The front of your foot or the area where your toes begin is called the forefoot.  This area consists of your toe bones, your phalanges and your metatarsals, the long foot bones.   This area is where you push off when ambulating and provides stability for forward propulsion.  This is a complex anatomical area and more than a few pathologies can exist in this location but I will discuss a few of the most common.  These include neuromas, capsulitis and stress fractures.

Neuromas are an entrapped nerve that can cause burning and tingling.  These usually occur in the 3^rd interspace.  Most patients have a sensation that is electrical and is worse in shoes and relieved by taking off their shoes and rubbing the forefoot.  These seem to be more common in women than men and especially around the 4^th-6^th decade of life.   Neuromas have some great treatment options available one of most successful is dehydrated alcohol injections.  The success rate with these injections approaches 89%.

Capsulitis is a term we use to describe inflammation of a joint.  This most commonly occurs in the metatarsophalangeal joint of the foot.  We tend to see this in a patient with a bunion or high arched foot.  The main cause seems to be a biomechanical imbalance.  It is important to get an x-ray with capsulitis as arthritis can have a similar presentation. 

Stress fractures usually present with swelling.  They often occur as one begins a new training program and can cause pain for weeks.  Typically these will be relieved with rest and exacerbated by activity.  Most will heal with a change in activities and calcium supplementation.  However again an x-ray is warranted to rule out other pathologies and to monitor healing.   

If you are having forefoot pain I can help.  Schedule an appointment with Dr Brandon Nelson, give us a call at 425-391-8666 or make an appointment online. 

Sincerely,

Dr Brandon Nelson

Board Certified Physician & Surgeon

Heel pain is by far the most common thing I see in the office.  The number one cause is still being plantar fasciitis.  Most patients with heel pain will have resolution of their pain within a month of seeing me.  However, there is a small percentage of patients that do not get better and further work up is warranted.  We call these patients the outliers or red herrings.  There are about 2 main causes of outliers or red herrings.  These are nerve issues, i.e., Baxter’s neuritis or a stress fracture. 

Baxter’s neuritis is not as common as plantar fasciitis.  It is basically an entrapment of a nerve near the heel.  The nerve becomes irritated and compressed.  The symptoms can be similar to plantar fasciitis.  The most common symptom seems to be burning in the heel.  Burning or tingling are often associated with nerve pain.  Usually, a nerve conduction study is required to diagnose this entrapment.  Once it is diagnosed sometimes a local injection of the nerve can help or a prescription orthotic to offload the area can be quite helpful.  Baxter’s neuritis differs from a stress fracture in presentation usually. 

A stress fracture of the heel bone or calcaneus both can cause heel pain however usually in different areas.  With the stress fracture it is usually a constant pain that is a dull ache or throb.  Additionally, there is often an increase in training that has resulted in a stress fracture.  Usually, a stress fracture will require an MRI and most resolve with time and protected weight bearing.  If you are suffering from heel pain, especially if it has been going on for more than a couple weeks I can help. If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment online. 

Sincerely,

Dr Brandon Nelson

Numbness and tingling can be quite common in people experiencing forefoot discomfort. Most people will describe symptoms like burning, pinching, numbness and tingling. These are often associated with nerve type issues and can continue to get worse without treatment. The most common causes of this in the foot are neuromas and capsulitis.

Neuromas are a nerve irritation that occurs in the foot and usually is a female between the ages of 40-60. The nerves that run between the toes are sensitive and any increases pressure can cause pain. This pain is usually made worse with tight fitting shoes or high heels. Patients usually have pain to the 3rd and 4th digit and often is only on one foot. Most people will say that rubbing the front of their foot seems to help as well as removing their shoes.

Capsulitis is usually around the base of the 2nd toe. There is often an underlying deformity like a bunion or tight calf muscle. Patients will often experience swelling and tingling or digit. It is usually made worse with walking and relieved with icing.

Neuromas and capsulitis both can be challenging for the patient and the doctor. It is important to identify the root cause and an x-ray is warranted. The treatment options available are usually very successful. If you are having forefoot pain we can help, make an appointment today.

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

Recent literature has proven that about 10%-20 of American adults will experience heel pain. Heel pain whether it is causes by plantar fasciitis, bursitis or a stress fracture can be challenging to treat. With constant use the foot and ankle rarely have time to recover from the constant pressures of walking. This can make heel pain and plantar fasciitis very difficult for many people.

If you are experiencing pain in the bottom of your foot, especially in the morning it could be plantar fasciitis. Often times patients will describe a bruised type feeling or tightness that loosens up with walking but returns at the end of the day. Some people will feel a numbness or tingling in the foot or even a burning. It is important to have a foot and ankle physician evaluate your foot before initiating treatment.

Treatment for heel pain focuses on finding the underlying causes. The majority of people with heel pain have a tight calf muscle. One of the best long term strategies is to begin a calf stretching program. I like to have my patients stretch 3 times a day and spend a couple minutes on the muscles of the calf. Another great option at home is to ice and rest.

Our clinic Issaquah Foot & Ankle Specialists has one of the most advanced protocols that is based on current research to fix heel pain permanently. The majority of patients we see have a greater than 50% reduction in symptoms in less than 1 week and a long term success rate of almost 98%. We focus on the underlying process that is creating the inflammation and help the body to recover and repair the heel pain. Our methods do not require and period of non-weight bearing and have treated thousands of patients. If you are suffering from heel pain call us at 425-391-8666 or make an appointment online today.

There are many sources of heel pain. Heel pain can be caused from a bone spur, stress fracture or the most common reason plantar fasciitis. Plantar fasciitis is caused by inflammation within your plantar fascia which is a big thick ligament like structure that supports the bottom of your foot. The fascia begins in your heel and runs to your toes.

This is why the most common spot for heel pain is right where the fascia attaches to your calcaneus or heel bone. With an increase in exercise or walking we see more stress on the fascia. This in turn can begin to create and inflammatory cycle and the beginning of plantar fasciitis. One of the best things we can do in the beginning is to stretch your calf muscles. I recommend stretching at least 3 times a day for about 2-3 minutes each session. One must make sure to stretch both the gastroc and soleous muscles. 

If you are suffering from heel pain or plantar fasciits we can help. Give us a call today at 425-391-8666 or make an appointment online.