timothy young
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Wednesday, 14 July 2021 16:46
Dr. Timothy Young Discusses Stubborn Capsulitis
I have had this condition myself. We are talking about capsulitis of the second metatarsal phalangeal joint (MTP joint) in the ball of the foot, near the base of the second toe. There have been previous blogs about the potential cause of this problem. Treatment has to address the underlying cause and foot structure as much as possible. If the calves are tight, then they have to be stretched and use a night splint or even have a gastroc recession surgery. If there is a bunion and the whole first metatarsal is not bearing is fair share weight then it can cause stress overload to the next in line second metatarsal. Orthotics and foot taping often help this.
Sometimes it's not enough and sometimes especially if there is damage to the capsule such as the plantar plate, we then have to correct the bunion and consider surgery on the second metatarsal. But there are other cases that don't require surgery. It still imperative to do all the other treatments. The correct shoes with a forefoot rocker, sometimes zero drop shoe such as Altra Shoes can also help. Avoiding the activity that seems to aggravate this also can be critical. For example, if you're runner or speed walker, you may have to put that on hold or do cross training until her symptoms have completely resolved. For myself, this seemed to come on after I had resumed running after several months off. I had to make sure my orthotics were still appropriate for this problem. I wore correct shoes. I had to stop running and cross train. I worked on stretching my calf and I have a night splint also.
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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Wednesday, 23 June 2021 17:29
Dr. Timothy Young, a Board Certified Foot Surgeon, Discusses How to Tell if a Fracture is Healing
Dr. Timothy Young, a board certified foot furgeon, discusses how to tell if a fracture is healing. Also, when does your Doctor know when the bone has healed enough to get out of that boot or cast?
Bone healing occurs after a fracture or bone, or fusion. In each case it is important to protect the bone and modify weightbearing or gait to allow the bones to heal in the appropriate alignment and position. For example, if you have a fracture of your second, third or fourth metatarsal you don't want to put regular unprotected weight on it because the far end of the bone or distal aspect will tend to elevate and then heal out of alignment, causing a long-term problem with the structure of your foot. Another exam would be after Lapidus or lapiplasty bunion surgery that requires a fusion of the joint. Again, bone healing is critical and needs to evaluated during the postoperative course.
X-rays are one aspect of evaluation. Your doctor will look at your x-rays and determine if there is signs of appropriate bone bridging. One bone heals without excessive motion there is no bone callus and this is called primary bone healing. This can be difficult to diagnose. X-rays may show only incremental healing and filling at the fusion site or fracture site. Initially this is quite subtle. At times ultrasound imaging can be quite helpful and can show areas of bone bridging and areas that do not have any bridging. CT scan can be useful.
Timing is another key. For younger patients for example those that are less than 20 years old one would expect bone healing to as fast as 4–6 weeks, for definitive stable bridging to be seen on x-rays. But as we all age bone healing can take longer. So for middle-aged patient it could take 8 weeks. And as we get older for example passed 50 or 60 years old it can take 8–10 weeks. Bone density and overall health can also be a factor, as well as other concerns such as smoking. I'm not surprised for an older patient that I don't see definitive bone bridging and stability at 4 weeks postop. But for the younger patients I do see this quite often. Therefore, the age of the patient will be a factor in what my expectations are regarding the amount of time it takes for the bone to heal and have adequate stability.
Compliance can be another factor. For example, some patients might initially stay off her foot and then pull weight onto soon and laterally cause a refracture and motion of the fracture or osteotomy site. This can reset the clock. One might expect to see bone callus and secondary bone healing in this case.
If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment onine today.
If you are experiencing foot or ankle pain, give us a call at 425-391-8666 or make an appointment onine today.
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Wednesday, 19 May 2021 14:56
Dr. Timothy Young, a Board-certified Foot Surgeon, Discusses Removing Hardware After Bunion Surgery
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.
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