Toe pain, especially of the 2nd, 3rd and 4th toe can be quite common and have a few different sources of pain. The 2nd toe often has pain associated with a bunion or instability of the inside of the foot. A lot of patients have a foot structure that can overload the 2nd toe and cause mechanical pressures that eventually fatigue the joint. The 3rd and 4th toe are more likely to have an entrapped nerve. The anatomy in this location causes a compression issue where the nerve exists and can create problems for patients.

The 2nd toe or 2nd metatarsal phalangeal joint has a thickening called a plantar plate. This thickening acts like a cushion and helps protect the toe and joint when walking. If your foot structure places too much pressure on this joint, you can tear the plantar plate. One will often see the toe start to drift towards the 1st or inside of the foot. The pain is often like a neuroma, burning, tingling, and swelling. Often patients will require an MRI to confirm the tear. Once the tear is confirmed the plantar plate usually requires surgical repair. There are two methods one from the top of the toe and the other from the bottom. I often will decide which is appropriate for the patient based on any other foot pathology that may need to be addressed, like a bunion.

The 3rd and 4th MTPJ or 3rd interspace, the area between the 3rd and 4th toes is common spot for a Morton’s neuroma. The foot has two large nerves on the bottom the lateral and medial plantar nerves. These two nerves come together in the 3rd interspace and are often compressed between the metatarsal bones. This squeezing affect can result in burning to these two digits. A neuroma can be treated very effectively with alcohol injections. The alcohol injection series is 89% successful in eliminating nerve pain.

If you are suffering from burning, tingling, or swelling in your foot we can help. Give us a call at 425-391-8666 or make an appointment online.

Mid foot bone spurs and surgery part two.

Surgery to treat a bony prominence in this area usually is very straightforward. It typically involves an incision directly adjacent to the prominence or bone spur. We surgically go down to the tissue layers and then expose the bony prominence. Then most commonly a power burr is used to smooth down the excessive bone in the area or sometimes a special surgical saw. The wound is cleaned up and flushed to remove any small bone fragments.

The remaining cut bony surface usually has an excellent blood supply and can cause swelling problems or even a small collection of blood like a hematoma. Therefore several different techniques can help deal with this. One is to use a small drain which allows for a path for the blood to escape the area, this is especially useful for the first several days postop.  Another strategy is to use bone wax to seal the bone.

Some Surgeons use topical fibrin to help clot exposed bleeding vessels that are small and embedded in the bone.  After the bone remodeling procedure is done, the soft tissue layers are closed and the procedure is then complete. Usually it’s a relatively quick recovery.  Remember that we are talking about a bony prominence without significant underlying midfoot arthritis.  The midfoot arthritis and surgical fusion of the involved joint can be a longer recovery.

If you have questions about spurs or bumps on the top of your feet forefoot surgery in general, and would like a consultation please let us know.  Give us a call at 425-391-8666 or make an appointment online. 

The Achilles tendon is the thickest and strongest tendon in the human body. It has more pounds per square inch applied to it than any other tendon. We consider it the work horse of the lower extremity. It is constantly in use and provides forward motion in the gait cycle. These reasons make it one of the most commonly injured or strained tendons.

Achilles tendonitis usually presents with pain and selling around the back of the ankle. Patients have usually increased activities or changed activities or even started to walk more. There is often pain when getting out of bed, that gets better as the day goes on, but returns with rest. Sometimes patients will describe weakness or a catching sensation.

Diagnosing Achilles Tendon injuries is relatively straight forward. A typical mechanical and musculoskeletal exam of the foot and ankle are performed. An ultrasound or x-ray can be helpful as well. More advanced cases can require an MRI to rule our tearing or degeneration.

Treatment is provided on a case-by-case basis. It is important to identify the cause and help eliminate or reduce this activity. Stretching is vital and reducing the mechanical burden. I always encourage people with Achilles issues to see a foot and ankle physician before implementing treatment as these measures are not always appropriate. If you are suffering from Achilles tendonitis, give us a call at 425-391-8666 or make an appointment online so we can get you back on the road to recovery.

