented immediately.  If you’re having heel pain please make an appointment today and I can help.

Sincerely Dr. Brandon Nelson

Board-Certified Foot and Ankle Physician and Surgeon

I have now been operating for about 15 years and can tell you bunion surgery has really changed. In the average week I correct 3-5 bunions and have now operated on 1000’s of bunions. Some bunions are small, and some are large and very complex, but all can be fixed. I continue to learn and research new techniques, and these have afforded me opportunities and skills to provide great outcomes and minimal down time.

In the past bunion surgery was done at the hospital and often required and overnight stay. Patients were placed in casts and often non-weight bearing for months. I have heard stories of patients being uncomfortable for weeks.

I can tell you techniques have changed, and I am happy to outline how the average patient experience goes at my clinic. My clinic has an onsite surgery center that provides a huge cost and time savings as compared to a free-standing surgery center or a hospital. Most bunion cases are completed in under 3 hours from the time one enters the clinic to when ones leaves. We utilize IV sedation which is safer and allows me to perform a nerve block for long term pain relief. Pain medication is only needed for a few days and many patients do not even take anything apart from an NSAID. Weight bearing status depends on any ancillary procedures, but most bunion patients can walk immediately after surgery.

If you have bunion and have been contemplating having it fixed make an appointment today and I will review your options and help you make an informed decision.

Sincerely,

Dr Brandon Nelson

Neuromas of the foot are common in woman between the ages of 40-60. The typical neuroma will present with pain, burning and tingling to the forefoot. Most people state the pain feels better without shoes and rubbing one’s foot can help. There does not need to be a history or trauma or even previous foot pain to have a neuroma.

The neuroma itself is usually located in the 3rd interspace of the foot. This is between the 3rd and 4th toe and can be either right or left foot and rarely both feet. The reason this is the most common spot is the fact two nerves come together in this location. Often this creates an entrapment as this location can have limited space.

Treatment options for neuromas range from stretching and icing to injections and orthotics. Rarely now is surgery required as the conservative measures are so successful. I typically employ a prescription orthotic in conjunction with a series of alcohol injections. I have developed a protocol over years of treating thousand of patients and this has proved so successful that I rarely find surgery needed. I even see quite a few patients that have seen multiple other providers. If you want to avoid surgery and have a neuroma I can help. I look forward to getting you back on the road to recovery, Dr. Brandon Nelson, Board Certified Physician and Surgeon.

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

Heel pain continues to be the most common reason a person visits the foot and ankle doctor or podiatrist. For us it constitutes about 1 out of every 4 patients and is one of the most important things we treat. We specialize in heel pain and have seen tens of thousands of patients for it. Our success rate with conservative measures to get rid of heel pain is close to 99%, very few people require surgical intervention.

Plantar fasciitis continues to be the number one cause of heel pain. Most people will get pain first things when they get out of bed in the morning or after standing for long periods. It is common for some with fasciitis to not have morning pain. There also is a correlation with a new exercise program and the development of plantar fasciitis. I always recommend getting in early to see us as it is much easier to treat early on.

Bursitis is another very common cause of heel pain. We often see this in a high arched foot or a runner. Patients will have symptoms like plantar fasciitis but usually on ultrasound we can see the bursal sack. Bursitis usually responds very well to the treatment program we provide and very few people need to sideline their activities.

Nerve entrapments can also create heel pain. This is usually a nerve called Baxter’s nerve. Most people will experience a lot of burning and tingling with this condition. However, this can be a tricky diagnosis and may require special testing. This condition can respond well to a steroid injection adjacent to the nerve.

If you are experiencing heel pain we are here to help give us a call at 425-391-8666 or make an appointment online today.

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 2^nd 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 2^nd toe, we now have an extra load going through the 2^nd metatarsal and toe joint.  Eventually the extra load can strain the 2^nd 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.