podiatrist issaquah

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Dr. Timothy Young, a Board-Certified Foot Surgeon Discusses Porokeratosis Lesions

A Porokeratosis is not caused by a viral infection, and it does not have the additional blood vessel growth that is classically seen with a plantar verruca. Often, these lesions will be on a weightbearing portion of the foot such as underneath one of the five metatarsal heads.  In the case of lesions with a weight bearing location, prescription orthotics can help.   When a pathologist looks at a sample of the plantar verruca there are distinct differences compared to a porokeratosis.

These lesions also can be in a non weightbearing portion of the foot such as the heel. These lesions can be challenging to treat.  There is some preliminary data that the Swift treatment (Microwave Verrucae treatment) can help reduce the pain from these lesions and in some cases, there can be reduction or resolution of the lesions.  Surgical excision of the porokeratosis lesions is another treatment option.  Larger lesions can be surgically removed, and a plastic surgical technique called a rotational flap is utilized to repair the deficit left after removal of the larger lesions.

If you are experiencing foot or ankle pain, 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 Plantar verruca and porokeratosis
In our clinic, we see a number of patients with plantar warts or plantar verruca. There are times when a patient presents to our clinic with skin lesions on the bottom of the feet (plantar aspect of the feet) that appear similar to a plantar verruca but are actually a different nonviral skin lesion. Plantar verrucae are caused by the human papilloma virus and therefore are a viral infection.

Typically, this skin infection develops additional blood vessels through a process called angiogenesis. Therefore, it is classic for plantar verruca have multiple punctate or pinpoint patches of dried blood or eschar, and during the examination when we lightly remove the superficial layer of the verruca and callused area, we see pinpoint bleeding. This pinpoint bleeding is very helpful to accurately diagnose these as plantar verrucae. There is a similar appearing lesion that is often called a porokeratosis.

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

normalfoot

Pain in the forefoot can range from tingling and burning to a dull ache or throb.  The majority of forefoot pain can be broken down into nerve pain ie a neuroma or mechanical pain ie capsulitis.  Both can cause similar type symptoms and differentiating between the two can be difficult. 

Capsulitis is the most common forefoot type of pain.  It is basically an overloading of the metatarsal phalangeal joints.   Most patients will experience a combination of burning and aching.  There are many causes of forefoot capsulitis or overloading.  This can be from tight muscle groups or abnormal anatomy.  The majority of patients will find conservative therapies successful and will completely recover.

Neuromas usually occur in a specific anatomical location, the 3rd interspace.  This pain is almost exclusively a burning or tingling.  It is almost always worse with shoes and primarily affects females.  Neuromas occur from irritation to the nerve that is mechanical or anatomical in nature.  Again the conservative success rate for this is high.

If you are experiencing burning or tingling in the foot I can help.  I have an exceptional protocol for both capsulitis and neuritis.  If you have foot pain, call today.

Sincerely,

Dr. Brandon Nelson

Bunion xray

Bunion surgery is one of the most common procedures performed in the United States.  It is almost exclusively done in an outpatient setting and the majority of procedures can be completed in less than 2 hours.  Most patients will experience pain that lasts a few days and can begin weight bearing fairly soon.  There are many different types of bunion surgery and not all are equally effective. 

There are a few things that will help patients get a better outcome with bunion surgery.  I will discuss these tips that can be helpful along with selection of the surgeon.

#1. The most important thing after having any type of surgery is to follow postoperative protocol.  There are many tips that can improve your outcome after bunion surgery and careful adherence to postoperative protocols is essential.

#2. Bone healing supplementation, there are many different types of bone healing supplementation that are not all created equal however some of them can be highly effective in decreasing healing times.  I have a brand that I recommend for all my patients that often shaves weeks off of healing time.

#3. Couch potato for your first week, set yourself up for success.  During that first week just really take it easy, take your medications as prescribed, ice and elevate your foot.

#4. Surgeon selection, the majority of us have very similar training and most foot and ankle physicians are highly trained in this procedure.  One question I would ask any surgeon is how many bunion surgeries they perform annually.

I hope this is helpful and can be utilized by you in the future.

Sincerely,

Dr. Brandon Nelson

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Dr. Timothy Young
 Discusses Achilles Tendon Injuries
Part 3
Dr. Timothy Young discusses Achilles tendon injuries without major tearing or rupture.

For these individuals, if it is a significant injury we will use a cast boot to protect Achilles tendon from further injury and or potential rupture. This is usually for minimum of four weeks. During this timeframe we can start shockwave therapy (EPAT). These individuals also will benefit from PRP injections. Once the initial acute phase has passed, patients can wear a special Achilles tendon brace and start nonimpact exercises such as aqua jogging or modified stationary bike exercises.

Some of this can be done under the direction of the physical therapist. One of the most effective long-term exercises to augment any Achilles problem is eccentric Achilles strengthening. This also can be done at home or under the direction of the physical therapist. There are numerous YouTube videos on this including a short one that we have provided from our clinic.

For some individuals with extremely large calf muscles and extremely tight calves and Achilles they may need to have a protective procedure done call a gastroc recessi. This is primarily for patients with chronic symptoms or who are at very high risk of reinjure of the Achilles tendon.

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

heel pain in the morning

Heel pain can be very challenging no matter when it occurs.  It can be common in the morning or after exercise.  There are many causes of heel pain and the most common is plantar fasciitis.  Plantar Fasciitis is a condition in which the plantar fascia in your foot becomes inflamed. 

