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Bunion (1)

Dr. Brandon Nelson, A Board Certified Physician & Surgeon, Discusses Bunion Surgery and Tips for Recovery

Bunion surgery is one of the most common foot and ankle surgeries in the United States.  On average I personally operate on around 100 bunions every year.  It is a very rewarding surgery for patients with great outcomes.  The hardest part is the recovery and I thought I would give some tips for patients that I have learned over the last 15 years.  I will break this down into pain control, healing and rehab. 

Pain control is essential for the first part of the surgical process.  I find it beneficial for patients to be on a narcotic with an anti-inflammatory.  I prefer Ibuprofen and usually only need any type of pain medication for the first couple days.  Additionally, I recommend keeping your foot elevated for the first week and making sure to ice for 10 minutes every hour while you are awake.

Healing is another important factor for recovery.  First bone healing this is usually the dictating factor for recovery.  The average bone takes 12 weeks to heal so target therapy to decrease bone healing times can be helpful.  I recommend always taking a bone healing supplement i.e. ProBono or Bone Up are two of my favorite over the counter supplements.  Next would be skin and soft tissue, taking collagen, biotin and zinc can increase production of new skin cells.  Once the wound has closed I like some sort of scar care cream or scar care product.   You must use some sort of silicone based cream for best results.

Rehabilitation after bunion surgery often depends if other procedures were performed as well.  Often times physical therapy can be helpful.  I recommend that patients start moving their toes through range of motion as soon as the stitches are out.  It is important to actively and passively move the toe joint to prevent stiffness.  The ankle joint should be mobilized as well with such exercises as writing the alphabet with your foot multiple times a day.  I hope you find these helpful. 

If you are experiencing foot or ankle pain, please give us a call at 425-391-8666 or make an appointment online today

Sincerely,

Dr. Brandon Nelson

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Dr. Timothy Young
, a Board-Certified Foot Surgeon Discusses Achilles Tendon Problems in Children
We see a lot of pediatric sports related injuries and conditions at our clinic. Achilles tendon problems are one of the common problems. This is often thought of as a problem for adults. The children that come in with these problems are often adolescent athletes. There are several variations of Achilles problems. Classically Achilles tendon problems involve the narrow part of the tendon above the heel where you can feel the tendon itself and this is called the watershed region. There are also problems where the Achilles tendon attaches to the heel bone.  And this also can also affect the growth plate of the heel bone (calcaneus) which is a common problem for children called Severs disease or calcaneal apophysitis.

There can be overlap between Severs Disease (growth plate irritation) and irritation of the Achilles tendon at the insertion, because there is such close proximity to both. In many cases treatment for calcaneal apophysitis and Achilles tendon problems are very similar. In fact a tight calf muscle or Achilles tendon can be a causative factor in calcaneal apophysitis. Therefore stretching the calf muscle and night splint use can be very helpful. There are special braces that can help Achilles tendon problems and they also can support and help treat calcaneal apophysitis.

Biomechanics can also factor into this, and either having a high arch or low arch can both exacerbate both conditions. Therefore treatments with supportive athletic shoes, over-the-counter high-level arch supports and prescription orthotics can be effective treatments. The bottom line, is that as with most medical conditions, appropriate diagnosis and treatment can be very effective. And there are many treatment options.

If you are experiencing foot or ankle pain, please give us a call at 425-391-8666 or make an appointment online today.
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Dr. Timothy Young, a Board-Certified Foot Surgeon, Discusses Removal of Hardware After Foot Surgery.
Hardware for foot surgery typically would consist of screws and if necessary, plates. Sometimes Staples wire and pins are used. Screws and plates can cause irritation after the surgery is complete and the bones have healed. At this point many of our patients asked to have hardware removed. If it involves just screws this is often a very simple process. It is a matter of locating the hardware to make the ideal incision for removal, and then removing the hardware. In the case of the screw is still embedded down with the head of the screw at the surface of the bone.

Sometimes there is bone overgrowth, and this requires a larger incision and bone removal. This would happen typically if it h been more than one or two years after the original surgery. Prior to surgery using x-ray or ultrasound imaging one can plan ahead of time and allow for a much smaller surgical incision and therefore a much quicker postprocedure recovery. In these cases often just one simple suture or Steri-Strips is all that is necessary for wound repair. In the case of screws where there has been bone overgrowth, or plates the larger incision has to be made.

Therefore, there will be more wound healing and additional sutures required. In the case of hardware removal with just several small screws and small incisions, often there can be returned to activity within a week. If it is a larger procedure as described above involving a plate or bone overgrowth, then there may be a longer recovery of two weeks or even longer. Another intraoperative tool that we have within our ASC is fluoroscopy. Fluoroscopy can help locate hardware if there has been bone overgrowth or other factors making it difficult to find hardware during surgery.

