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Hammertoes are a common pathology I see in my office.  Most patients with curled toes have pain with activities and a hard time fitting shoes.  They describe a progression of the toes where other forefoot pathologies can be present. 

 

Causes:

The most common cause appears to be foot structure and genetics.  We see patients that have flatter feet require increased pressure from the tendons in their toes to stabilize.  This repetitive pressure can cause pain and discomfort.  Some people will inherit a foot structure that can predispose them to hammer toes.  These foot structures are ones that often develop bunions as well.

Symptoms:

The symptoms can vary from patient to patient.  The most common symptoms include swelling and pain.  Some patients relate a significant stiffness or bending to the toes that pushes in their shoes.    All can be painful, especially with physical activities. 

Treatment:

We have many options available for hammer toes.  But it should be noted it is based on the degree of the hammer toe.  How significant is the bending and contracture of the digit.  It is important to have a good clinical evaluation and an x-ray.  If you would like a consultation for your hammer toe pain I can help.  Call to make an appointment with me at 425-391-8666 or make an online appointment.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Issaquah’s Top Podiatrist

 
Introduction: Midfoot arthritis can significantly impact one's quality of life, causing pain, stiffness, and limited mobility. While conservative treatments like medication and physical therapy can help manage symptoms, advanced cases may require surgical intervention. Adductoplasty, a surgical procedure aimed at addressing midfoot arthritis, has gained attention for its effectiveness in restoring function and reducing pain. In this blog, we'll delve into what adductoplasty entails, who can benefit from it, and what to expect during the recovery process. In addition it is helpful to know that the adductoplasty procedure in many ways is similar to the Lapiplasty procedure and in some cases the 2 procedures can be combined.

 

What is Adductoplasty? Adductoplasty is a surgical procedure designed to treat midfoot arthritis by realigning the bones in the midfoot region. It specifically targets the midfoot joints, such as the 2nd and 3rd metatarsal cuneiform joints (also known as the tarsometatarsal joints or TMT joints), which are commonly affected by arthritis. The goal of the adductoplasty procedure is to correct deformities, alleviate pain, and improve joint function and address arthritis joint pain.

 

Who Can Benefit from Adductoplasty? Adductoplasty is typically recommended for individuals with moderate to severe midfoot arthritis that hasn't responded adequately to conservative treatments. Common symptoms that may indicate the need for adductoplasty include persistent pain, stiffness, swelling, and difficulty walking or bearing weight on the affected foot.

 

The Procedure:

 

  1. Preoperative Assessment: Before undergoing adductoplasty, patients undergo a thorough preoperative assessment, including imaging studies like X-rays or MRI scans to evaluate the extent of arthritis and deformity.
  2. Anesthesia: Adductoplasty is performed under general anesthesia or IV sedation type anesthesia, depending on the patient's health and surgical preferences.
  3. Incision and Access: The surgeon makes an incision on the affected foot to access the midfoot joints. Minimally invasive techniques may be used to minimize tissue damage and promote faster recovery.
  4. Bone Realignment: Using specialized instruments, the surgeon realigns the bones in the midfoot to correct deformities and restore proper joint alignment. This will involve removing damaged cartilage or bone spurs.
  5. Stabilization: Additional procedures like joint fusion are necessary to stabilize the joint and promote healing.
  6. Closure and Recovery: Once the procedure is completed, the incision is closed, and the foot is bandaged. Patients are monitored in the recovery room before being transferred to a hospital room or discharged home, depending on the surgical plan.

Recovery and Rehabilitation: The recovery timeline for adductoplasty varies depending on the individual and the extent of the procedure. However, here are general guidelines:

 

  • Postoperative Care: Patients are advised to keep the foot elevated and apply ice to reduce swelling and discomfort.
  • Weight-Bearing: The surgeon will provide instructions on when and how much weight can be placed on the foot. Crutches or a walking boot may be recommended initially.
  • Physical Therapy: Rehabilitation typically involves physical therapy to improve strength, flexibility, and mobility. Patients learn exercises to restore function and prevent stiffness.
  • Follow-Up Visits: Regular follow-up visits with the surgeon are essential to monitor healing, address any concerns, and adjust the rehabilitation plan as needed.

