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Saturday, 17 June 2017 15:29

Juvenile Bunions

 
A bunion is prominence and sometimes enlargement of the first metatarsal head.  Typically it is a misalignment problem.  Some of our patients develop these at a very early age. They can be teenagers or even preteens.  When this is noticeable, x-rays will show the alignment problem of the foot and often they show the growth plates are still open and the foot will still be changing and growing.  Juvenile onset bunions come from the foot structure that was inherited, including a number of factors such as pronation, midfoot misalignment and metatarsus adductus.  Some sports may also aggravate this.  For example ballet and sports that require a very snug fitting shoe or cleat may aggravate a bunion.
 
Juvenile bunion treatment does vary.  If the boy or girl has growth plates still open than we usually do not consider surgery.  At that point we would recommend prescription orthotics, splinting or taping to help the alignment of the foot and the bunion and great toe, comfortable shoes that offers good support and plenty of room for the toes including the great toe.  Once the growth plates have closed, if the bunion is severe enough and/or symptomatic enough we would consider surgery.  Because they occur at such an early age and the particular individual was so prone to developing a bunion, juvenile bunions are more prone to recurrence even after surgery. 
It is with this in mind that we want to make absolutely certain that the bunion is fully corrected.  That means that in addition to surgery involving the first MTP joint soft tissue balancing and reduction of the bunion prominence itself. It is important to do work at the base the first metatarsal.  Most frequently we would recommend a fusion of the first metatarsal-cuneiform joint (Lapidus bunionectomy).  We would also recommend continuing to utilize prescription orthotics after surgery on an ongoing basis.  We have had extremely good results with this procedure for juvenile onset bunions.  One advantage of bunion surgery is juvenile onset is that the younger the patient, the faster the bone healing typically occurs.  Which means most of these patients can be in a cast for much less time than an adult or elderly adult would require.  Because they heal faster it's often easier to get the range of motion back to the great toe joint after surgery and to get back to normal walking faster also.
 
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Saturday, 17 June 2017 15:27

Why Do Bunions Form?

Many of our patients ask:
Why did I get this bunion. Was it hereditary? Was it from wearing running shoes? Was it from an injury?  These are questions we commonly hear.
The answer is that there are multiple factors.  Sometimes we see very early onset bunions–juvenile bunions.  These almost always involve a foot structure that has been inherited that is prone to developing a bunion.  Part of this foot structure issue is a low arch or increased pronation (similar to a flatfoot).  Part of this structure may be metatarsus adductus -- where the bones in the midfoot are misaligned and there is a "headstart" forming a bunion. 
It is very rare that these would be due to wearing the wrong shoes or tight or pointed shoes at this young age.  For someone who has a mild tendency for developing a bunion, over middle-age the bunion may start forming very gradually.  This is where some factors may speed up the process such as high heel pointed shoes or a very pronated foot.  A lack of good shoe support may also even be a factor.
Once a patient comes into our office, a physical examination and x-ray is needed to thoroughly evaluate a bunion.  It is important to look to see if there is enlargement of the metatarsal head, if there is misalignment of the sesamoid bones with the metatarsal phalangeal joint (first MTP joint), and also to see if there is significant splaying or spreading of the first and second metatarsals. 
It can be helpful also to see if the foot overall has significant underlying metatarsus adductus.  Patients who have significant metatarsus adductus and a bunion usually have a magnified bunion problem and alignment problem.  The physical examination may show instability or hypermobility of the first metatarsal.  This is often a factor of the stability of the first metatarsal-cuneiform joint. 
There may even be radiographic evidence of excessive motion in this joint.  In addition the patient may have pain next to the joint over–base of the second toe.  This surprises many of our patients when they find out that the bunion doesn't really hurt but the bunion is indirectly causing the problem to the next joint over.  This is because the first metatarsal is designed to bear up to have to wait of the entire forefoot especially when the heel comes up off the ground.  When this is not occur, the next in line metatarsals get overloaded and overstressed.  One can develop problems in the second metatarsal-cuneiform joint or even a stress fracture of the second or third metatarsal.  It is important to evaluate the whole foot to determine the best treatment options.
So here some examples.  We have already mentioned juvenile bunions.  Early middle-age bunions can be from early onset (juvenile onset) and therefore will be severe and middle-age because they were already quite pronounced during the teenage years.  Other middle-aged patients will have more of a mild to moderate bunion where they just were not is prone and did not have as many factors make an them predisposed.  Some patients will also have had an injury or be prone to significant arthritis with the bunion.  As mentioned some patients may, in with non-bunion symptoms.
 
