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From a medical standpoint, gout is one of the oldest recognized forms of arthritis dating back to the middle ages. This is often considered a disease of the well-off, because it's associated with over eating and drinking. Gout is an inflammatory disorder that often affects the big toe joint. What can occur is uric acid precipitated out of the body and builds up in joints and tissues causing pain and swelling. The primary source of uric acid is from the metabolism purines from foods we eat. Therefore we elected to focus on recognizing foods that are high in purines or can increase uric acid levels. One of the most common is sugar and all forms can increase gout reduction.

It is advisable to avoid especially sugary drinks and candies, however naturally occurring sugars found improvement but still usually have significant effect. In addition we know that processed foods as well can have an increased effect and uric acid production. Other foods that should be avoided include red meat, organs and wild game. In addition some fish like Salmon and Tuna should be limited as well. Alcohol consumption has a long-standing association with causing significant gouty attacks. Vegetables are generally considered safe. If you are suffering from big toe pain, swelling and redness we at Issaquah Foot and Ankle Specialists can help.

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

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We have discussed many things to consider after foot surgery in the previous post. There are several other things of course to think about with narcotic pain medication. Number one is to respect the potential for narcotic addiction. As soon as your pain is much reduced, you should stop taking your narcotic pain meds. You have to plan on meals and food. Remember to take narcotic pain meds with food. Make sure you drink plenty of water. It’s also good idea to plan on taking a stool softener so that you don’t get constipated with a narcotic pain medication such as docusate (Colace). A fiber laxative may also be helpful. Buy the stool softener before your surgery so you are prepared. If things get too far along don’t forget to take a suppository as another option. The most critical thing is that you need to make sure that you have bowel movements daily and you don’t get behind on this.  You should keep track of your bowel movements along with your narcotic and post op medication log.  ust add the info to your medication log.

 

If you have questions about hallux valgus bunion surgery or bunion correction, please let us know if you would like a consultation. Give us a call today at 425-391-8666 or make an appointment online.

Tuesday, 22 December 2020 22:44

Dr. Brandon Nelson Discusses a Torn Plantar Fascia

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Greg Olsen, a tight end recently signed with the Seattle Seahawks, is recovering from his torn fascia. Many of you know him as a great tight and with a long story career. He has been on injured reserved for his torn fascia. Tearing of the fascia can be extremely painful event as you can see with his original injury he was carted off the field. Most people will feel a pop in their foot and had instant pain. 

Some people called a burning or searing type pain. He can take quite a long time to recover from a torn fascia and anytime you hear popping or tearing it is recommended he seek help from a physician. Has been amazing to see Greg’s progress with this torn fashion has returned activities. Often times this can be a long arduous recovery however most people will make a full recovery. Being a professional athlete does have some advantages as far as modalities available for recovery and treatment. If you are suffering from plantar fasciitis especially long term plantar fasciitis and can lead to a torn fascia. Do not let this happen to you. please contact Issaquah Foot and Ankle Specialists today, and we'll be more than happy to help you. 

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

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Make sure to get your prescriptions well before bunion surgery, so that they are filled, and you are ready to go. Make sure that you have everything that you need. This can range from narcotic pain medication to something to help for nausea that often accompanies the narcotic pain medication and then you might need antibiotics. If you have antibiotic's we do recommend that you take a probiotic also. 

Regarding narcotic pain medication and bunion pain relief, it’s a good idea to consider promethazine or even Benadryl. Nausea with narcotics is common and it is best to have a plan to make sure that you can address nausea or be proactive, so it never happens!  Medications such as promethazine and can help with nausea.  Promethazine can also make a narcotic medication more effective at pain control.  Promethazine can cause respiratory depression and it is important to follow your medical advice.  We have lowered our dose of Promethazine from 25mg to 12.5 mg to help address concerns with respiratory depression.  There are other medications such as Zofran that also help with nausea.  Zofran is great because there is an "under the tounge" form that is great if you are already nauseated and cannot keep food down.  That beats a suppository!  Be aware that many people who take any kind of narcotic such as Vicodin or Percocet often get nausea. You should take promethazine with food and wait 10 or 15 minutes before you take your narcotic pain medication.  It can be easy to lose track of what medications that you have taken and when you have taken them. It’s a good idea to keep a medication log so you can keep track of the pain medication also and make sure that you’re taking them on time with the correct schedule. 

 

If you have questions about hallux valgus bunion surgery or bunion correction, please let us know if you would like a consultation. Give us a call today at 425-391-8666 or make an appointment online. 

Tuesday, 15 December 2020 22:03

Dr. Young Talks About Using a Scooter After Surgery

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If you need to keep off your foot after surgery, then you can do this one of several ways. A scooter can be a very good option. If you have to use a scooter then you can plan on that ahead of time also. There are different ways of getting a scooter. One would be to use a medical supply company that could deliver it and possibly your insurance would pay for it. Many times our patients will look on craigslist, offer up or next-door and either buy a used one or in some cases they can just borrow one on a site such as next-door. 

Either way make sure that you practice with the  scooter, and make sure it is going to work in your situation. For example you may want to make sure that you’re on the main floor of your house where are use your scooter. Also, make sure that you have a plan to get up and down the stairs to you Your house. So you might need to use crutches for the house, and then keep the scooter in the car. You need to come up with a plan how to do this. Remember, it is easier to get your scooter before surgery and go through scenerios of where and how you are going to use it. When you’re done with the scooter you may be able to simply list it on craigslist or offer up or next-door and be done with it. 

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



It may be helpful to have your house set up for easy navigation and getting around.