 

Benefits of Adductoplasty:

 

  • Pain Relief: Adductoplasty can significantly reduce pain and discomfort associated with midfoot arthritis, allowing patients to engage in daily activities more comfortably.
  • Improved Function: By correcting deformities and realigning the bones, adductoplasty improves joint function, enhancing overall quality of life.
  • Long-Term Results: Many patients experience long-lasting benefits from adductoplasty, especially when combined with postoperative rehabilitation and lifestyle modifications.

 

Conclusion: Adductoplasty is a valuable surgical option for individuals suffering from midfoot arthritis, offering pain relief, improved joint function, and enhanced quality of life. If you're considering adductoplasty or exploring treatment options for midfoot arthritis, consult with a qualified orthopedic surgeon to determine the best course of action based on your specific needs and goals. With proper care, rehabilitation, and follow-up, adductoplasty can pave the way for a more active and pain-free lifestyle.

 

If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young
Foot & Ankle Surgeon
Issaquah's Top Podiatrist

Here are the key points:

  • Day of Surgery:
    • Arrival at the surgery center, where preparation and anesthesia discussions occur.
    • The surgery typically lasts around 2 hours, involving incisions, bunion removal, and toe joint realignment.
  • Recovery Timeline:
    • Post-operative care in the recovery room with monitoring and pain management.
    • Most patients go home on the same day.
  • First Weeks After Surgery:
    • Pain management with prescribed medication.
    • Swelling and bruising are normal; ice packs and elevation help.
    • Weight-bearing timeline varies, with gradual progression from non-weight bearing to partial weight bearing over weeks.
    • First 2 weeks after the Lapiplasty, using a scooter or crutches and keeping weight off week 3-6 after surgery you start to progressively bear weight with your boot. For example, at the beginning of week 3 you will spend 15 minutes per hour allowing weight with the boot on your heel. The following week you'll spend 20 - 30 minutes per hour with the boot and with the final week 45 minutes per hour with the boot.
  • Long-Term Recovery:
    • Physical therapy may be recommended after 4-6 weeks to restore strength and flexibility.
    • Driving can be as early as 6 weeks after surgery.
    • Using the stationary bike and upper body workout can be done as early as week 5 - 6 after surgery.
    • Gradual return to normal activities over several months. Bone healing and stability of the fusion site usually occurs after the initial 4 months. This is why it's necessary to wait for high-impact activities like jumping and running until 4 months.
    • Full recovery can take six months to a year.
  • Complications:
    • Working closely with our patients, our goal is to avoid complications such as infection, poor wound healing, nerve damage, or bunion recurrence.
    • Following post-operative care instructions is crucial to avoid these complications.
  • Conclusion:
  • Bunion surgery can be life-changing and literally change the structure of your foot.
  • Patients should follow their surgeon's advice for a smoother recovery and embrace a more comfortable, active lifestyle with patience and proper care.

If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young
Foot & Ankle Surgeon
Issaquah’s Top Podiatrist

Neuromas are an inflammatory disorder of the nerves in your foot. Typically, it is in the forefoot between the 3rd and 4th toe. It most commonly presents in the 3-5th decade of life and seems to be more common in women.

Causes:

The most common cause appears to be foot structure. We see patients that have a higher arched foot put a lot of pressure on their forefoot. This reparative pressure can inflame the nerves in the front of the foot causing a neuroma to form. Footwear choices can further exacerbate this, especially narrow shoes, or high heels. Other things like repetitive stress, running, jumping, anything that causes more forefoot pressure can cause neuroma pain.

Symptoms:

The symptoms can vary from patient to patient. However, some of the most common symptoms include burning, tingling and pain. Some patients relate that taking off their shoes reduces the pain and burning. Some relate rubbing helps the symptoms and some may feel a lump with rubbing of their foot.

Treatments:

We have many options available for treatment of neuromas. Some of the most common included orthotics, NSAIDS, and injections. I personally like to use dehydrated alcohol therapy it seems to have the highest success rate approaching 90%. Before treatment the most important thing is to get a correct diagnosis.