Bunion surgery is one of the most common procedures that I perform. I see patients from all over the Northwest that come to have surgery at our office. Our onsite surgery center makes it convenient and provides a huge cost savings as compared to a hospital or free-standing surgery center. We provide sedation and a nerve block that makes the surgery completely pain free and comfortable.

Bunion surgery itself is a successful surgery. There are a few factors that need to be addressed before surgery. A complete foot exam, gait analysis, and x-ray usually provide all the vital information that is needed. Once I have all these factors it is easy to make a recommendation of what procedure would provide the best outcome.

Bunion surgery can really be broken down into two types. The first what is called a head procedure, this is the most common bunion to date. The second type is what is called a base procedure. Often the head procedure or Austin bunionectomy is utilized for small to medium bunions that have no sign of foot collapse. This surgery is done by cutting the head of the metatarsal and shifting it towards the outside of the foot. The bone is usually help in place with a screw or a pin.

The second type of bunionectomy the base procedures can be broken down to what is called an osteotomy or fusion. The osteotomy is where you remove a wedge of bone to correct the deformity. This procedure can be used for large bunions with no foot instability. The other type of bunionectomy, the fusion or Lapidus as it is called provides significant stability to the foot. This procedure is phenomenally successful and provides great improvement to the overall function of the foot. If you are suffering from a bunion, give us a call at 425-391-8666 or make an appointment today and together we can come up with a long term plan that provides the best out come for you lifestyle.

About 150,000 bunion surgeries are performed every year. Most of these procedures continue to be the Austin bunionectomy or what is called a distal osteotomy. Before we get into what the procedure is let us get a little background as to what a bunion is. A bunion is an inherited foot condition. It occurs when the 1st and 2nd metatarsal separate and create and enlargement on the inside of the foot. Please watch this video to get a general understanding of the bunion. You will need to open the video labeled bunions in the first column titled “Podiatric Medicine” it is the 5th video in that drop down menu.



There is a common misconception that something grows on the inside of the foot. However as seem above on the x-ray you can see the 1st and 2nd metatarsal are deviating. The 1st metatarsal is the long bone on the left side of the picture and the 2nd is the long bone directly to the right of the 1st. The 1st metatarsal continues to separate and begins to poke out the side of the foot leading to the bunion deformity we are familiar with.

Surgery is the only way a bunion can be removed. The surgery involves working on the head or base of the foot. The head of the 1st metatarsal in towards the top of the picture and the base is towards the bottom. The most common procedure continues to be the Austin bunionectomy.

The Austin bunionectomy involves cutting the head of the metatarsal and shifting it back into place, or towards the 2nd metatarsal. Please watch the video below to see an example of the Austin bunionectomy.

http://www.physicianwebpages.com/animator/austin_l.html

The typical Austin bunionectomy patients can walk the entire time post-operatively because of the technique I use. I tell my patients you will be sore for a few days but able to walk. The recovery depends on the patient’s overall health and how well they follow post-operative protocols. I have taken years to develop my post-operative protocols and do everything possible to decrease recovery times. If you have a bunion and would like to have a consultation with a bunion surgery expert please call my office at 425-391-8666 or make an appointment online. 

What is it?

Burning or tingling can be one of the most challenging symptoms to treat in the foot. The number one reason patients have burning of tingling in the foot is neuropathy. Neuropathy is a disfunction of the sensory nerves in the lower extremity. The most common cause for neuropathy is diabetes. High levels of glucose in the body can attack the nerves and lead to burning and tingling. There are other causes including medications, alcoholism and exposure to toxic metals. Additionally, about 60% of neuropathy is idiopathic, meaning we are unable to identify a cause. Neuropathy typically gets worse as time goes on and can become quite debilitating for patients.

How can we help?

