Heel pain has many causes, however the most common cause for adults is Plantar Fasciitis. Most of us have heard this term at some point in our lives because a friend or co-worker has talked about it. But what is it? The Plantar Fascia is the main supporting network of the foot. It runs from your heel bone all the way to your toes. It is active every time you stand or walk and is very important for normal gait cycles. Since this structure is under chronic strain it can become inflamed and over used. This will typically lead to pain in the morning or a bruised type sensation on the bottom of the heel. Patients will often state they feel like they are walking on a pebble. Plantar Fasciitis left untreated can become extremely painful and debilitating.

So when should you see a doctor. I cannot tell you how many patients I see that have had heel pain for greater than a year. The majority of patients will have tried icing and stretching and continue to have pain. I cannot stress enough that plantar fasciitis is much easier to treat with early intervention. I find it extremely valuable to get in to see your doctor early. This will lead to faster recovery and a better long term outcome. Additionally, they are other causes of heel pain and some of these can create serious long term damage. I think it is best if you have pain for greater than a week it is time to have it evaluated. Once evaluated my average patient has a 50-90% reduction in symptoms in less than 1 week.

If you are suffering from heel pain please give us a call at 425-391-8666 or make an appointment online.

Surgery can be quite a bit to think about. Patients need to make work arrangements and plan with family and sometimes even friends. Especially if it is your first time having surgery it can feel like a lot. We at Issaquah Foot & Ankle Specialists have helped so many patients with surgery that our process makes it extremely easy and relaxing. We will help every step of the way. We provide a surgical binder that has everything you need and will make sure that you get all the assistance you need to make the process feel simple.

I think the most important part of planning when to have surgery is simply preparation. I tell most of my patients to think ahead and figure out when the slowest time of year is for you with both family and work. This is not always possible so the good news is we are here to help. The majority of procedures will allow patients to get back to activities in a few days. We have years of experience and can provide answers to any questions or concerns you may have.

The surgical process is easy as well. We have an onsite surgery center and most of the time you will be at the office for just a couple hours. We have dedicated rooms and staff that will assist you the entire time. If you are contemplating having your bunion fixed or having your neuroma or hammertoes corrected, we can help. Give us a call today at 425-391-8666 or make an appointment online.

Diagnosis: The diagnosis for this condition is similar to that of a posterior tibial shin splint.  Again this condition can range from the more severe case of a stress fracture of the tibia, to irritation where the muscle attaches to the bone (periosteum), to fatigue and involvement of the muscle itself but not the main attachment to bone.  This can be diagnosed by physical examination and is exacerbated by activity.  It can also be diagnosed in severe cases with a bone scan or MRI.  Again sometimes ultrasound or x-ray can be helpful. 

Treatment: The treatment for this is similar to that of posterior shin splints.  Because it is a mechanical problem it isn't there is some Has less fashion is often due to training and sport activity and this has to often be curtailed while the muscle and related attachments gets a chance to calm down and "rest".  Changing activities such as avoiding going up and especially downhill can be helpful for runners.  Avoiding a hard surface such as concrete for workouts or sport activities can be helpful.  Wearing shoes that have good shock absorption to help deal with impact of heel strike can be helpful and some shoes may be worse for this condition even the weight of the outsole is designed where the shoe impacts the ground at heel strike.  Cases respond to mechanical treatment and support that can include wearing good shoes. 

-Good shock absorbing shoes that are not cantilevered or flared at the back of the outsole.   

-Stretching and icing. 

-Taping such as KT tape. 

-A shin splints sleeve can be helpful. 

-Prescription orthotics are recommended especially for difficult cases. 

-Shockwave therapy is excellent treatment for difficult cases. 

