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Tenex Procedure for Plantar Fasciitis, Dr Brandon Nelson a Board Certified Physician and Surgeon
Despite all the available conservative options available for plantar fasciitis some patients do still require surgery. There are many different surgical procedures to address chronic plantar fasciitis. This includes the traditional open fasciotomy, the endoscopic fasciotomy, Topaz procedure and the Tenex procedure. The Tenex procedure is relatively new and has showed promising results with minimally invasive technology.
Tenex, is basically a small tool that you insert in the fascia that removes tiny pieces of the fascia. It is inserted multiple times via a very small incision and safely removes some of the diseased fascia and stimulates new fascial growth. The procedure itself can be done in less than 10 minutes and does not require anesthesia. A little bit of numbing medication can be injected around the fascia and then the procedure can be performed. Patients are required to wear a walking boot for about 3 weeks.
The initial results are very promising, and patients experience no pain after the procedure. I have seen very little swelling or bruising after the procedure and patients have been extremely satisfied with the recovery course and reduction of plantar fascial pain. I believe this procedure will change the open approach for a lot of surgeons and is demonstrating incredible results. If you are suffering from plantar fasciitis we can help.
Give us a call today at 425-391-8666 or make an appointment online today.
Dr. Timothy Young, Board Certified Foot Surgeon Discusses a More Involved Tailor's Bunion Surgery Correction
In some cases, the fifth metatarsal bone was away from the adjacent fourth metatarsal so much that to correct the problem we must reset the bone. This is much like creating a surgical fracture realigning the bone exactly where it should be amenable allowing it to heal in its new position. This can correct a more pronounced tailor's bunion.
This requires some type of fixation. Usually this involves one or 2 small screws to hold the bone in the newly aligned position. Bone healing typically takes 6–8 weeks. Therefore, the cast boot is used long enough to allow for the additional bone healing. This can also help if the patient has a pressure point under the fifth metatarsal or callus under the fifth metatarsal. There are several different ways of realigning the bone and then fixating this.
Dr Brandon Nelson, a Board Certified Physician and Surgeon, Discusses Numbness and Tingling of the Foot
Burning pain in the feet can be quite common for diabetics or people with what is called neuropathy. This is a condition that occurs when our nerves have some dysfunction. There are quite a few causes of neuropathy but the most common is diabetes. Diabetes can result in high levels of sugar in our blood that then causes irritation or damage to our nerves. The nerves involved are usually the nerves in our hands or feet, the peripheral parts of our body, hence the term peripheral neuropathy.
Tingling is another sign or peripheral neuropathy. Often times it feels similar to hitting your funny bone and can progress as time goes on. I recommend anybody with these symptoms should be evaluated and tested for nerve problems. A test I often order is called EMG/NCVs. These test will allow one to see if the numbness or tingling is coming from your nerves.
Treatment can usually begin right away and have dramatic effects. I like to use an FDA approved laser, that has zero side effects, in combination with a nerve supplement and infra-red light. I have had patients experience 80-90% improvement in symptoms. If you are suffering from neuropathy, fibromyalgia or burning and tingling in the feet we can help.
Give us a call today at 425-391-8666 or make an appointment online.
Dr. Timothy Young, Board Certified Foot Surgeon Discusses Surgery for a Bunionette or Tailor's Bunion Surgery
A tailor's bunion is a problem, or the fifth metatarsal and the fifth metatarsal head protrude laterally or to the outside of the foot. This causes pressure and pain especially with shoes ski boots etc. This is usually a structural problem. The fifth metatarsal tends to angle outward away from the adjacent fourth metatarsal. Sometimes it is a simple problem and it's just enlargement of the head of the fifth metatarsal. From a surgical perspective this can be treated by surgically shaving down the bump. This tends to be a much quicker recovery.
This would involve the incision, surgically incising the joint capsule then shaving down the bone and using a surgical orthopedic burr to smooth that down area. After the bony prominence has been smoothed down and reduced the wound is flushed and the layers including the capsule subcutaneous layer and skin are all surgically repaired and sutured. This tends to be a quick recovery it can be as short as 3 weeks in a cast boot.
Give us a call today at 425-391-8666 or make an appointment online today.
My Heel is Sore All the Time!
Heel pain continues to be the most common reason a person visits the foot and ankle doctor or podiatrist. For us it constitutes about 1 out of every 4 patients and is one of the most important things we treat. We specialize in heel pain and have seen tens of thousands of patients for it. Our success rate with conservative measures to get rid of heel pain is close to 99%, very few people require surgical intervention.
Plantar fasciitis continues to be the number one cause of heel pain. Most people will get pain first things when they get out of bed in the morning or after standing for long periods. It is common for some with fasciitis to not have morning pain. There also is a correlation with a new exercise program and the development of plantar fasciitis. I always recommend getting in early to see us as it is much easier to treat early on.
Bursitis is another very common cause of heel pain. We often see this in a high arched foot or a runner. Patients will have symptoms like plantar fasciitis but usually on ultrasound we can see the bursal sack. Bursitis usually responds very well to the treatment program we provide and very few people need to sideline their activities.
Nerve entrapments can also create heel pain. This is usually a nerve called Baxter’s nerve. Most people will experience a lot of burning and tingling with this condition. However, this can be a tricky diagnosis and may require special testing. This condition can respond well to a steroid injection adjacent to the nerve.