We understand how frustrating neuropathy can be and how emotionally taxing it can become. Our goal is to help identify the cause and to help decrease the factors that make it worse. We have now established a protocol that significantly reduces the symptoms of neuropathy. Recently I had a patient tell me he felt his feet for the first time in 10 years. We have a combination approach that is extremely successful. We utilize an FDA approved laser for neuropathy in combination with some vitamin supplements that are specifically designed for nerve pain.

If you are suffering from neuropathy or fibromyalgia we can help, schedule an appointment today. Give us a call at 425-391-8666 or make an appointment online. 

Burning and tingling in the toes or even electrical shooting type pains can often be the result of nerve injury. Nerve pain or injury often produces a shooting style pain and can be quite painful. Often it is worse with shoe gear, especially tight-fitting shoes, standing or activities. There does not need to be any previous trauma to get nerve pain in can be causally related to anatomical issues or even genetic.

The most common cause of nerve pain in the foot is a neuroma or a nerve entrapment like tarsal tunnel syndrome. Neuromas typically cause shooting pain to the 3rd and 4th digit of the feet and are more common in woman than men. Tarsal tunnel syndrome is usually located around the ankle and causes electrical pain around the inside of the ankle. Patients with tarsal tunnel often have a history of carpal tunnel in the wrist.

It is important to get an accurate diagnosis of a neuroma or tarsal tunnel. The best place to start is an x-ray. However, some patients will require a MRI or Nerve conduction studies to further support the diagnosis.

Treatment is centered around the cause. It can be useful to remove pressure and decrease inflammation around the nerve. If you are experiencing nerve pain we can help. Give us a call at 425-391-8666 or make an appointment online. 

Thinking about bunion surgery can be overwhelming. I like to help my patients at least a week before surgery so we can prepare together. It is important to think about all the factors that can influence your outcome. I have patients make a list of questions before we meet and advise them to bring a family member or friend to their pre-operative appointment.

A few suggestions to think about before surgery are:

1. Set up a general operation center, i.e the couch with everything you need

2. Think about how you will use the shower and bathroom

3. Supplements, these can be important, examples are calcium and collagen

4. Exercise plan, what can you still do?

5. Review your timeline, how long will you be down?

6. Do you have all your post-operative appointments?

7. Consider side effects of mediations, constipation/nausea

8. Make and freeze a few meals

This list is not exhaustive but it is a good place to start. The majority of your questions will be answered at your pre-operative appointment.

The Surgery itself:

Bunion surgery usually takes about 1 to 2 hours and is done in an outpatient setting. Our practice is set up to provide the most convenient and cost-effective approach to your bunion surgery by having a surgery center on site. The day of surgery most patients will have nothing to eat or drink 8 hours before surgery and will show up at the practice about an hour before their operation.

You will see the surgeon again and meet your anesthesia provider. Next you will be brought into the operating room and an IV will be started and you will wake up after the surgery is completed. Typically, most patients have a nerve block that will last about 24 hours. You will then have your first post-operative appointment with 4-10 days.

Recovery:

Recovery really depends on the procedure selected. All our bunion surgery patients can walk after surgery. We also help our athletes stay in shape by helping them tailor a recovery period workout. Recovery can be influenced by your diet and how well you follow the post-operative course.

If you are struggling with bunion pain we are here to help! Give us a call 425-291-8666 or make an appointment online. 

Most bunion surgeries require screws or plates (or a combination). It’s important during bunion surgery, in order to get full correction and realign the bones and joints, the bone is typically resected or effusions are done to realign the first metatarsal.  This requires hardware such as plates and screws. Once the hardware has done his job and the bone has healed and maintained the new corrected alignment and position, many of our patients elect to have hardware removed. The hardware can be medical grade stainless steel or titanium. These are the most common metal/metallic implants used. 

Sometimes the head of the screw causes minor irritation or part of the threads protrudes enough that there is irritation with some of the adjacent soft tissue. 

In other instances some patients seem to be sensitive to having a foreign body or a non-human item in the body. Some patients have minor skin manifestations although this isn’t common.  In general patients feel better once the hardware is out. 

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