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Dr Brandon Nelson, A Board-Certified Physician and Surgeon, Discusses the Best Long Term Outcome Bunion Surgery
Bunion surgery takes years to master and hundreds of procedures to become proficient. Experience is one of the best outcome predictors in addition to ongoing training and learning. As a physician part of our job is to constantly evaluate our own outcomes and explore techniques to improve our results. I continue to monitor my outcomes and satisfaction from patients. This has helped me to have a unique perspective on long term bunion surgery outcomes.
I have found that two bunion surgeries seem to be the most predictable procedures that have favorable results. They both have been around for years and have been utilized on hundreds of thousands of patients. These two procedures are the Austin and Lapidus bunionectomy.
The Austin is a procedure that is preformed on the head of the first metatarsal. It involves the release of some soft tissue around the bone and then cutting and sliding the bone back into position. This procedure works very well on smaller bunions with no foot instability. It has a quick recovery and can be done in under 1 hr.
The second is procedure the Lapidus or Lapiplasty is the work horse of bunion surgery. It utilized on larger bunions, people with foot instability or juveniles. It provides great correction and incredible long-term results. It involves release of some soft tissue structures around the head of the first metatarsal, then realignment of the first metatarsal and a tarsometatarsal fusion. It can take about 2 hours and has a longer recovery.
If you have a bunion, I would be glad to help you evaluate it and weigh your options between conservative and surgical correction. Give us a call at 425-391-8666 or make an appointment online today.
Board Certified Foot & Ankle Surgeon
Dr Brandon Nelson, A Board-Certified Physician and Surgeon, Discusses Heel Pain and Exercise
Exercise for me is an integral part of my daily life. I enjoy going for a run before work or on the weekends with my daughter. It provides much needed stress relief and helps to recharge my mind and body. I have suffered from heel pain and it was both depressing and challenging to continue on with my exercise and even daily activities.
Heel pain can often be exacerbated by exercise so I am going to provide a few tips that can be helpful:
1. Ice after exercise
2. Warm up before exercise and cool down
3. Stretching after you exercise
4. Switch to low impact activities until pain is under control
If you have suffered from heel pain for more than a month, please give us a call at 425-391-8666 or make an appointment online today.
Dr Brandon Nelson, A Board-Certified Physician and Surgeon, Discusses Ball of Foot Pain
Ball of foot pain usually refers to pain in one’s feet right before or near where the toes start. This is a common area to experience pain and can be attributed to quite a few pathologies. Typically, we see certain foot structures that are associated with ball of foot pain, and these include high arched feet or a foot with a bunion deformity. These foot types can develop to two most common forefoot pathologies which are capsulitis or neuritis.
Capsulitis or metatarsalgia can create pain in the ball of one’s foot especially with activities. Most people that have capsulitis will see some swelling and sharp or a bruised type of sensation. It appears to be most common in the 2nd metatarsal and has a slow progression to worsening symptoms. Shoe gear usually makes it feel better and often there is some instability in the foot itself.
Neuritis or neuromas are often isolated to the 3rd interspace of the foot. We usually see this more often in females as opposed to males. Typically, it will be a burning or tingling type feeling. Shoes often exasperate the symptoms and foot structure does not usually have much of an influence on this pathology.
There are many different techniques to diagnosis and treat capsulitis, metatarsalgia or neuromas. It is important to obtain and x-ray and a thorough evaluation of the foot itself. There are a few instances where more advanced imaging like an MRI can provide some value. Treatment for either pathology is conservative in most cases and has a high resolution rate.
If you are suffering from ball of foot pain, make an appointment today and I will help you get back on your feet! 425-391-8666
Dr Brandon Nelson, A Board-Certified Physician and Surgeon, Discusses How to Get The Best Bunion Surgery
Bunion surgery can be overwhelming to think about, really any surgery can. In general, I see a few patients a day with questions about their bunions and about bunion surgery. I believe the process can be simplified when the surgeon you see has both experience and timelines to help you understand the entire process.
Most bunion surgeries can be done in an outpatient setting. At my office office, we are lucky enough to have an onsite surgery center which is both a huge cost and time savings. It also allows me to operate on more bunions and has provided me with a well of experience. It is important to understand that experience and the number of bunions a surgeon sees makes a dramatic difference.