For example, if you’ve got crutches a scooter or a walker, then practice ahead of time and make sure it will all work in your location. If you’ve got a couch downstairs and you don’t want to go up and down your stairs you may want to plan on setting up some type of a bed on your couch on the main floor. If you have to go up and down the stairs, some of our patients will go up and down on their "rear-end" so that they don’t have to try and balance with crutches. 

We like to go over these details and more at your "preop" appointment.   

We are happy to further discuss in person, if you would like to see myself Dr. Timothy Young or my partner Dr. Brandon Nelson. Give us a call at 425-391-8666 or make an appointment online.

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There’s several different things to think about in preparation for upcoming foot surgery

It is important to think about these things before hand and to plan ahead of time. 

There will be things to do to your surgical site to help make sure things heal correctly. For example, you can get a shower protective sleeve to go over your foot and calf. 

When you have a bath or shower it will help to have a plastic chair outside of the shower.

And a plastic chair inside of the shower.  I recommend using a hand held shower head that has a long flexible hose. These are about $20 at Home Depot and very easy to install. This way you can be sitting in the shower and not worrying about having to keep your balance. Also having the plastic chair inside the shower gives you a place to sit while use that hand held shower head and hose. Once you’re done you then have a plastic chair outside of where you can dry off and again not be sitting there balancing yourself.  Note that it can be very hard to get in and out of a bathtub, the shower may be best (at least initially). 

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

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One of the most common patient complaints to a foot and ankle physician is heel pain. It is important for patients to understand there are many other causes of heel pain and we will review some of those today. A short list of these would include lumbosacral radiculopathy, plantar fascial rupture, tarsal tunnel syndrome, Baxter’s nerve entrapment and fat pad atrophy.

Lumbosacral radiculopathy:

The most common cause of back pain leading to heel pain is nerve entrapment around L4-S1 vertebral level. Most patients will have a history of back pain or heel pain that manifests. It is important to consider an MRI of back for this or any EMG NCV which are nerve conduction studies. Often times physical therapy for nerve medication can help control the symptoms.

Plantar fascial rupture:

Ruptures of the plantar fascia are relatively uncommon, but can occur for patients that have had ongoing heel pain. The majority of patients that we see rupture their fascia have had some sort of high impact activity like football players or long distance runners. Diagnosis of the rupture often includes an MRI treatment can depend on the varying degree of the rupture in the site of the rupture. There many options for plantar fascial rupture including repair.

Tarsal tunnel syndrome:

Tarsal tunnel syndrome is a nerve entrapment that is similar to carpal tunnel. Usually involves the posterior tibial nerve and branches that wrap around the heel. Many patients will describe burning or tingling in predispositions, this include patients with diabetes or a flatfoot. Often times an MRI or nerve conduction study is needed to verify this. Treatment often can require steroid injections or decompression of the nerve.

Baxter’s nerve entrapment:

This is a common condition that a lot of physicians will not recognize as this is a tough diagnosis. This can be undiagnosed or underdiagnosed relatively easily. This often times can be confused a tarsal tunnel syndrome as well. One of the key diagnostic indicators for this is inability to move your fifth digit. Again often times advanced imaging is utilized and a steroid injection and sometimes decompression the nerve is required.

Fat pad atrophy:

Fat pad atrophy is typically seen in older or obese patients. The majority us have a nice cushion on the bottom of the heel to help with shock and provide support. Often times there are thinning in other areas of the foot that can be identified help clue physicians in. This usually can be solid with a prescription orthotic and a rocker-bottom soft tissue.

If you have heel pain, call Issaquah Foot and Ankle Specialists today at 425-391-8666 or make an appointment online. 

Tuesday, 17 November 2020 18:40

Dr. Brandon Nelson Discusses Heel Pain in Children

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I currently have two children and actually have had one that was experiencing some heel pain. It was pretty classical symptoms of apophysitis or what we call Sever’s disease which is and inflammation of the growth plate. Kids often present with this type of pain after activities or after going barefoot. Most commonly we see this in young girls between the ages of 8 and 14 and young boys between the ages of 12 and 16. This is when kids often experience a growth spurt and the growth plates can become quite inflamed.

This inflammation of the growth plate can often be seen on x-ray and I highly recommend kids with heel pain get an x-ray. There are many great modalities that work well. I recommended starting with ice and stretching in the calf. However, I would discourage parents from doing home therapies until an accurate diagnosis is made. If your child is experiencing some heel pain we would like to help.

Give us a call at 425-391-8666 or make an appointment online today.
heel pain out of bed in the morning

Plantar fasciitis, heel pain or bone spurs of the foot can be extremely painful. Quite a few patients suffer from this and have been for years. We see patients that have had to change activities and even give up exercising. I personally suffered from plantar fasciitis and can empathize with patients when they are in extreme amounts of pain. Typically plantar fasciitis will exhibit pain in the morning or pain after prolonged periods of rest. However there can be many other presenting symptoms of plantar fasciitis. It is important to have heel pain evaluated as there are multiple causes and they all respond to different modalities.

I feel an x-ray is often warranted especially on the initial visit to rule out other causes. The x-ray can often reveal a bone spur or inflammation around the fascial band or even a stress fracture. Initial therapies for fasciitis usually include resting and stretching. There are many other initial treatment options and I can tell you the success rate is about 95% for our patients. There are a small number of patients who go on to have more of a chronic type issue and further diagnostic work workup is warranted. Often times an MRI or nerve conduction studies can be valuable for patients. Depending on the cause of the fasciitis there are many extremely successful long-term fixes for fasciitis. Often times or degenerative medicine or shockwave therapy can provide permanent fixes. If you suffer from heel pain and would like it fixed permanently come see Issaquah Foot and Ankle Specialists.

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