Guest Editor, Dr. Alan Ng 
1994 World Kyuk Too Ki Heavyweight Bare Knuckle Champion
Second Degree Black Belt Enshin Karate
First Degree Black Belt Shidokan Karate

With the new popularity of athletic activities involving the martial arts, a variety of injuries will occur that are not seen with mainstream athletics. The diversity of the martial arts can be broken down into two different types of training. The traditional martial artist or kickboxer's training will involve a series of activities. A training session will involve stretching, basic techniques and combinations, bag and/or pad training, forms or kata, and finally sparring. A new type of training has become very popular in today's society is aerobic kickboxing otherwise known as "tae Bo". This type of training or exercise involves utilizing martial arts technique combined with traditional aerobic exercises. A class of aerobic kickboxing will combine stretching, basic techniques and combinations in an aerobic type format.

Training

The most important aspect of martial arts training or aerobic kickboxing training is that the student or participant must stretch extensively before a training session. By stretching the amount of minor soft tissue injuries such as muscle strains, tendon strains will be decreased. Stretching should be performed for a minimum of fifteen minutes before performing any kicking or punching techniques.

Injuries that can occur vary from minor injuries to severe dehabilitating injuries. When assessing aerobic kickboxing, injuries that occur are generally minor. Common podiatric related injuries when performing aerobic kickboxing are; plantar fasciitis, Achilles tendonitis, seasmoiditis, ankle sprains. When looking at traditional martial arts which involve striking pads, a heavy bag, and/or another student, the injuries become more extensive. In addition to the injuries mentioned above, traditional martial arts injuries include; fractures, hematomas, and dislocation joints and tendons.

Plantar fasciitis, or plantar fascial injuries can occur when training due to the constant pivoting and elevation of the foot while performing kicks. The mechanics of performing a front or roundhouse type kick involves the supporting leg to pivot on the ball of the foot, while the other leg is in the air striking the target. The fascial injury can occur on the supporting leg due the strain on the fascia, or a fascial injury can occur to the striking leg due to the repetitive pushing off and tightening of the fascia when beginning the kick, or when the kick is concluding which causes the kicking foot return to the ground which causes tightening of the fascia. The pain will be located at the inside of the heel and at the bottom of the heel when this type of injury occurs.

Achilles tendonitis is another common injury during martial arts training. The Achilles tendon is involved bringing the foot into position for many of the kicks, and is also responsible for the initiating motion when performing a kick. Since the amount of kicks performed in a training session can be over 500, an overuse injury to the Achilles tendon can cause a tendonitis when training.

Seasmoiditis, is another type of repetitive motion related injury. When performing kicks properly, the supporting foot is elevated onto its metatarsal heads, which allows the supporting leg to pivot. The long bone behind the big toe has two small round shaped bones underneath the head of this bone. These bones can become irritated and inflamed and cause pain just behind and under the big toe.

As with many other sports, ankle sprains are very common in martial arts training. The abundance of side-to-side motion and one limb support while kicking makes this injury a common one when training.

Basic Treatment Recommendations

With the four injuries listed above, basic treatment of resting the injury, icing the injury, and elevating the extremity should be performed. If the conditions persist after a few days of rest, ice, and elevation, further assessment should be performed by your podiatrist.

Other Injuries

With the addition of contact activities in traditional martial arts, fractures are common in the foot and ankle. Common types of fractures while training are; digital fractures, and metatarsal fractures. With these types of injuries, the pain is severe and often results in the inability to bear weight on the limb. Swelling and bruising will often accompany the fracture. If any injury is severe enough to hinder your ability to walk, and a fracture is suspected, it is recommended that you visit your podiatrist so x-rays of the area can be taken.

Hematoma formation may be the most common injury in the traditional martial artist. Hematoma is caused when the foot or leg strikes the target improperly or strikes a target which is not padded well. Objects such as bony prominences, a hard heavy bag, or even sandbags. What occurs is that by striking this object multiple vascular structures are disrupted causing bleeding inside the foot or leg. This will cause the foot to swell most commonly on the top of the foot, and the swelling causes pressure on the nervous structures which will result in pain. Hematomas can occur with or without fractures of the bones. The primary treatment for this type of injury is again rest, ice, compression, and elevation. It is very important thought to assess this injury properly. If you notice that the toes are cold, and the pain is very severe you must immediately have the injury assessed at a hospital or an urgent care center. A condition called Compartment Syndrome can occur in this area which if not treated immediately, can result in loss of your foot.

