Stanley G. Newell, DPM, PS

Notice: The Seattle Foot and Ankle Clinic will be closing on March 17th. Therefore, Dr. Newell will be going on a sabbatical, but continuing his research on how the foot affects the back. He is unsure if he will return to practice podiatry. You may obtain a copy of your chart by calling 206-527-4177. For continuity of care you can make an appointment with Dr. Erik Lilja who will be moving to a UW Medical Clinic in the Fremont area, by calling that same number, or a podiatrist of your choice. You may check this website for further developments.

Common Conditions

Heel Pain/Plantar Fasciitis

Heel pain is one of the most common complaints regarding the foot and ankle. Due to the repetitive nature of walking, the structures of the foot must resist an enormous amount of stress every day. Then they have to get up and do it again! Walking itself is often enough injury over time to create significant problems in the feet. Plantar fasciitis is most often the result of overuse. Everyone has a different threshold for symptoms, and therefore, not everyone has experienced heel pain, but if you are over 30, you likely know someone who has struggled with plantar fasciitis if you haven’t already.

Fortunately, our office has been successfully treating painful heels for years. We focus on the mechanical underpinnings of heel pain and help return your feet into efficient and pain free walking partners.

Knee Pain and Chondromalacia

Lower extremity alignment affects the leg from the ground to the hip. Our success treating runners’ feet and ankles has also resulted in a profound improvement in many of our runners’ knees, hips and backs. While we (specialize in/treat) the foot and ankle, we have gleaned from patient feedback that many running related knee problems improve with orthoses.

Dr. Newell reviewed several hundred runners with ancillary knee complaints at the time of treatment. He was able to categorize the response of the knee complaints against duration of orthotic use. He found that many common knee complaints improved following regular use of orthoses. These include symptoms consistent with patello-femoral syndrome, ilio-tibial band syndrome, patellar tendonitis, pes anserina pain and even Osgoode-Schlatter pain in children.

Pain in front of the knee, chondromalacia, and pain underneath the kneecap is a 1:1 relationship usually related to the way the foot functions. By allowing the foot to be in its proper position, it allows the leg to externally or internally rotate and line up the knee in a proper way so that the patella tracks properly. Most of this, if caught early enough, will respond dramatically to treatment in a short period of time.

Back Pain

Back pain is becoming the second most frequent foot related problem seen in our office. Our success rate with backs has created a steady stream of patient referrals from physicians and others dealing with back pain.

There are many reasons for back pain and anyone who has back pain should be screened by a physician for arthritis, disk problems, tumors, etc. We have had much success treating low back pain with proper alignment. We believe that chronic low back pain is aggravated by rotation of the pelvis and spine on all three body planes,. This abnormal motion is created when the legs internally rotate forcing the femur into an internal rotation and the pelvis tilting to unload the hips, resulting in the malposition of the spine. This puts the vertebrae in an unhealthy position. By insuring that the foot, knees, and legs are in their proper position, it takes strain off the lower back.

Growing Pains

We believe that “growing pains” is a misnomer. It tends to be a term that physicians apply to foot or leg pain that cannot be explained.

A number of years ago, we tracked 142 kids that had been diagnosed with growing pains. On average these kids had experienced pain for 3 ½ years. Almost without exception as soon as we put the patient into a custom Orthotic, ensuring proper alignment, the pain went away.

We believe that most of the time the knee, low back, leg, heel, arch, Achilles, and night pain that wake them up at night, are related to poor alignment. By doing a good biomechanical exam to diagnosis the problem and getting these kids into a custom Orthotic they do really well.

If your child is experience “growing pains” please give us a call.

Achilles Tendonitis

The largest tendon in the lower extremity, the Achilles tendon is subjected to tremendous stress during even routine activity. Inflammation of this tendon can be quite painful. The most common location for tendonitis is the center of the tendon just above the heel bone. Pressure on the side of the tendon is painful and walking or running can be difficult. Morning stiffness is a common complaint. Early tendonitis doesn’t result in significant swelling or other visible changes. However, progression can result in structural changes including swelling as large as a golf ball. Ultimately, the tendon structure itself becomes infiltrated with degenerating tissue and routine activity becomes very uncomfortable.

All these symptoms are related to abnormal stresses on the tendon resulting from internal rotation of the leg, eversion of the calcaneus which causes bowing of the tendon and ultimately, torquing of the tendon. Aligning the foot with orthoses straightens the Achilles and usually improves activity tolerance within a short period of time. More advanced degeneration often requires more aggressive intervention including casting and rarely, surgery.

Ingrown Nails

Ingrown nails occur when the edge of the nail injures the adjacent skin. The skin becomes swollen, painful and oftentimes becomes infected. The cause can be difficult to determine. Shoe gear, poorly cut nails, excessive sweating/moisture and occasionally, injury, can lead to painful ingrown nails. Remedy can involve simple to significant interventions. Some painful nails resolve on their own. Epsom salt soaking, taping the sides of the toe back and lotion can sometimes resolve the early symptoms of an ingrown nail. Should the symptoms worsen, or should red streaking develop that is spreading up the toe or foot, you should contact your podiatrist. Prevention includes avoiding tight shoes and allowing your feet to “breathe” or dry out if they are exposed to prolonged moisture. Unfortunately, even with appropriate care and resolution, ingrown nails can return. In this case, your podiatrist will discuss permanent options to avoid the recurrence of the ingrown nail.