Dr. Timothy Young Talks About Posterior Shin Splints (Medial Tibial Stress Syndrome)

Causes: Shin splints are common problem. These can either affect the front of the shin or the side of the shin (most commonly the medial or inside of the shin). A posterior shin splint is the inside of the shin or medial aspect that involves the posterior tibial muscle. The purpose of this muscle is primarily to stabilize the foot during the stance phase of gait and running. It is also one of the primary muscle tendon complexes to help limit and slow pronation. The most common individuals to have this problem are athletes and especially runners. It is not uncommon to have this problem from too much too soon (overtraining). But it can also happen from individuals to train very well but just have mechanics that put extra stress and an extra workload on the posterior tibial muscle. Therefore patients that pronate a lot are more prone to this problem. 

Diagnosis: This problem can range from muscle fatigue and overuse, to actual damage where the muscle attaches to the outer layer of bone (periosteum), to more severe cases that can become stress fractures. Diagnosing this can be done with physical examination. A stress fracture can be more difficult to diagnose and is often pinpoint pain over the tibia or shin bone.  It can be diagnosed in severe cases with an x-ray, or earlier onset cases can be diagnosed with a bone scan or MRI. Sometimes an ultrasound can be helpful also. 

Treatment:  Severe cases and stress fractures require a cast boot and rest.  Chronic non-severe cases respond to mechanical treatment and support that can include wearing good shoes. 

-Pronation control stability type of athletic shoes and avoiding going barefoot.   

-Stretching and icing after activities always helpful. Anti-inflammatories may just mask the problem. 

-Taping such as KT tape can be helpful.  

-You can also purchase a shin splints sleeve either at a local sporting goods store such as Dicks sporting goods, or online at Amazon.  

-Chronic and difficult cases are treated with prescription orthotics.   

-Shockwave therapy is another excellent treatment for chronic and difficult cases.  

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

Bunion surgery is by far the most common surgery I perform. In an average year I fix approximately 100-200 bunions. I have been operating now for 15 years and that adds up to a lot of bunions. That is why I am excited about a new option for helping my patients with bunions. The Lapiplasty is a new option that helps correct bunions. The procedure itself has been around for greater than 50 years however this new instrumentation system allows for quicker healing times and smaller incisions. Please watch this video to see an introduction to the Lapiplasty.

The Lapidus technique to fix a bunion has proven to be one of the best options we have available for bunion surgery. We have been using this technique for years and it has proven to have excellent results and long term outcomes. The Lapiplasty technique is a modification to an existing procedure that improves patient recoveries. See this video for an explanation of the surgical technique.

If you are suffering from a bunion and are finally ready to have it fixed schedule and appointment today. Dr. Nelson has extensive experience with the Lapidus and can help you fix your bunion and get you back to the activities you love. Give us a call today at 425-391-8666 or make an appointment online.

Patient Testimonials: See some happy patients below.

https://vimeo.com/277107417/761e175d4e

https://vimeo.com/472737283

Bunion surgery and even surgery in general requires planning. Covid-19 has created a new work environment for a lot of people in Washington State. A larger percentage of people are working from home and have decided this provides an opportunity for them to have bunion surgery.

Surgery in general can be challenging, trying to find the correct time and date, planning for the recovery and taking time off work. However, we have seen quite a few people this year that have found working from home to be an advantage for surgery recovery. Without the need for a commute recovering at home and working has seem to work well.

I agree with these patients as foot and ankle surgery often requires modification to one’s work schedule. People working from home have a great opportunity to get the surgery they have been putting off. I think that this is a silver lining of Covid-19. I have personally seen our surgical load increase this year as people want to have elective surgeries they have been procrastinating.

I still think it is important to plan ahead. I like to provide my patients with all the information they require so they can prepare and make their recovery easier. Being preparde can make the surgical process much easier. Getting your house ready, making sure you have a way to get around, setting up a work station all these little tips make a big difference.

If you have a bunion or have been waiting to have surgery on your foot or ankle now is a great time. Give us a call today at 425-391-8666 or make an appointment online. 

Why Us?

The bunion is a complex deformity that arises for many reasons. It is primarily a deviation of the toe on the first metatarsal and the medial cuneiform.

However, it is much more complex than that. The majority of surgeons do not appreciate the fundamental nature of the bunion and the inherit instability of the foot that leads to the bunion. That is where Issaquah Foot & Ankle Specialists are different than the majority of clinics, we specialize in bunions and are considered the premier experts.