Most bunion surgeons do two types of procedures one in the head of the 1st metatarsal and one in the base. The 1st metatarsal is the bone with the bunion deformity. The head procedures allow patients to walk right after surgery and is used for small to medium bunions. The base procedures usually require about 3-4 weeks of non-weight bearing. This procedure is usually for pediatrics or larger bunions. Both can provide excellent correction when used appropriately.
If you are thinking about bunion surgery come see me and I can be of some help with the process. Give us a call at 425-391-8666 or make an appointment online today.
Dr Brandon Nelson, A Board Certified Physician & Surgeon, Discusses Surgery For Heel Pain/Plantar Fasciitis
With heel pain affecting so many Americans, surgery is a common question I receive in the office. Most people that are curious about surgery have suffered from heel pain for months or even years and have tried all the conservative measures. They have tried things like orthotics, injections, splints, physical therapy and are still having pain. The discussion of surgery is an appropriate next step but at my office we have a few options that most physicians do not offer.
Surgery for heel pain or plantar fasciitis is highly successful and there are a few different procedures, but all have similar results. Many of the surgeries involve cutting or releasing the fascia and stimulating the biology of the body. The stimulating of the biology is important as it will increase blood supply and help with healing. Another procedure that has been in the current research is a gastric recession. This is where you lengthen a fascial type of structure in a patients leg to help reduce the pull of the Achilles tendon. Lately this has received a lot of attention and is showing very promising results.
I think a discussion on biology is important for this blog as well. Part of the long-term problem is chronically inflamed tissues. One’s fascia becomes chronically irritated and if you change the biology, you can usually fix the problem. I have developed a protocol and technique that is non-surgical that helps to stimulate your bodies own natural healing techniques and fixes most of the plantar fasciitis permanently. If you are suffering from heel pain I can help make and appointment today. Give us a call today at 425-391-8666 or make an appointment online.
Dr. Timothy Young, a Board-Certified Surgeon Talks About Finding the Best Foot Surgeon to Treat Your Bunions
Bunion surgery is something not to take lightly. Bunions can be very painful, and they can be hard to treat. This is a structural problem with the first metatarsal and related joints. It is a condition that is often genetic and at the foot type that is prone to bunions is inherited. So, some individuals will have bunions at a very early age, and we call this a juvenile onset bunion. These tend to progress much quicker than those that develop later in life. Again, it's common to have other family members with bunions because of the common foot structure that is prone to this.
Dr Brandon Nelson, A Board-Certified Physician and Surgeon, Discusses Bunion Pain
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Bunions can become extremely painful especially with exercise and shoe gear. The bunion itself becomes uncomfortable when the bone begins to protrude out of normal alignment. Many people wonder what has caused the bunion itself and why it is now painful. We will explore both of these thoughts and I will provide some insight as to what can be done.
Bunions we know are primarily a hereditary foot structure issue. What I mean by that is the foot structure or foot alignment is what causes the bunion. You inherit your foot from your family genetics and often the foot type you inherit may lead to a bunion. There is usually a family history of bunions, and this can often skip generations. There is a portion of the bunion as well that can be exacerbated by environmental factors. Shoe gear, i.e high heels can put more pressure on the front of your foot increasing bunion formation. Other factors include things like exercise or really anything that increases foot pressures. Even injury and trauma have been associated with bunion development. The bunion is a complex pathology that has both generic and environmental factors that lead to its formation.
Pain, pain is by far the most common reason people come to the doctor. The most frequents spots for bunion pain are right near the knuckle of the big toe or under the 2nd toe. The knuckle of the big toe, or technically the first metatarsal head begins to protrude out and cause pressure with shoe gear. This gets worse with time as the bunion gets bigger. The 2nd metatarsal or 2nd toe becomes painful as the bunion gets bigger and the foot less stable.
If you have a bunion and would like to schedule a consultation, call 425-391-8666 or make an appointment online.
Dr. Timothy Young, a Board Certified Surgeon Talks About Midfoot Arthritis.