Neuromas can be very challenging and there are a few other problems that mimic neuroma symptoms. A careful diagnosis and treatment plan can be successful and not result in the need for surgical removal of the neuroma.

If you would like a consultation for your neuroma pain I can help. Call to make an appointment with me at 425-391-8666.

Sincerely,

Dr Brandon Nelson
American College of Foot & Ankle Surgeons
Issaquah’s Top Podiatrist

pic heel pain 4


I have to say that exercise for me helps with my mental health and overall wellbeing.  I typically workout 6/7 days a week and enjoy running, biking, rucking and walking the dog.  It is a great stress relief and helps me clear my head after a day of work.  I am sure many of you can relate and as the weather clears more of us are getting back into an exercise routine.

That being said, I always see a spike in heel pain patients this time of year.  It makes sense with the weather drying up and everyone wanted to get outside and ready for summer.  Heel pain can really sideline you as you return to activities.  It can come on suddenly and stick around for months.  As a side note, the earlier you get treatment the faster you can recover.  It is usually caused by inflammation of your plantar fascia. 


The plantar fascia is the main support network of the foot.  It is a soft tissue structure that runs from your heel to your toes.  It has the function of controlling the foot and helping with propulsion.  It can get worn out with time or tired from increased loads.  It is by far the most common condition I treat. 

Some patients wait quite a while before coming in and these cases are often what I call “stubborn heel pain” or “chronic fasiitis”.   This is because the inflammation has now become chronic, and the body has given up on trying to fix it and now coexists with this pathology.  These cases are harder to treat and usually require more extensive care.  I think it is important to understand that once it becomes chronic, part of the treatment usually requires a reactivation of the body’s ability to recognize this condition.  You must take the chronic state of inflammation and turn it back to an acute state. 

I really enjoy helping my patients get their life back and their feet pain free.  If you would like a consultation for your heel pain I can help.  Call to make an appointment with me at 425-391-8666 or make an appointment online.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Issaquah’s Top Podiatrist

bunion picture1


Bunions are one of the most common reasons people schedule an appointment with a foot and ankle surgeon.  It is by far the most common surgical procedure I do.  People of all ages and activity levels can have a bunion.  The primary reason people schedule an appointment is difficulty fitting the shoes they would like to wear.

I think there are quite a few reasons to fix your bunions these days and I will discuss a few of the most beneficial reasons.

1.     Foot Structure

Bunions are an inherited foot disorder and are more common in women.  They are usually the result of a foot that wants to flatten out too much or what we would call pronate.  A bunion results when the first metatarsal tries to stabilize the medial arch.  This results in the first metatarsal moving out of place and the bunion developing.  Fixing a bunion can result in stabilization of the medial arch.  This can have effects on the overall stability of the foot.  I see patients that have had plantar fasciitis or other stability issues that resolve once the bunion is fixed. 

 

2.     Shoe Fit

Another big issue with bunions becomes an inability to fit in normal shoes.  I see a lot of wide shoes and short extra depth shoes when people try to accommodate bunions and other toe deformities.  It is often a relief to be able to have shoes fit again and get back to wearing the shoes you once enjoyed or liked after your toe is straightened. 

 

3.     Your Bunion Will Get Larger

Many people believe they can use straps or tape or toe straighteners and change their bunion.  However, we know from long term data this is not true.  There is no way to reverse your bunion without surgery.  Everyone’s bunion with time and mileage will get bigger.  I recommend having it fixed before it causes the 2nd toe to become a hammer toe or begins to cross over or under the 2nd toe.

If you have a bunion and want an evaluation schedule an appointment with me, or make an appointment online, I will help you. 

Sincerely,

Brandon Nelson

Board Certified Physician & Surgeon

Issaquah’s Top Podiatrist & Foot/Ankle Surgeon


bunionectomy



Every week a few patients come in wondering about having their bunion fixed.  I really enjoy these discussions and helping patients decide what is best for them.  There are quite a few common questions I get so I decided to answer them in this blog 

1.     How much time will I need to be off my feet?

This question really depends on what procedure is utilized to correct your bunion as well as any additional procedures performed. It can be as little as a few days or up to 6 weeks. I like to get my patients walking as quickly as possible.