If you are experiencing any foot or ankle pain, give us a call at 425-391-8666 or make an appointment online today. 

heel pain in the morning

“Ouch my feet are killing me when I get out of bed!”   This is what I used to say every morning.  Heel pain can be so overwhelming and frustrating, especially if you are having pain with your first step in the morning.  I remember those days so well and I could hardly bring myself to get out of bed.  Plantar Fasciitis will affect about 60% of all adults at some point in their lifetime. 

Heel pain or plantar fasciitis is by far the most common reason people seek care from a foot & ankle physician.  Once a physician is involved normally recovery can be extremely fast.  I specialize in treating heel pain and can get you back on your feet and on the road fairly quickly.  The majority of patients I see are 50-80% better in less than 1 week.  The fact I have suffered from it myself keeps me abreast to the latest and most effective techniques available to feel plantar fasciitis.

Not all heel pain is the same.  There can be many other causes of heel pain that is why physician care is essential.  An x-ray is warranted in order to rule out other causes and start the appropriate treatment.  I find experience can be extremely valuable for heel pain care.  There are quite a few outliers that can mimic plantar fasciitis.  If you are suffering from heel pain I can help! Give us a call at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr Brandon Nelson

heel pain out of bed in the morning

Heel pain
can be very frustrating for anybody.  We often hear of symptoms ranging from burning and tingling to a bruised sensation in the heel.  The timing of the pain is typically after exercise or when first getting out of bed.  The length of symptoms have existed seem to be months to years.  Often there is no underlying injury and causes can vary by age but is more common in adults. 

Heel pain is a common symptom of many pathologies.   The most common being plantar fasciitis.  This is a condition where a band of support tissue on the bottom of the foot is inflamed.  It can become fatigued when overused.  The most common cause in children is inflammation of a growth plate.  This is often seen around sporting events or as children go through a rapid growth spurt.  Regardless, both have many options available for treatment.

Treatment always begins with an x-ray.  The x-ray is important to help rule out other causes and establish a diagnosis.  Once a diagnosis is established we can begin to find causes and contributing factors.  It is essential to identify things that may be potentiating the pain and dysfunction.  Then a treatment plan can be established that will help to mitigate symptoms and work on recovery. 

Recovery can be challenging as there may need to be a change in activities.  I often see a correlation with the amount of time the patient has had the pathology with the recovery length.  The longer a patient has had the issue the longer it can take to recover.  The most important factor is to see a physician that specializes in your problem so you can get the correct plan to heal.  If you have heel pain I can help please call  us at 425-391-8666 or make an appointment online today.

Sincerely,

Dr. Brandon Nelson

austin bunionectomy

Bunion surgery
involves one of two things.  These are either cutting the bone and realigning the joint or realigning the joint and fusing bones together.  The two different procedures depend on a whole host of variables like size of deformity, quality of bone, activities levels and age of the patient.  Both of these types of procedures have excellent outcomes and are utilized extensively.  Healing from either of these two procedures can be increased by concentrating on healing soft tissue and bone.

Soft tissue i.e. skin healing is part of the recovery process after bunion surgery.  Incisions are required to access the boney correction and often soft tissue release.  There are often incisions in joint capsules, release of ligaments and even release of tendons.  Additionally, sometimes soft tissue balancing or plication of capsular tissues are required.  Regardless, there are things you can do to heal skin faster after surgery.  These include taking biotin, collagen and zine.  Supplements are important to ensure adequate nutritional support happens and the building blocks of soft tissue requires certain minerals, peptides and proteins.  A good diet and avoiding things like alcohol and Tobacco is important as well for both skin and bone healing. 

Bone healing also can be increased with dietary supplements.  I recommend Pro-bono for all my post-op patients.  This supplement is extremely powerful in healing bones and I often see recovery time decrease by 1-2 weeks.  Another tool that can be helpful is a bone stimulator.  These are devices that help the body produce bone.  Each device is a little different but they work by stimulating cells that produce bone.  These usually require a prescription from your doctor.  Lastly, make sure to follow your surgeon's advice.  If you have a bunion I would love to help you decrease your post-operative healing course!                            

Sincerely,

Dr. Brandon Nelson

Achilles Tendon

I think for athletes or weekend warriors we have all had the dreaded Achilles tendon pain or tendonitis.  I can recall the first time I suffered with it and how long it took to get better.  It was a real bummer to be sidelined and put my workouts on hold for this issue.  It has been some years now since I have had any recurrence in part to my daily recovery routine.  It makes me wonder why it only took me 46 years to figure out the importance of active recovery daily!