As we all get older there will always be some degenerative arthritic changes. One of the more common type is degenerative joint disease. This primarily affects the weightbearing joints of the body including the foot. In addition to normal wear and tear, some individuals have a foot structure that is much more prone to increased and disproportionate stress loads through the midfoot. The stress loads are one of the biggest factors leading to long-term arthritis of the foot. For example, an individual that has a large bunion, will often have poor mechanics and weightbearing function of the first metatarsal-this bone is designed to bear up to half the weight of the whole foot especially through propulsion and push off during gait. When this does not happen, a disproportionate stress load goes through the next in line second metatarsal. Eventually that stress load can manifest at the base of the second metatarsal where it articulates with the second cuneiform.
Over time this increased and disproportionate stress load causes premature and excessive wearing through this joint. Initially there is dorsal compression on the joint causing bone spurs on the top of the joint and increased wear and tear on the articular surfaces with thinning of the articular cartilage. Eventually this can become bone-on-bone. In mild and moderate early cases this can be treated mechanically with orthotics and appropriate shoes. As it becomes more pronounced and more severe than additional treatment options can be considered. At the moderate stage often times sympathetic joint lubricant can be utilized. It is critical to use ultrasound imaging to make certain that this synthetic joint lubricant goes directly into the appropriate joint. Our clinic typically utilizes supartz brand sympathetic joint lubricant. This same highly viscous solution is used, only in the knee and that is where the initial studies for utilization were done. If it is primarily a problem with a painful bone spurs on top then these can be surgically removed. However, usually this is just the tip of the iceberg and in severe cases the second metatarsal–cuneiform joint should be surgically treated with a fusion. This stabilizes the joint and illuminates the damaged cartilage and excessive motion here.
Give us a call today at 425-391-8666 or make an appointment online today.
Dr Brandon Nelson, A Board Certified Physician and Surgeon, Discusses Achilles Tendonitis
The Achilles tendon is the primary tendon utilized in gait. Meaning that every step, every jump, every run you take you puts mechanical pressure on it. This can result in a lot of wear and tear on this tendon. This can begin to manifest as some pain and even swelling in the Achilles. The irritation usually begins where it attaches to the foot or a few inches above the ankle. Most people that experience Achilles’ tendon pain will be avid exercises. Additionally, it seems to be men rather than woman and between the ages of 40-60.
Evaluating the condition of the tendon before treatment is important. A thorough exam by a physician is essential. There are a lot of factors that play a role in Achilles’ tendonitis and these need to be addressed. These range from foot structure, to training errors to tight muscles. An x-ray or even and MRI may need to be part of the evaluation process. Once the deforming forces and anatomical issues are identified a recovery program can begin.
I encourage anybody with Achilles’ tendon pain to seek help from a physician. This tendon is known to often take months before returning to a normal state. While it is inflamed you run the risk of rupturing the tendon. If the tendon ruptures surgery is required and it can take 6-12 months to completely heal from that scenario.
Give us a call at 425-391-8666 or make an appointment online today.
Dr. Timothy Young, Board Certified Foot Surgeon Talks About How His Capsulitis of the Second Toe Was Treated
Capsulitis of the second toe and the second MTP joint is one of the more common conditions that we see and treat. Much of this problem is mechanical in nature. Some it has to do with the foot structure itself and it can also be an overuse injury. There is essentially too large a stress load going to this one joint (2nd MTP) disproportionate to the adjacent joints. The traditional treatments that are still critically important include prescription orthotics and good shoes that have forefoot rocker such as a Hoka shoe or Altra shoe. Other treatments include stretching the calf with a night splint and there are other treatments such as taping.
This can be a chronic and frustrating condition to treat. For the most intense problems where there is inflammation of the capsule we often consider adjunctive treatments. One of the simplest treatments that can be done that does not involve an injection is shockwave therapy. The goal of the shockwave therapy is to do intense treatment and the body essentially receives this treatment and believes there has been more trauma. The body reacts by increasing the blood flow to the local tissues including the capsule.
Also some the local healing factors, become more available to this tissue. This is very similar in some ways to other treatments that help the body regenerate. There are other treatments that can be done such as injections. Injections of Supartz which is sympathetic joint lubricant can be very helpful especially if some of the problem is actually intra-articular and not just the capsule but inflammation and pain of the actual joint itself including cartilage pathology and degenerative joint disease. Other injections may include Traumeel which is a non-cortisone based anti-inflammatory. In severe cases the plantar plate can be damaged an MRI may be indicated. These cases often require surgical repair.
Give us a call at 425-391-8666 or make an appointment online today.
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