Dislocation of joints in martial arts will involve the digits the majority of the time. With traditional martial arts the training is performed without shoe gear. This allows the digits to be exposed and vulnerable to dislocation. If a digit becomes dislocated, see you podiatrist as soon as possible to avoid any long-term complications in that digit.

Tendon dislocation can also occur as a result of martial arts training. The primary tendon which can dislocate when training is the peroneal tendon which runs just behind the fibula. Often times this injury is mistaken for an ankle sprain. The characteristic of this injury is that the tendon which is usually behind the fibula will pop around the outside of the bone when the foot is pushed up. The injury will feel much like an ankle sprain. If you notice the tendon displacing in this way, or you notice that what you thought was an ankle sprain is not getting better you should see your podiatrist for further evaluation.

Conclusion

Martial arts is an excellent method of exercise and stress relief. As with any type of exercise, injuries are a common occurrence. Being able to identify the type of injury, and the proper treatment modality will allow for a faster recovery and a faster return to activity.

Foot problems can be magnified with every step, causing trouble beyond just your feet.  Pain in other areas of the body such as knees, hips and the back can result from foot disorders.  Ideal foot function can help the rest of your body.  When your foot has structural problems that impact the way you walk, your whole body suffers. 

Our clinic specializes in custom-fit orthotic prescription and biomechanical gait evaluation.  Prescription orthotics from our office are custom medical devices made from a cast of your foot.  Your foot is placed in the best functional position and then casted.  The cast is what is used to make the custom orthotic.  Dr. Young or Dr. Nelson complete a unique prescription based upon your specific problem and foot type.  The orthotic fits inside your shoe to change and improve the biomechanics of your gait. 

The following is a list of some of the conditions that prescription orthotics are used to treat:

• chronic heel pain (plantar fasciitis)
• severe pronation (arch problems)
• knee pain
• growing pains
• shin splints
• tendonitis
• bunions
• hammertoes
• abnormal gait

The prescription orthotic process is very straightforward and begins with an evaluation by our doctors of your specific problem.  They will assess your foot disorder and will decide the best treatment plan.  If that plan includes orthotics, they will perform a biomechanical gait evaluation to assess your walking patterns. Precise plaster casts will then be made of each foot.  The orthotic prescription is completed based on both the biomechanical gait evaluation and the plaster casts.  The custom orthotic laboratory makes the orthotics, you pick them up and after a few weeks, you should feel relief!  

Contact us today to get started on your prescription orthotics!

Fungi thrive in warm, moist, dark places such as close-toed shoes. This is one of the most common causes of toenail fungus, however it is not the only. Fungal infection is the most common cause of yellow toenails; however rarely some other disease conditions can also cause yellow toenails. Some of these conditions are psoriasis, jaundice, paronychia, lymphedema, bronchiectasis and tuberculosis. However, with these other conditions, usually there will be other symptoms also typically including the discoloration of the fingernails.

If a fungus is the cause of your discolored or thick toenails you may notice have streaks of discoloration and the nail may appear more brittle. If you’re unable to scrape off the yellow color with a nail file, chances are you’ll dealing with a fungus. Some toenail polishes can turn nails yellow.

If your feet are exposed to warm and moist public places such as locker rooms you are at higher risk for fungal nail infection. Fungi thrive in these warm, moist environments and even your footwear can cause this environment that fungi love. Your risk also increases when your feet are kept in damp sweaty socks or not properly drying your feet. Wearing tight fitting shoes can also cause your feet to sweat. This can create the environment for fungi to grow and create thick yellow fungal toenails.

