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normalfoot

Neuromas
usually present as forefoot pain that is common in woman between the ages of 40-60. Most patients describe a burning or tingling that is worse in shoes. This is most common between the 3rd and 4th toes but can also be present between the 2nd and 3rd. This is primarily do to the anatomical design of the foot and the coming together of nerves in that location.

There are many different treatment options for neuromas and to date one is the most successful. Treatments options can range from toe spacers to injections and physical therapy. The most successful seem to be injection therapies and offloading of the nerve. A well-made prescription orthotic can be extremely helpful for active patients.

Injection therapy is the mainstay of neuroma treatments. Currently the most successful by far is alcohol injections. Alcohol injections work via osmosis by dehydrating the nerve. Our nerves are primarily composed of water and if alcohol is injected adjacent to the nerve over time the nerve will shrink. The nerves that are involved with neuroma formation are sensory nerves. This means these nerves provide pain input and do not contribute to any movement of the toes. The most promising part of alcohol injections is the success rate. The literate states these injections are 89% successful. This is a great option for anybody not wanting surgery.

I have been utilizing alcohol injection therapy for more than 10 years. I can tell you it is highly successful but user dependent. What I mean by that is you need to have a physician that is doing a lot of these to get the best result. I also advise do not have a physician inject without the use of an ultrasound. An ultrasound is key to the successful outcome. Ultrasound helps to identify the nerve and then one can watch the needle placement and the injection will be highly successful. Again I cannot stress that enough, find a physician with an ultrasound so you have the best possible outcome!

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

plantarfasciitis

Plantar fasciitis
continues to be the most common source of heel pain. The majority of our heel pain patients are still presenting with fasciitis. Patients usually feel pain in the morning or after sitting for a short period of time. The symptoms can range from burning and tingling in the heel to a bruised like sensation when walking. There does not need to be any history of trauma or even an increase in exercise. The major causes continue to be anatomical and foot structure related.

I can tell you I have been treating plantar fasciitis now for almost 15 years. I would say a conservative estimate is probably close to 10,000 patients that I have treated for heel pain. I have learned a lot with this time and quantity. I continue to read and learn and study each patient. This has provided me with a unique perspective. I would say I am probably one of the foremost experts on heel pain.

The best long-term treatment to date that I have discovered is utilizing one’s own biology to heel the plantar fasciitis. This condition is created when the fascia is overworked and needs to be strengthened structurally and functionally. The technique I utilize is unique to my practice and has taken years to perfect. Basically I harness a patient’s natural ability to heal and utilize that to repair the fascia. There is no down time, and the success rate is close to 97%. If you suffer from fasciitis make an appointment today and I will help.

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

austin bunionectomy

Bunion surgery
is by far the most common surgical procedure that I perform. That is why I developed the Washington Bunion Center. We use state of the art equipment, the latest techniques all to provide the best possible patient experience and outcomes. We have advanced protocols for pain control after surgery and to decrease healing time. Additionally, I minimize surgery time for a better patient outcome, reducing things like post-operative nausea and grogginess regardless of the type of bunion surgery needed.

The average bunion surgery requires cutting of the bone or fusion of a joint. These are the two most common bunion surgeries to date. Regardless of the procedure needed I can make sure patients are walking immediately after surgery or within a few days by utilizing special techniques and weight bearing options. This had taken years to develop and the reason I am able to do this is related to years and years of experience.

This experience is what sets me apart from other bunion surgeons. I have fixed so many bunions over the last 15 years that is has provided me with invaluable skill and knowledge that results in excellent outcomes. I feel that by combining these two attributes’ patients have the best possible results. If you are thinking about fixing your bunion schedule an appointment today so I can help.

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

pic heel pain 4

Heel pain
can be common in children especially as they return to sports. We typically see girls between the ages of 8-12 and boys around 10-14. This increased incidence of heel pain at this time can be correlated with growth spurts or changes in activities. There is often a family history of heel pain as well from a parent or siblings. Unlike adults, very few children will have plantar fasciitis as the cause of heel pain. So, what are the main causes of heel pain in children? I will discuss a couple below.

Coalitions, these are where you have an abnormal connection between bones in the feet that should not be connected. Often, we see this type of pathology becoming painful after an injury, like an ankle sprain. Usually, an x-ray in needed to diagnosis this. This can differ based on location and there are two general locations of the coalitions. The two main locations are a calcaneal navicular and a talar calcaneal as the most common. The types of coalitions can vary, from bone to cartilage and even soft tissue.

Another common cause of heel pain in kids is Sever’s disease. This is basically an irritation of a growth plate that was first described by Dr Sever. This is especially common in cleated sports like soccer or football. There is usually a family history and common in flatfeet and kids with tight calf muscles. While this list is not exhaustive of all types of heel pain it is two of the most common, others can include a bone tumor, stress fracture or even a nerve irritation. Please make an appointment online or give us a call at 425-391-8666 if your child is having heel pain so we can help.

austin bunionectomy

Bunion surgery
is by far the most common foot surgery in the United States. The number of bunion surgeries performed per year in the U.S. is about 150,000. The majority of these bunion surgeries are done in an outpatient setting and take less than 1.5 hours.

What is a bunion?

Please watch the following video for more information on a bunion;

https://www.bestfootdoc.com/patient-education-videos

So, what is the most common bunionectomy to date? The answer is a distal osteotomy or cutting of the bone towards the head of the metatarsal. This procedure is called an Austin bunionectomy.

Please watch the following video to learn more about bunion procedures; https://www.youtube.com/watch?v=U_D0NhTZOyY

Bunion surgery does not need to be scary or overwhelming we are here to help.