An inflamed plantar fascia is often characterized by burning or a bruised type sensation one's heel.  Many patients describe the fact they feel like they are walking on a marble or pebble.  This can get worse as time and activity levels go on and can become quite debilitating.  This can be brought on by many causes but most notable is overuse.

Overuse is by far the most common cause.  Patients often relate the start of a new exercise program or a new activity.  This new activity can put new stresses on your fascia which ultimately leads to inflammation and pain.  It is always best to ease into activities as this can help minimize fascial pain.  Another key characteristic of facial pain is morning stiffness or irritation.

Morning pain is a hallmark of fasciitis.  This is very common and one of the most challenging parts of having plantar fasciitis.  This is often because when you sleep and then step down on your foot your fascia instantly becomes irritated.  This can be extremely difficult to get rid of and often sticks around for months.  This is when it is time to make an appointment with a heel pain specialist.  I have been treating heel pain for 15 years and can help you get rid of it quickly.  Give us a call today at 425-391-8666 or make an appointment online today. 

Sincerely,

Dr Brandon Nelson

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Dr. Timothy Young
 Discusses Achilles Tendon Injuries and Rupture

Part 1

We see a number of Achilles injuries in our clinic. For most active individuals with a complete rupture the Achilles tendon we advocate surgical repair. During the surgical repair any of the significant internal bleeding or hematoma is removed to facilitate the repair itself. After the repair has been done during the surgery we often augment this with other treatment. The original injury blood clot itself does have components that may be beneficial but some of those components also can become excessive scar tissue. Eventual augmentation with shockwave therapy can also benefit these patients who have had open surgical repair of an Achilles rupture.

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

Dr. Timothy Young, a Board-Certified Foot and Ankle Surgeon, Discuss His Treatment For Anterior Tibial Tendinitis

Whenever possible addressing the underlying mechanics is helpful. Also decreasing the activity that exacerbates is the problem and cross training is helpful. For example when playing tennis one might have to switch from singles to doubles and be aware of abrupt and sudden movements that will cause the foot to hit the ground quickly and with runners this may involve avoiding running hills and doing flat work instead.

Additional treatments can include decrease in workload on the anterior tendon itself such as anterior tibial athletic taping such as KT tape, especially during activity.
A lace-up ankle brace can also be quite helpful for this but can be bulky and difficult to fit into shoes. Prescription orthotics hold the foot in a more stable position so that when it does contact the ground there’s less mechanical force through the foot and ultimately decreasing the workload on the anterior tibial tendon.

Icing, rest, taping, orthotics and braces are all very helpful.

And for stubborn cases we also can treat this with shockwave therapy.   For severe cases, PRP combined with shockwave therapy is an excellent treatment.
If you have tendinitis-like symptoms, please schedule a consultation at our clinic. 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 Anterior Tibial Tendinitis

In our practice I see anterior tibial tendon symptoms as one of the common tendon conditions of the foot and ankle. The anterior tibial muscle is commonly thought of as the shin muscle and is on the front of the leg. Toward the ankle and foot the muscle transitions into the anterior tibial tendon and then inserts into the inside or media last to the foot directly at the level of the first metatarsal – cunieform joint.   This tendon condition is more commonly seen in tennis players and sometimes runners. Tennis players commonly have high impact foot planting on the hard concrete tennis surface. This engages the anterior tibial tendon especially during heel strike and foot planting.
One of the functions of the anterior tibial tendon is to decelerate the foot as it lands on the ground after heel strike. This can happen more properly during certain sports and activities such as tennis.  And also for runners when they’re going downhill to avoid foot slap just after heel strike.  Anterior tibial muscle shin splints can have a similar mechanism especially with runners.

The tendon also helps to hold the foot up during the swing phase of gait.  Therefore this muscle/tendon complex works during two different phases of gait both with the swing phase and also the contact phase of gait.

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

bunionsurgery

Bunion surgery
is by far the most common surgery I perform.  In the average week I usually do 3-5 bunion surgeries. I really enjoy helping patients with bunions. The before and after is exciting for everyone.  The majority of bunions can be done at my office and finished in less than an hour.  Larger or more complex bunions often take 2 hours to correct.  Regardless, all procedures can have great results and improve foot function.

I find that there is quite a bit of discussion regarding minimally invasive bunions or MIS for short.  These are great procedures and can provide excellent outcomes.  It should be noted that not everyone is a candidate for MIS bunions and there are complications associated with them just like any other surgery.  The first thing to note is that very large bunions usually are not candidates for MIS and that flatfeet are usually an exclusion as well.  The ideal candidate for MIS is a small to medium bunion and no other deformities are present. 

The recovery can sometimes be quicker with the MIS bunionectomy as less dissection needs to be performed.  Sometimes there is less swelling as well and less pain.  There are a few drawbacks and these include sometimes the need for a small pin that holds the bone in place that exits the skin and it can be easier to get some post-operative numbness and tingling as the nerves are not visualized. kangen water is an antioxidant rich healthy alkaline water. 

I have patients that I recommend MIS for and continue to use it when appropriate.  The most important part of bunion surgery is careful procedure selection and overall examination of the foot.  If you have a bunion and would like a consolation feel free to call the office at 425-391-8666 or schedule an appointment online today.

Sincerely,

Dr Brandon Nelson

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