How to Treat Fungal Toenails

Because people are often inclined to hide their yellow or “ugly toenails” they keep them confined. This can make the problem worse by sealing in the fungus. If the fungal infection is allowed to continue untreated, you may end up losing the entire toenail. Additionally, the infection can spread to other people if you share towels or footwear. The best solution is to see your doctor for treatment. There are oral medicines and topical medicines that have traditionally been used to treat this condition.

Over the counter topical medicines may be effective in some cases, however require long-term consistent use and many people do not have success with this treatment. With other more advanced cases some doctors may prescribe an oral medication. Many people cannot, or do not want to attempt the use of, the oral anti-fungal because it can cause elevated liver enzymes. Sometimes combined systemic and topical anti-fungal medications may also be prescribed. Usually prolonged treatment for up to 1 year may be required to cure a fungal toenail infection. As a result, many people are choosing the latest laser technology as their treatment for this condition.

Have your fungal toenail(s) evaluated by the doctors who specialize in effectively treating this condition today. They will evaluate your condition and design a treatment plan specifically tailored to your case. Read our section about Treatment Options for more details.

Prevention of Fungal Toenails

The fungi causing yellow toenails require warm, moist and dark environment to grow. Wearing closed shoes for prolonged duration provide this ideal environment for the fungi to grow. Moreover, inadequate personal hygiene also makes one more susceptible to develop toenail fungal infection. Poor blood circulation in the feet and increased sweating also predisposes to toenail fungal infection.

Therefore, preventing measures involve regular washing of the feet with soap and water and allowing them to become completely dry. Wearing shoes for prolonged duration should be avoided as much as possible. Feet should be completely dried before wearing closed footwear. Moisture absorbing socks are better to keep feet relatively dry, especially if one sweats more than usual. Toenails should be adequately trimmed. Regular exercising (walking, running, etc.) helps to improve blood circulation in feet and reduces chances of toenail fungal infection.

• Wear Clean Dry Socks
• Wear Breathable Footwear
• Avoid Going Barefoot in Public and Damp Areas
• Avoid Sharing Towels, Bathmats and Clothes if Someone Else has a Fungal Infection.
• Clean and Dry Your Feet and Toes Daily.
• Maintain Proper Foot and Toenail Hygiene.

In addition to improper toenail trimming, ingrown toenails are also  caused by shoe pressure from ill-fitting shoes, injury, fungal infection, heredity, or your natural foot structure. Ingrown toenails occur when the corners or sides of the toenail grow into the skin, often leading to infection. A common ailment, ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender; and if untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.

Heredity – Many people have simply inherited the tendency of ingrown toenails.

Injury – Stubbing your toe, dropping objects on your toes or repetitive movement under high pressure. If your shoes are rather tight fitting in the toe box for your foot structure and running or other activities cause repetitive movement this can contribute to the development of ingrown toenails.

Nail Trimming – Perhaps the most common cause of ingrown toenails is improper toenail trimming. If nails are cut too short there is an increased likelihood nails will grow into the skin that surrounds the nail. Skin around the nail is raised in comparison to the nail and if cut to short this skin may encroach the area where the nail will grow into. As a result, the nail will grow into the skin.

Footwear – Your running shoes may be too tight and may be cramping your toes. Many people sacrifice comfortable footwear for the sake of fashion. As a result, shoes with a narrow toe box may cram your toes into narrow places, put added pressure on your toes and lead to ingrown toenails, among other issues.

Adolescent boys in particular are more prone to developing  ingrown toenails. They are growing so fast their shoes can become tight fitting quickly. This shoe pressure is often a causative factor in ingrown toenails.

For children we use a combination of topical anesthetic and gentle electrical stimulation. The patient controls electrical stimulation themselves to help keep the nerves “busy” and the local anesthetic injection is administered. Younger patients benefit from this special technique. They are often very apprehensive about an injection, however with our techniques, the patient and their parents are often pleasantly surprised at how well they do.

Other Conditions – Injury or trauma which lead to toenail loss can create a situation for ingrown toenails when the nail grows back in. Also fungal infections that cause changes in the nail can cause ingrown toenails.

Beware, bathroom surgeries often lead to infection.

Do not attempt to remove infected nails on your own. If you notice an increase of swelling, pain or any discharge is present; the toenail is likely infected and should be treated by a podiatrist.