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Friday, 09 June 2017 15:25

What is Arch Pain?

Arch pain is the term that's used to describe pain under the arch of the foot. Arch pain is commonly caused by plantar fasciitis and is a very common condition. When you experience arch pain, it's usually indicative of inflammation of the tissues within the midfoot. Here at Issaquah Foot & Ankle Specialists, we've treated many patients with arch pain using simple treatment solutions. We've found that patients respond well to anti-inflammatory medications and stretch exercises. However, we also strongly recommend prescription orthotics, as they are effective treatments for arch pain. 

If left untreated, arch pain can lead to the development of heel spurs, which is a bony protrusion at the heel area. If you are experiencing arch pain, which typically occurs in the morning, do not hesitate to give us a call at 425-391-8666 or contact us online for an appointment. 

 

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Thursday, 01 June 2017 15:23

Treatment for Tailor's Bunion

We often see patients in our clinic that present with pain on the outside of their foot. Patients often come in with pain related to activities or pain with wearing shoes and no history of any trauma. It is common for these patients to remove their shoe and a Tailor’s Bunion is present. A tailor’s bunion is a enlargement of the fifth metatarsal. This enlargement can be related to a shift in position of the bone or a bowing of the bone itself.

This pain can increase with the more activities the patient performs and often can conservative measures do not help. When our patients have failed conservative measure often surgery is the best option. With surgery it is important that the proper procedure is selected and we have treated quite a few tailor’s bunions of the years. Here is a recent example of a patient that had a hard time hiking and wanted to have her tailor’s bunion surgical fixed. The before x-rays are first followed by the after.

               

                                                                         

She had an extremely successful surgery and was in a walking boot for four weeks and then was back to activities. If you suffer from a tailor’s bunion and need some advice and live in Bellevue, Kirkland, Seattle, Issaquah, Maple Valley or Renton contact us so we can help. One of the best things about our clinic is we are highly experienced in treating tailor’s bunion and have an onsite surgery center that can save you thousands of dollars. Call us at 425-391-8666 to make an appointment today or contact us online. 

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Thursday, 25 May 2017 15:20

New Synthetic Cartilage For Big Toe Arthritis

 

Great toe arthritis, also known as hallux limitus and hallux rigidus, is a common condition and the United States. Osteoarthritis of the big toe often creates pain and stiffness as one tries to walk. The stiffness can also feel like jamming of the joint and eventually there may be swelling or enlargement of the joint.

There are many great options available for treating this arthritis, including conservative measures as well as surgical measures. Some of the conservative measures include injections and custom molded prescription orthotics.

There are two types of surgical intervention these include joint spurring and joint destructive. Recently FDA approved and artificial cartilage implant that can be utilized to decrease recovery time. Cartiva is durable and able to withstand loads similar to natural cartilage and can hold up too long periods of stress.

It’s also great alternative to people but don’t want a fusion. Some patients are back to normal activities in as quickly as 4 weeks. If you are looking for a great alternative to fusion or aggressive surgical procedures and have pain and swelling and live in Issaquah, Bellevue, Seattle, Kirkland or Maply Valley contact our office to see if Cartiva is right for you. Make an appointment to see us today or call us at or 425-391-8666.

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Thursday, 18 May 2017 15:18

Big Toe Arthritis

First Metatarsal osteoarthritis can be a very painful condition. Patients often experience stiffness, clicking or grinding of the big toe. Many times this has occurred following trauma to the big toe, like a turf toe injury or can be wear and tear with activities.

There are many different treatment options available for great toe arthritis. One of the newest options is Cartiva. Cartiva is a new FDA approved synthetic cartilage implant. Cartiva shows some promising results and could become a great alternative to fusion of the toe.

Most patients experience a substantial reduction in pain and improved range of motion with Cartiva. Right now Cartiva is the only FDA PMA approved cartilage-like biomaterial for treatment of MTP osteoarthritis. If you are looking for a great alternative to fusion and have pain and swelling and live in Issaquah, Bellevue, Seattle, Kirkland or Maply Valley contact our office to see if Cartiva is right for you. Tel: 425-391-8666

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Thursday, 11 May 2017 15:16

Spring is Here!