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

normalfoot

Numbness and tingling can be quite common in people experiencing forefoot discomfort. Most people will describe symptoms like burning, pinching, numbness and tingling. These are often associated with nerve type issues and can continue to get worse without treatment. The most common causes of this in the foot are neuromas and capsulitis.

Neuromas are a nerve irritation that occurs in the foot and usually is a female between the ages of 40-60. The nerves that run between the toes are sensitive and any increases pressure can cause pain. This pain is usually made worse with tight fitting shoes or high heels. Patients usually have pain to the 3rd and 4th digit and often is only on one foot. Most people will say that rubbing the front of their foot seems to help as well as removing their shoes.

Capsulitis is usually around the base of the 2nd toe. There is often an underlying deformity like a bunion or tight calf muscle. Patients will often experience swelling and tingling or digit. It is usually made worse with walking and relieved with icing.

Neuromas and capsulitis both can be challenging for the patient and the doctor. It is important to identify the root cause and an x-ray is warranted. The treatment options available are usually very successful. If you are having forefoot pain we can help, make an appointment today.

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

Achilles Tendon

Achilles tendonitis
or bone spurs in the Achilles tendon are common pathologies we see as foot and ankle surgeons. These two conditions are often started with over training or long-standing tight calf muscles. Both can lead to rupturing or a painful Achilles tendon with any sort of activity. It can be quite challenging to rest this area or rehab this tendon as it never really is inactive when ambulating.

Many patients will end up requiring surgical repair of their Achilles and new modern approaches can minimize down time. Previously all patients had required at least 6 weeks of non-weight bearing. However new techniques have improved outcomes and eliminated the need for non-weight bearings.

Achilles tendonitis usually presents around the mid substance of the Achilles. It is usually a painful bump that can swell with exercise. In the past patients requiring repair required a standard incisional approach with a long recovery. However, I have been utilizing the Tenex procedure which has almost no downtime and can be preformed without anesthesia if patients prefer. The Tenex stimulates new growth and repair of old tendon pathology. After the procedure patients can walk and return to activities shortly.

Bones spurs in the Achilles tendon have previously requires an extensive surgery to remove the bone and repair the tendon. I have been using Tenex on these cases as well and patients can walk immediately after the procedure and require no re-attaching of the Achilles tendon. If you are looking for a quick recovery, minimal down time or minimally invasive Achilles tendon surgery I can help. Give us a call today at 425-391-8666 or make an appointment online today. 

Wednesday, 15 September 2021 20:41

Bunion Surgery Recovery, Dr Brandon Nelson

austin bunionectomy

Quite a few patients ask about bunion surgery and bunion surgery recovery.  I hear a lot of stories from patients about neighbors, friends or family members that have had bunion surgery.  There seems to be some misconceptions about bunion surgery and some general misconceptions.  I want to help clarify this for patients and anybody thinking about fixing their bunion.

Bunion surgery can really be broken down into two different procedure locations.  Bunions can be corrected at the head of the metatarsal or the base of the metatarsal.  The head procedures are generally utilized for smaller bunions and base procedures are better suited for larger bunions. 

Head procedures are probably the most common bunion procedure.  This is often called an Austin bunionectomy and has been around for greater than 50 years.  It was one of the first bunion procedures and has great success and most patients can return to a normal shoe in about 4-6 weeks.  Patients can walk the entire time after surgery in a boot for about 4 weeks.

Base procedures are a little more involved surgery and therefore the recovery is longer.  Most base procedures can allow patients to walk in a boot in 2-4 weeks.  However, the total recovery from this type of surgery can be 8 weeks or longer.

I hope this helps to answer a few bunion surgery questions!  Give us a call at 425-391-8666 or make an appointment online today. 

heel pain in the morning

Despite all the available conservative options available for plantar fasciitis some patients do still require surgery. There are many different surgical procedures to address chronic plantar fasciitis. This includes the traditional open fasciotomy, the endoscopic fasciotomy, Topaz procedure and the Tenex procedure. The Tenex procedure is relatively new and has showed promising results with minimally invasive technology.

Tenex, is basically a small tool that you insert in the fascia that removes tiny pieces of the fascia. It is inserted multiple times via a very small incision and safely removes some of the diseased fascia and stimulates new fascial growth. The procedure itself can be done in less than 10 minutes and does not require anesthesia. A little bit of numbing medication can be injected around the fascia and then the procedure can be performed. Patients are required to wear a walking boot for about 3 weeks.

The initial results are very promising, and patients experience no pain after the procedure. I have seen very little swelling or bruising after the procedure and patients have been extremely satisfied with the recovery course and reduction of plantar fascial pain. I believe this procedure will change the open approach for a lot of surgeons and is demonstrating incredible results. If you are suffering from plantar fasciitis we can help.

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

bunion

In some cases, the fifth metatarsal bone was away from the adjacent fourth metatarsal so much that to correct the problem we must reset the bone. This is much like creating a surgical fracture realigning the bone exactly where it should be amenable allowing it to heal in its new position.  This can correct a more pronounced tailor's bunion.  

This requires some type of fixation.  Usually this involves one or 2 small screws to hold the bone in the newly aligned position.  Bone healing typically takes 6–8 weeks.  Therefore, the cast boot is used long enough to allow for the additional bone healing.  This can also help if the patient has a pressure point under the fifth metatarsal or callus under the fifth metatarsal.  There are several different ways of realigning the bone and then fixating this.  
 
If you have concerns about a tailor's bunion, please come to our clinic for surgical consultation. Give us a call today at 425-391-8666 or make an appointment online. 
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