Contact us if you are experiencing painful ingrown toenails, especially if you believe the condition worsening or you have diabetes or circulation issues. Addressing this condition early will help in the prevention of infection and other complications. Ingrown toenails can be very painful and can be treated easily depending upon the severity.

Here are a few tips from Dr. Brandon Nelson and Dr. Timothy Young from Issaquah Foot and Ankle Specialists:

Choose appropriate footwear – If you are active and participate in sports select footwear designed for that specific type of activity. A toe box appropriate for your foot structure is important preventing ingrown toenails and other injuries. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for running should have plenty of room also, but not be too loose.

Check your toes – Ingrown toenails can often be avoided if you take care of your feet. Take a moment to examine your feet and look for signs of ingrown toenails. If you notice any red, swollen and painful areas of your toes near your nail you should have it evaluated.

Perfect your cuts – When trimming nails be conscious of how short and curved you trim your nails. The more skin exposed the greater the opportunity the nail has to regrow into the skin. Always use a clean, sharp nail trimmer. When trimming your toenails consider briefly soaking your foot in warm water to soften the nail. Trim toenails straight across the top, do not taper or round the corners or trim too short. Never pick at or tear your nails.

 

False relief – Topical medications that are available can relieve temporarily relieve the pain associated with an ingrown toenail. However this only masks the pain and the issue will continue to worsen.

 

Avoid bathroom surgery – visit our ingrown toenail home treatmentssection for more information about these complications.

Ingrown toenail surgery is a simple out patient procedure that is fairly quick with minimal pain. Steps can be taken to minimize the pain and in our office some techniques provide virtually eliminate pain. We use a nerve stimulation device that the patient controls the electrical stimulation themselves to help keep the nerves “busy” and a local anesthetic injection is administered. Moments after the injection the area is numbed and patients typically report only dull pain if any during the procedure to remove the ingrown nail.

Patients may experience some discomfort after the procedure however this will depend upon the severity of the condition. Many people report pain is not noticeable after the procedure unless there is direct contact with the area like stubbing their toe. The images on the left show a local injection of a numbing agent that can be used to dull the sensation of the procedure. A section of the nail is removed and the toe was bandaged to prevent infection and provide some cushioning. The final image is after the bandage was removed.

 

 

Partial removal of the toenail may only temporarily cure the problem and the nail can grow back again.  To prevent regrowth of that section of nail that caused the issue, part of the nail bed is destroyed using a chemical agent to prevent regrowth. This procedure is called a partial matrixectomy. A section is excised and the nail matix for that section is treated so a small section of nail will not regrow in the same area of the original issue. The skin that once lay under the nail will appear raw until it changes to resemble the skin that lay next to the nail.

The actual surgical procedure is relatively quick and numbing agents minimize discomfort. Recovery times will vary based on the extent of the condition and course of treatment. Most patients can resume their normal activities withing two to three days post surgery.

Flatfoot is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed correctly and is lowered or flattened out.  There are many causes of flatfoot, such as: genetics, rheumatoid arthritis, stroke or diabetes.  Individuals who have flat feet rarely have symptoms, but they might experience pain in the following instances: sudden weight gain, minor injury, incorrectly fitted footwear, changes in work environment or excessive standing, walking, jumping or running.  Treatment for flat feet usually consists of wearing spacious, comfortable shoes with good arch support.  Many times, orthotics are recommended to balance the foot in a neutral position and cushion the foot from excessive pounding.

 

How do the doctors of the Washington Bunion Center treat bunions?

Depending upon the severity and progression of the disorder non-surgical options are typically preferred. If left untreated bunions will progress and typically become increasingly painful. This can cause restricted or painful motion of the big toe (small toe for a Tailor’s bunion) resulting in decreased activity levels, inability to wear common footwear and the development of corns.

Non-Surgical Bunion Treatments

After an evaluation of a patients bunion(s), sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays may be recommended.