2.     When can I start to exercise?

Again this is a tough one to answer.  But, I am an avid exerciser and know how important it is to maintain our current levels and not lose too much ground with time off.  I like to help my patients develop a post-operative plan to continue working out and modify activities.

3.     When will I be back in a normal shoe?

This again depends on other procedures performed and how much work was needed to correct your bunion.  I see some patients back in a normal shoe at 4 weeks and some as long as 10 weeks.  The best thing you can do as a patient is follow your post-operative instructions.

4.     Will my bunion recur?

I always recommend seeing a physician that does quite a few bunion surgeries as this will give you better outcomes.  Procedure selection is the most important component to decrease recurrence rates.  With proper selection recurrence rates are about 2-3%.

If you have a bunion and would like a consultation please call 425-391-8666 and make an appointment online.

Sincerely,

Dr Brandon Nelson

Foot & Ankle Surgeon

Issaquah’s Top Podiatrist

blisters

Introduction: As winter settles in, along with its frosty bite, many of us bundle up in layers of clothing to protect ourselves from the cold. Despite our efforts, some may still find themselves facing an uncomfortable and sometimes painful condition known as chillblains. Chillblains, also spelled chilblains, are a common affliction during colder months, yet they remain relatively misunderstood. Chilblains is the common term used for this and Pernio is the medical term for chilblains. Very similar conditions include Raynaulds phenomenon and acral cyanosis. In this blog post, we discussed the details of chillblains, exploring their causes, symptoms, and effective treatments.

What are Chillblains? Chillblains, medically termed pernio, are a localized reaction of the skin to cold temperatures. They occur when the skin is exposed to cold but not freezing temperatures and then undergoes rapid warming, causing blood vessels to expand and leak. This leakage leads to inflammation and injury to the surrounding tissues.

Causes of Chillblains: Chillblains typically develop in response to repeated exposure to cold, damp conditions. Individuals living in cold climates or those who spend prolonged periods outdoors during winter are at higher risk. Certain factors may predispose individuals to chillblains, including poor circulation, hormonal changes, and medical conditions such as Raynaud's disease.

Discussion: Vasospasm of the smaller blood vessels in the digits are common in this case pulses in the feet may be intact but despite this the blood flow to the digits is essentially cut off. With a lack of oxygen there can be tissue damage and resultant inflammation even after the blood flow is reestablished. It also can be common for the individual’s foot to be moist from perspiration such that a “damp chill” on the feet occurs. This is why one of the strategies is to keep the feet dry and wool socks do a great job with this. In addition in the toes if there is a place where the toes often rub together that seems to be a common location to get purple/cyanotic nodular enlargement and irritation from the contact between the toes. Patient will come into the clinic with these purple painful nodules on their toes and states that they been to other clinics and owns quite certain what it is. They commonly think that they started out as a blisters.

Symptoms of Chillblains: The symptoms of chillblains can vary in severity but commonly include:

  1. Redness or purplish discoloration of the skin
  2. Swelling and tenderness with nodular enlargement
  3. Itching or burning sensation
  4. Blistering or ulceration in severe cases, often these are purple or cyanotic.
  5. Pain or discomfort, particularly upon warming the affected area

Chillblains most commonly affect the extremities, such as the toes, fingers, ears, and nose, but can also appear on other parts of the body exposed to the cold.

Treatment and Management: While chillblains can be uncomfortable, they typically resolve on their own within a few weeks once the affected individual is no longer exposed to cold temperatures. It’s not uncommon for these to last often on through the winter and then totally resolved each summer. But as the years go by sometimes the become progressively more of a challenge or problem. However, several measures can help alleviate symptoms and promote healing:

  1. Keep the affected area warm but avoid sudden temperature changes.
  2. Gently massage the area to improve circulation.
  3. Apply soothing lotions or creams to relieve itching and discomfort.
  4. Avoid scratching or rubbing the affected skin to prevent further irritation.
  5. Protect the skin from further exposure to cold and moisture by wearing appropriate clothing and using gloves, socks, or earmuffs.