If you are experiencing heel pain we are here to help give us a call at 425-391-8666 or make an appointment online today.
Dr. Brandon Nelson, Discusses How To Get Through Bunion Surgery
Bunion surgery can be overwhelming when one starts to think of all the logistics. It is important to start planning early in order to maximize outcomes and have a smooth recovery period. I have some advice that I think can be quite helpful for patients thinking about bunion surgery. Here are my top 10 tips:
1. Make a list of expectations for your surgeon. Bring a list to your preop and we are always happy to go through these.
2. Take a week off, be a couch potato. Sacrifice upfront will make it easier in the long run.
3. Know that you will have pain, discuss any concerns with your surgeon. Have all our pain meds/rxs filled before surgery.
4. Plan how you will get around, crutches, knee scooter, etc.
5. Have a central place in your house set up. Make it close to the bathroom and anything you will need to be comfortable.
6. Take a bone healing supplement this will decrease healing times.
7. Start your toe range of motion early this will help with stiffness.
8. Plan how you will shower, sleep and use the toilet.
9. Purchase some bandages, 4x4 gauze and coban.
10. Look at your post-op surgical schedule, when will you start walking, start ROM, be able to shower, etc.
Well I hope this is helpful and goodluck!
If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online today.
Dr Brandon Nelson, A Board Certified Physician, Discusses Morning Heel Pain
Moring heel pain is extremely painful and can cause quite a disruption to your daily routine. It is not only uncomfortable but also can become emotional upsetting to start one’s day with pain. It is estimated that about 60-70% of adults will experience this at some point in their life and it can last months without treatment.
The pain is one’s heel is usually related to inflammation of your plantar fascia. Your plantar fascia provides structural support to your foot and is activated when you walk. It runs the entire length of your foot and starts at your heel and continues to your toes.
Treatment of morning pain usually starts with stretching and icing. I recommend using a theraband or a belt to stretch before you get out of bed. Massage is another option and icing can provide help with the inflammation. It is important to consult a physician before beginning your treatment as not all heel pain is plantar fasciitis.
Dr Timothy Young Talks About Tight Calves and Foot Problems, Part 2
Tight calves and Achilles are a major factor in many foot problems. That is why we use a night splint and calf stretching is helpful for many problems. Problems in the front of the foot like 2nd toe capsulitis metatarsalgia often respond well to calf stretching. We have discussed how during gait, early heel rising and transfer of weight to the front of the foot can increase the load and weight transfer to the forefoot (and midfoot). This early transfer of weight and mechanical load can be destructive.
With our example of capsulitis of the 2nd toe, we now have an extra load going through the 2nd metatarsal and toe joint. Eventually the extra load can strain the 2nd metatarsal and capsule. This can lead to capsulitis or even a stress fracture of the metatarsal. So, to help with this, we have our patients stretch their calf and use a night splint. We avoid shoes that further put more pressure on the front of the foot (like high heeled shoes). We even recommend shoes with zero heel drop, like Altra shoes. This is just one example of how equinus can factor into a foot problem, there are so many more examples where this happens. So, this is just the “tip of the iceberg” as a major factor in many foot problems and pathology. Keeping your calf stretched out is one of the single best exercises you can do to keep your feet healthy!
If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online.
Dr Timothy Young Talks About Tight Calves and Foot Problems
Dr Timothy Young Talks About Tight Calves and Foot Problems
As mentioned, the mechanical load on the foot from the calf and ultimately the Achilles is tremendous. So, with equinus ( a tight calve and or Achilles) there are many problems. Think of a woman who wears high heel shoes every day for many years and over time the calf gets less flexible. Now with that tight calf, her gait has changed. As she walks, with each step going forward that tight calf pulls, and her heel comes off the ground early. Early heel off with gait leads to early transfer of weight and force to the front of the foot. Over time, this extra pressure on the front of the foot can cause problems. This is like the childhood toewalker, but with adult body size and weight.
If you are experiencing any foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online.
Dr Brandon Nelson, A Board Certified Surgeon, Discusses Ankle Surgery
Surgery of the ankle is a fairly common procedure. The majority of ankle surgeries have to do with the outside of the ankle or the lateral ankle complex. The lateral ankle complex is composed of the lateral ankle ligaments and the peroneal tendons. The ligaments on the outside of the ankle are the most important ligaments for stability. These ligaments are often injured with an ankle sprain or ankle fracture. The peroneal tendons work to dynamically stabilize the ankle with activities. These tendons can also be injured with repetitive use or chronic ankle sprains. It is important for anybody that has more than 1 ankle sprain a year to have the structural integrity of their ankle evaluated.
Evaluation of the ankle usually involves and x-ray and a physical examination. In addition, I will often order and MRI to get a better appreciation of the structural components of the ankle. I like an MRI because one can see what the ligaments and tendons look like. This is extremely helpful for evaluation of what needs to be repaired for surgery and what the tissue consistency looks like for the repair.
The surgical procedure itself, or the repair, can be relatively straight forward as in just a ligament stabilization or more complex included bone work. The most common ankle procedure is the lateral ligament reconstruction or the Brostrum procedure. This is a great procedure for anybody with chronic ankle sprains. With this procedure there is a chance you may need the tendons repaired as well.
If you are experiencing frequent ankle sprains or have pain on the outside of the ankle I can help. Make an appointment today and we will get you back on the road to recovery. Give us a call at 425-391-8666.
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