However, in many cases some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. Some of these treatments include wearing proper fitting footwear, avoiding narrow pointed shoes, or the addition of padding to footwear.  Padding and taping will provide some cushion to the area and may reduce friction, swelling and sensitivity. Orthotics or shoe inserts can provide relief. However, prescription orthotics are often more helpful.  These prescription orthotics are made specifically to address your unique issues that many of the over the counter orthotics cannot address. Modifying activities that aggravate this condition may be necessary, ice and anti-inflammatory medications can help with swelling and pain.

Non-surgical treatments are preferred by both doctor and patient and there are a variety of devices and treatment options available. The best way to relieve the pain and take steps to address the progressiveness of the disorder is to have your bunion(s) evaluated. As the bunion continues to progress untreated non-surgical treatments become less effective.

Because they are bone deformities, bunions do not resolve themselves. The goals of bunion treatment are to relieve the pressure and pain caused by irritations and limit the progressive growth of the bunion. Common methods used for reducing the pressure and pain caused by bunions include:

• Protective padding, often from felt materials, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
• Removal of corns and calluses on the foot.
• Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
• Orthotics are used to help stabilize the joint and place the foot in the correct position for walking and standing.
• Exercises to maintain joint mobility and prevent stiffness or arthritis.
• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

If a bunion disorder progresses to the point when surgery is needed, what are the options?

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

When Is Surgery Needed?
Severe bunions may need to be surgically corrected. A variety of surgical procedures are available to treat bunions. Surgical procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is to reconstruct the foot and therefore reducing pain.

Visit our bunion surgery page for more information about this form of treatment.

Are you experiencing pain related to a bunion?

If you experience pain on the inside of your foot at the joint of your big toe and experience the following, it is likely a bunion…

• Swelling or redness in the same region
• A burning sensation or numbness in your big toe
• Decreased range of motion of your big toe joint
• Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint
• Pain in this area while wearing shoes – especially shoes too narrow or high heeled shoes
• Pain in this area during activities
• Development of  a corn in between your big toe and second toe
• Callous formation in this region

You do not have to live with a painful bunion that prevents you from participating in activities or wearing your favorite pair of shoes. Bunions are a progressive disorder that if left untreated may require surgery to reconstruct the foot. Many people will deal with bunion pain until it becomes unbearable and by this point surgery is more commonly recommended if the deformity has progressed to this point. There are corrective measures that can be performed to correct or slow the progression of a bunion deformity so early intervention is best.

What can be done about bunion pain?

In addition to the bunion treatments provided by the Washington Bunion Center many people find some relief from these simple tips:

Wear shoes with a wide toebox
A little extra room can go a long way to easing the pain and pressure on your toes.

High heels can lead to high levels of pain
If you cannot avoid wearing high heels, or shudder at the thought, wear them in moderation.
Wear shoes that fit properly
We are putting together a quick guide for finding the right shoes for bunion sufferers. Check back as we continue to put it together. Once we have it complete we will email it out to you if you like. So please check back soon for a link here. Here is a tip in the meantime… Did you know that your feet are often slightly larger toward the end of the day? After spending time on your feet your feet will swell slightly and because of this we recommend that this is the best time for shoe shopping.

Padding
There are many devices, pads and cushions that used to ease the pain of bunions. The local drugstore likely has a variety of options. However, it may be best to have us evaluate your bunions and we can recommend the best solution that will provide you with relief.

Orthotics
Did you know that bunions are hereditary? Not the bunions themselves, but the structure of your feet that leads to the development of bunions is hereditary. The structure of your feet will predispose you to certain foot conditions and bunions are no exception. Orthotics are custom made devices that provide the correct type of support your feet need based on their unique structure. Orthotic devices are available at your local drugstore, however they do not provide the unique support that your feet need. Custom made prescription orthotics address many issues that are related to ones unique foot structure and gait.

Slip off your shoes once in a while
When you have the chance to let your feet out of restricting shoes, take advantage of it.

The best course of action
Bunions are progressive and can become painful protrusions of the foot that can affect your ability to enjoy your favorite activities, or even your favorite shoes. Therefore, the best course of action is early evaluation and treatment. To have your bunions evaluated request an appointment today using the link below or call us.

Bunion Treatments

Start learning about the latest bunion treatments provided by the Washington Bunion Center.