In more severe cases or if complications arise, medical intervention may be necessary. This may include prescription medications to reduce inflammation, promote healing, or manage underlying conditions contributing to poor circulation.

Prevention: Prevention is key to avoiding the discomfort of chillblains. Some tips to prevent chillblains include:

  1. Dress warmly in layers, paying particular attention to extremities.
  2. Keep indoor environments warm and dry, especially during colder months.
  3. Limit exposure to cold and damp conditions, and take breaks to warm up if spending extended periods outdoors.
  4. Wear moisture-wicking socks and breathable footwear to prevent moisture buildup.
  5. Maintain good circulation through regular exercise and avoiding tight-fitting clothing or accessories that may restrict blood flow.

Conclusion: Chillblains are a common but often misunderstood condition that can cause discomfort during colder months. By understanding the causes, symptoms, and effective treatment options, individuals can better manage and prevent chillblains, ensuring a more comfortable and enjoyable winter season. If symptoms persist or worsen, it's essential to seek medical advice for proper evaluation and treatment. Remember, staying warm and dry is key to keeping chillblains at bay.

If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young

Foot & Ankle Surgeon

Issaquah’s Top Podiatrist

plantarfasciitis



Heel pain is usually caused from inflammation of your plantar fascia.  However, this is not the only cause of heel pain.  Other causes can include arthritis, nerve irritation, bursal sacs and even mechanical foot collapse.  I always recommend physician intervention as things will subside much faster. 

Plantar fasciitis is characterized by pain in the morning or after rest.  Most patients have increased activities or spend a lot of time on their feet.  The pain can feel like a bruise or throbbing that can extend from the heel to the arch.  This can go on for months before patients seek treatment or even years.  But remember the sooner you see a foot and ankle physician the faster the recovery and return to normal activities. 

The mainstays of heel pain treatment are stretching and icing.  It is important to get a correct diagnosis before starting any treatment as somethings can exacerbate heel pain and make symptoms worse.  An x-ray and careful physical examination are essential to helping discover the underlying causes of heel pain.  Assuming all heel pain is plantar fasciitis is a mistake.  I have been treating heel pain for over 15 years and have a protocol so successful that most patients are 70% better in less than a week. 

Do not let heel pain control your life.  How long have you been suffering?  Call today and let me help you get better.  If you would like a consultation for your heel pain I can help.  Call to make an appointment with me at 425-391-8666 or make an appointment online.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

austin bunionectomy

Bunions are painful deformities that are common and can cause pain and discomfort daily.  Surgery for bunions has been around for over 100 years but recent advancements have made bunion surgery easier than ever.  Today we will discuss the Lapiplasty bunion procedure, its advantages and how it has changed the way we correct bunions. 

What is a bunion?

A bunion is an inherited foot issue that involves the deviation of a bone in your foot.  Specifically the 1st metatarsal begins to drift in the wrong direction making it difficult to fit shoes and can be quite painful.  Genetics play a big role in the development of a bunion and things like shoe gear can contribute to the bunion. 

Lapiplasty procedure

Convention bunion surgery often involves cutting the bone and realigning a joint.  This type of procedure has been utilized for years and is still the most popular bunion surgery in the world.  It has its applications and is appropriate for certain individuals.  The Lapidus or Lapiplasty focuses on larger bunions and people that have a more unstable foot.  It aims to correct the bunion in a more comprehensive approach and provides the best long term results.

It involves correcting the bunion in 3 planes, realigning the metatarsal, correcting the bunion at the root cause.  The joint where the bunion originates is cut and realigned and fixated to heal in the proper position.  Recovery can vary by patient and bone quality same with healing times.  I do recommend physical therapy and follow up is essential.

In conclusion Lapiplasty has revolutionized bunion correction and provides excellent long term results and is by far the best procedure for many patients.    

If you would like a consultation for your bunion I can help.  Call to make an appointment with me at 425-391-8666 or make an appointment online.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons


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