Neuroma

Neuromas are a very painful benign nerve tumor that as been caused by the nerve being damaged over a long period of time. These are most commonly found between the third and fourth toes. Pain is usually felt on the bottom of the foot and you can sometimes get numbness and tingling into the toes. Many times it is related to shoe wear.

If neuroma has been there a long time, the doctor can usually feel it on examination. Ultrasound can sometimes be a helpful diagnostic tool.

Neuromas usually respond to early treatment. If we see them within the first 6 months, most of the time conservative treatment works. If the symptoms have persisted for more than a year, then sometimes surgical intervention may be necessary. 

Bunions/Hammertoes

What is a bunion? This common foot condition affects millions of people and is widespread on any given sunny day. The difficulty with bunions is that they can significantly affect how an individual walks, runs, or even wears shoes. The change in shape of the foot actually results in pain for many people with this deformity. Pressure from shoe gear and internal stress on the great toe joint are the most common causes for discomfort. So… what is a bunion?

Bunions are the result of a shifting in the alignment of the bones in the front of the foot. Essentially, the bone that the big toe attaches to starts to move away from the rest of the foot. When this happens, the big toe moves toward the other toes, the arch drops, and the smaller toes begin to see more stress. As the bunion progresses, the change in position of the foot bones continues and the foot starts to absorb more energy during walking. This results in accumulative stress injuries that cause an inflammatory response and finally, pain.

Is my bunion worth treating? Yes! Fortunately, not every bunion requires surgery. We have great success with conservative measures improving a significant portion of our patients’ complaints. Controlling the mechanics of the foot can remarkably reduce symptoms and increase activity tolerance. Shoe selection and custom orthotics offer the best options for improved function and comfort without significant lifestyle changes.

Keratoma

Keratomas are a thickened, concentrated, hard, painful and deep callous usually under a bony prominence. This is caused by repeated abnormal pressure on the skin at the site of the prominence. Treament involves reducing the keratoma and then protecting the involved area. Most of the time these respond well to treatment and stay symptom-free for long periods of time. We have found that we rarely have to resort to surgical intervention.

Arthritis

Arthritis is a complex term with many hidden interpretations and meanings. For most people, arthritis means PAIN! While this is true, the insidious nature of arthritis belies the fact that it is a slowly progressive degeneration of a joint or joints. Eventually, this degeneration results in discomfort with the use of the affected joint/s. The body quickly adapts to protect the joint by altering the way that people use the joint. This may result in an evident limp, or another more subtle alteration in motion, such as walking on the outside of the foot. While this change might improve the symptoms at the painful joint, it often results in pain somewhere else! This is why we often say that “the most common cause of lateral foot pain is medial foot pain.”

Arthritis is generally classified as either inflammatory or degenerative. Inflammatory arthritis includes diagnoses such as Rheumatoid Arthritis, Gout, Reactive Arthritis, Reiter’s Syndrome, Ankylosing Spondylitis and Mixed Connective Tissue Disease among others. These illnesses are the result of the body’s immune system targeting its own tissue or some other internal derangement which results in joint inflammation, degeneration and pain among other things. This type of arthritis does respond to mechanical control, but will often also require the input of a Rheumatologist.

Most often, we see people with degenerative arthritis, which is also called osteoarthritis. This is the typical “wear and tear” arthritis that comes with overuse and age. Nearly all of us are subjected to this eventually. Some people struggle with only one joint while other people have difficulty with many joints. The cause is multifactorial and can include any combination of the following: injury, weak cartilage, overuse, poor alignment, or loose ligaments among other things. Treatment includes anti-inflammatories, ice, change in activity level, orthotics, shoes, steroid injections and surgery.

Ankle Sprain

Ankle sprains are some of the most common injuries that humans experience. Any emergency room or other primary care facility is very familiar with this injury. Fortunately, ankle sprains improve rapidly in most circumstances. However, it is not uncommon for people to experience nagging complaints months after an ankle sprain. The frequency of these long-standing pains after ankle sprain reflects the complex nature of the ankle and the many tissues that can be injured during a relatively benign “sprain.” We commonly encounter people months after a sprain that present with latent tendon, bone, ligament and joint problems that were the result of the initial injury. The ankle architecture is a close association of many different systems that may be subtly damaged with the forces involved in a sprain. Consequently, we do not consider ankle sprains to be trivial injuries. If you are experiencing difficulty with your foot or ankle longer than expected after an ankle injury, please call for an evaluation. There may be a good reason for your discomfort.

































© 2017, Stanley G. Newell, DPM, F.A.C.F.A.S.
Phone: 206-527-4177