The Achilles tendon never has an opportunity to rest when we are up and moving.  It is constantly firing for the gait cycle and is the biggest, thickest tendon in the human body with the most cross sectional load.  It is no wonder it is commonly inflamed and on average can take up to 6 months to recover from an injury.  This being said if you have pain or swelling do not wait to see a physician as the longer you wait the longer the recovery.

The best options to recovery from Achilles tendon issues are to first identify the underlying cause.  This can be training errors or foot structure issues or even overall body inflammatory processes.  Once these are identified next comes tackling the symptoms, ie swelling and pain.  These can be accomplished by many different options but one of my favorites is shockwave.  Shockwave utilizes sound waves to break up the inflammatory tissue and increase blood supply to repair the tendon.  Once this is accomplished stretching and strengthening are just as important.  Long term a program to maintain this tendon is essential.  If you are suffering with Achilles tendon pain I can help.  Please call 425-391-8666 or contact us online and we will get you on the road to recovery. 

Sincerely,

Dr. Brandon Nelson

hammertoe

Dr. Timothy Young
, a Board-Certified Foot Surgeon Discusses Digital Foot Surgery.

Sometimes during toe surgery, a pin will stick out the end of the toe.  And other times, the pin will be buried or covered with skin. As we've discussed previously, it is common to use a K wire or pin during hammertoe surgery or other digital foot surgery. Often times the pin will stick out of the tip of the toe and be visible. When this is done it is very easy when the time is appropriate, for your surgeon to remove the K wire without making an incision in your toe. The advantage to having the K wire covered with skin or buried is that there is no direct pathway for bacteria to travel from the pin into the toe.

Therefore it is okay once you incision has healed to get your foot wet with the buried K wire, but that is not possible when it sticks out of the toe. Also the K wire can be left in this buried position for a longer period of time without pin track irritation or infection. The disadvantage of a buried K wire is that removal will require a minor procedure to remove the pin. Sometimes because there is such a thin fat pad at the tip of the toe, it's difficult to get enough tissue or skin to properly.

If you are experiencing foot or ankle pain, please give us a call at 425-391-8666 or make an appointment online today.
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Dr. Timothy Young, a Board-Certified Foot Surgeon, Discusses Why Toes Are Often Pinned During Foot Surgery

Pinning toes (with a K wire) is a common practice with foot surgery. In reality what is called a pin is a Kirschner wire or K wire. The K wire is typically is placed directly within the bones of the toe. The purpose is to hold the toe incorrect alignment. For example in other parts of the body including midfoot, ankle and leg when there's a fracture often a cast will work. But one can not effectively cast a toe. Therefore pinning a toe is an excellent option that holds it stable to allow for the correct healing and the correct alignment to be maintained during the postop time frame. For example, a patient with a hammertoe will have a contracture and adaptation of the proximal interphalangeal joint or the first knuckle within the toe.

This bone has to be surgically remodeled to allow for realignment. Once the bone remodeling is done, rather than just putting a bandage on the toe, a K wire is used in the toe to make certain that the correction and alignment are maintained exactly as necessary and so that the postoperative healing will continue in the correct alignment until that initial healing is adequate. In some cases the toe is actually fused and typically the K wire with stay in between four – six weeks. The closer to the six week timeframe, the higher correlation with long-term successful fusion.

If you are experiencing foot or ankle pain, please give us a call at 425-391-8666 or make an appointment online today. 

I see many patients that come in for burning or tingling of the forefoot.  Some even relate a stabbing or shooting pain in the front of the foot.  Typically they often describe pain that is worse with shoe gear and relieved by taking off their shoes and rubbing their feet.  These are very typical symptoms of somebody with nerve pain.

Neuromas are one of the most common causes of nerve pain in the feet, specifically the forefoot.  Neuromas occur typically in females between the ages of 40-60, however they are common in men of the same ages as well.  The neuromas itself occurs where two nerves in the feet come together.  These two nerves are the medial and lateral plantar nerves that are branches of the posterior tibial nerve.  They come together to form one nerve in the 3rd interspace of the foot.  This is the region between the 3rd and 4th toes. 

Most people will present with numbness and tingling.  However some patients just present with pain to the toe or toes.  Often there can be a change in shoe gear or activities that precipitate the nerve irritation.  The prevailing theory is that this nerve is getting mechanically stimulated or crushed by the surrounding structures or the foot, most likely the metatarsal bones.  Repetitive irritation leads to the symptoms that we see i.e., numbness and pain. 

There are many great options to relieve nerve pain or neuroma pain.  However the most important part of that is identification of the cause.  It is paramount to see a provider that has experience and expertise in this area.  I have been treating neuromas for over 15 years and have many excellent options to relieve pain and neuromas symptoms long term.  If you are experiencing nerve pain I would love to help you get your life back. Give us a call at 425-491-8666 or make an appointment online. 

Sincerely,

Dr Brandon Nelson

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