To further expend on why we are the only place to have bunion surgery will take a little understanding of the deformity itself. The bunion is not a simple deviation of the toe it is complex condition that requires consideration of the overall foot structure and the cardinal planes of the body. Cardinal planes or anatomical planes are terms we use to describe the three-dimensional relationship of the human body

and how it moves in space. The three cardinal planes are the frontal, transverse and saggital.

Why are these cardinal planes important when it comes to bunion surgery?

It is extremely important to evaluate all three anatomical planes when it comes to a bunion. The vast majority of bunion surgeons do not evaluate the bunion with respect to these planes and often use a 2-D picture to describe a 3-D problem. An example of this is what is called the Anterior-Posterior x-ray view. This is the view most commonly employed for a bunion.

The problem with only evaluating the bunion on this top-down view is it only provides a picture of the deformity in one anatomical plane. This is where the problem lies. The large majority of bunion surgeons stop here and provide a correction in this plane only. This can ultimately result in reoccurrence and revisional surgery. This is an incomplete understanding of the bunion and one of the main reasons for poor outcomes. Issaquah Foot & Ankle Specialists provide a complete evaluation of the foot and bunion as a whole. That is why we also incorporate an x-ray technique that helps to evaluate the bunion relationship to the foot and all anatomical planes.

The above picture is called a sesamoid axial x-ray. It is one of the most important x-rays for a bunion. This helps the surgeon, in combination with the top-down view we saw above, make the best possible decision in planning for a bunion deformity correction. This sesamoid view above determines the bunion’s relationship in another anatomical plane the frontal plane. The frontal plane basically describes the position of the bunion and whether there is any rotation of the bone. If your surgeon only looks in one cardinal plane, they will miss the rotation of the bunion and only provide correction in one plane and your reoccurrence rate goes up.

I strongly recommend anybody that is contemplating bunion surgery to have your foot evaluated by one of our Doctors, we are Board Certified Bunion Experts and have over 30 years of experience and performed 1000’s of bunion surgeries.

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

It is well known that the number one cause of heel pain is plantar fasciitis. The most common presenting symptoms if one has plantar fasciitis are pain in the morning and a bruised type sensation on the bottom of the heel. However, there can be many other causes of heel pain and I will discuss a few today. It is important to remember to have your foot evaluated by a physician as this will lead to better outcomes and prevent further damage.

Bursitis, bursitis refers to an inflammation process of a sac of fluid or a bursa. This can be a common cause of heel pain. The presentation of heel bursitis is very similar to plantar fasciitis. One of the best ways to differentiate the two is to have an ultrasound of the heel. Issaquah Foot & Ankle Specialists keeps an ultrasound on hand for all patients with heel pain. Heel bursitis is usually seen on a patient with a thin fat pad and high arched feet.

Tarsal Tunnel Syndrome, or another type of nerve entrapment are common for people that have burning in their feet. This condition is very similar to carpal tunnel of the wrist and involves a nerve or nerves being compressed in the foot or ankle. Typically these patients will have numbness or tingling or pain that does not go away. Often this diagnosis will require a nerve conduction study.

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

Many foot surgical procedures such as bunion surgery, involve fusions or cutting the bone and then realigning the bone. An example could also include a lapiplasty bunionectomy. The bones are then held in place with plate screws or pins. One of the most important things for proper healing is to make sure that you don’t put weight on that part of the bone until there’s adequate bridging of the bone.

Your doctor will take x-rays to help determine the timing for this. Also you will have either a boot or a fiberglass cast and you may also have other forms of protection such as a scooter crutches or even a wheelchair. Make sure to plan ahead on this also. For example if you’ve got a short distance then you can put weight on your heel but not the front of your foot that may be fine. If you have to go a longer distance, you may want to plan ahead and bring crutches or use your scooter for that longer distance and only do the short distances with a walking heel part of your cast boot.

If you have questions about bunion surgery, and would like a consultation please let us know. Give us a call today at 425-391-8666 or make an appointment online. 

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.