A lot of people get a very common and contagious fever in the Springtime. Some like to call it Spring Fever. Especially here in the Northwest.

It is almost impossible to not go on long beautiful hikes or take long walks after dinner. There are other added activities that can cause extra heel pain flare up as well. A nice long run, maybe it is time to get scanned for a new pair of prescription orthotics.

If you are having a little added pain in the morning or at night do not hesitate to call our office and make a Spring check up appointment.

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Friday, 27 January 2017 15:12

Bunions Before And After (With And Without X-Rays)

 
Bunions look much different when you look at your foot than they do when we look at your x-rays. Just looking your foot, it looks like a large bump is sticking out.  However, when we look at your x-rays we can see that the first and second metatarsals are very often out of alignment.  
 
This causes the whole foot be wider than it should be.  It is because of this problem that fixing the bunion requires several different elements.  Of course we always have to remove the bump itself and/or enlargement.  
 
But then the next stage would be to determine how much correction is needed to get the first metatarsal back in line with the second metatarsal.  It is this portion of the correction that determines whether or not it is a head procedure or a base procedure.  For a mild to moderate bunion, a head procedure often will offer excellent correction.  But for moderate to severe bunion or if there is pronounced hypermobility of the forefoot (including potential pain near the base of the second toe), then it is time to consider realigning the whole bone at the base of the metatarsal.  
 
Doing the work further back (at the base) offers more correction but can require additional time for healing. It is in these instances that we use a special fiberglass cast with a walking cast heel, and we then split the cast  (bivalve the cast) to make it easy for you to go to physical therapy if necessary and for bathing.  
 
Despite this, we do not recommend that you walk around without your cast or cast boot on–early after bunion surgery.  It is important to wait for adequate bone healing before using unprotected weight bearing pressure.  When correction is done further back at the base of the metatarsal there is more potential correction and leverage (which must be minimized to allow for proper bone healing).  
 
We recommend full weightbearing x-rays to show the extent of a bunion deformity and allow for the weightbearing deforming pressure.  
 
If you have questions or would like xray evaluation regarding potential bunion or foot surgery, 
please contact our clinic at Issaquah Foot & Ankle Specialists: Dr. Brandon Nelson and Dr. Timothy Young. 
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Friday, 20 January 2017 18:30

Achilles Tendonitis and Pain in the Morning

The Achilles tendon is the strongest and thickest tendon in the human body. It is required for normal walking, jumping and exercises. It is one of the most common tendons to become inflamed from over use. Often times we see patients who recently had a change in exercise activities or who just started a new exercise program that develop Achilles pain. Some of the most common symptoms patients experience with this condition include:

● Pain when first getting out of bed

● Swelling around the heel

● Stiffness of ankle when first start walking

● A grabbing or catching sensation around the Achilles

Some of the first lines of treatments for Achilles tendonitis include icing and stretching as well as an anti-inflammatory like ibuprofen. We strongly encourage people to seek medical intervention for Achilles pain as the long term complications can include rupturing or tearing of the tendon. For some great stretches please see the following video.

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Friday, 13 January 2017 18:27

It's That Time Of Year Again, When Your Deductibles Reset

 
Ouch!  It is nice to know that your overall out-of-pocket expenses will be significantly less at our state of the art certified surgical center.  There are several fees to consider including the surgeon's fee and the facility fee.  The facility fee at our surgical center is a fraction of that compared to having your foot or ankle surgery done at the local hospital.  
 
Our certified ambulatory surgical center (ASC) has to follow guidelines that are often virtually the same or similar to those of the hospital. Take a look at our surgical facility for yourself!
 
To help minimize the risk of infection and to benefit your health and safety,  strict guidelines are followed at Foot and Ankle Surgical Center of Issaquah.  We treat you like family!  In fact, many of our family members and close friends do come here to have their procedures done at our facility.  
 
Our goal is to treat you in the safest possible manner and help maximize the best possible outcome. Each year, hundreds of our patients have surgical treatment for their foot or ankle condition at our facility.  Our patients enjoy the best quality care and our surgical facility consistently receives outstanding reviews from our patients.  This is a great reflection on our facility our surgeons and our staff.  If you do need foot or ankle surgery, we can have our billing service check your benefits and determine your out-of-pocket portion.  
 
Please contact our clinic at Issaquah Foot & Ankle Specialists: Dr. Brandon Nelson and Dr. Timothy Young.
 
Tel: 425-391-8666 
 
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