April 2025
Foot Surgery
In most cases, foot surgery is often chosen as the last available option for conditions that have otherwise been unsuccessfully treated. Surgery may be necessary for several reasons, including the removal of foot deformities (e.g. bone spurs or bunions), arthritis problems, reconstruction due to injury, and congenital malformations (e.g. club foot or flat feet). Regardless of one’s age, foot surgery may be the only successful option for treatment for certain conditions.
The type of surgery one undergoes depends on the type of foot condition the patient has. For the removal of a bunion growth, a bunionectomy is necessary. If the bones in the feet need to be realigned or fused together, a surgical fusion of the foot is needed. For pain or nerve issues, a patient may require surgery in which the tissues surrounding the painful nerve are removed. Initially, less invasive treatments are generally attempted; surgery is often the last measure taken if other treatments are unsuccessful.
While in many cases surgery is often deemed as the final resort, choosing surgery comes with certain benefits. The associated pain experienced in relation to the particular condition is often relieved with surgery, allowing patients to quickly resume daily activities. The greatest benefit, however, is that surgery generally eliminates the problem immediately.
Podiatry history has shown that foot treatments continue to evolve over time. In the field of foot surgery, endoscopic surgery is just one of the many advanced forms of surgery. As technology vastly improves so too will the various techniques in foot surgery, which already require smaller and smaller incisions with the use of better and more efficient tools. Thanks to such innovations, surgery is no longer as invasive as it was in the past, allowing for faster and easier recoveries.
Bunions and Recovery After Surgery

A bunion is a bony bump that forms at the base of the big toe as the top of toe to angles inward toward the other smaller toes. This deformity often results from inherited foot structure, wearing improper footwear, or medical conditions like arthritis. Over time, bunions can lead to pain, swelling, and difficulty walking. When conservative treatments fail to relieve symptoms, bunion surgery may be recommended to correct the alignment and relieve discomfort. Recovery from bunion surgery involves rest, elevation, and wearing a special shoe to protect the foot during healing. Swelling may last for several weeks, and, with proper care, most individuals can return to normal activities. If you have a bunion that is causing you pain, it is suggested that you confer with a podiatrist who can determine if this type of foot surgery is right for you.
Foot surgery is sometimes necessary to treat a foot ailment. To learn more, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor will assist you with all of your foot and ankle needs.
When Is Surgery Necessary?
Foot and ankle surgery is generally reserved for cases in which less invasive, conservative procedures have failed to alleviate the problem. Some of the cases in which surgery may be necessary include:
- Removing foot deformities like bunions and bone spurs
- Severe arthritis that has caused bone issues
- Cosmetic reconstruction
What Types of Surgery Are There?
The type of surgery you receive will depend on the nature of the problem you have. Some of the possible surgeries include:
- Bunionectomy for painful bunions
- Surgical fusion for realignment of bones
- Neuropathy decompression surgery to treat nerve damage
Benefits of Surgery
Although surgery is usually a last resort, it can provide more complete pain relief compared to non-surgical methods and may allow you to finally resume full activity.
Surgical techniques have also become increasingly sophisticated. Techniques like endoscopic surgery allow for smaller incisions and faster recovery times.
If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Geriatrics and Podiatry
Bone density loss, dry skin, poor circulation, and rough and brittle nails are some of the common problems that can occur as people age. The effect that these problems has on foot health should be of particular concern in comprehensive geriatric care.
Feet that are diseased or injured have a negative effect on overall health and safety. Painful feet limit a person’s willingness and ability to stay active. Poor foot health can also cause gait change, which can lead to falls and accidents. Even though recovery time from health problems naturally slows as we age, many foot problems can be avoided altogether with regular prophylactic care.
Feet should be thoroughly washed in warm water daily. Care must be taken to dry the feet well, making sure to dry between and under the toes. Any left-over moisture can cause problems like foot fungus. After cleaning feet carefully check for problems such as cracked skin, bruises, swelling, cuts, corns, or other irregularities.
Examine toenails for ingrown, jagged, or split nails. Long toenails should be cut straight across. Never cut toenails at an angle or down the side as this may lead to ingrown nails.
Cracked and dry feet should be treated once or twice a day with a non-greasy moisturizer. Rub the moisturizer into the skin and allow it to dry before putting on socks and shoes. Sweaty feet can be dusted with a small amount of talcum powder. Avoid putting talcum directly into shoes as this may make feet slip within the shoe and cause a serious fall.
Wear clean dry socks each day. Not only do clean socks feel better on the feet, but socks worn for longer periods may harbor disease and odor-causing bacteria. Socks should not be tight around the top as they can leave marks on the leg. Socks that are too small can bring about bruising caused by pressure against the toes.
Wear comfortable and well-fitting shoes. If possible, consult a professional footwear specialist when purchasing shoes. Do not walk around barefoot as this exposes the feet to possible injury and bacteria.
Good foot health allows a more active lifestyle, which improves blood flow. Good circulation aids in recovery from injury or illness. It is also important for maintaining overall health.
Serious health problems can manifest themselves as symptoms in the feet. The elderly should seek professional help from a podiatrist if experiencing foot problems like tingling, numbness, pain, infection, or a sore that does not heal. Taking care of these problems right away can prevent the development of severe cases.
Sources of Foot Pain Related to Aging

Foot pain is a common complaint as people age, often resulting from years of wear and tear on the feet, toes, and ankles. Age-related foot issues include bunions, stress fractures, osteoarthritis, plantar fasciitis, and collapsed arches. These conditions can arise as the soft tissues lose elasticity, bones weaken, and joint cartilage wears down. Women are especially prone to developing foot problems due to factors such as hormonal changes and a higher likelihood of bone density loss later in life. In addition, high heels, often worn for many years, can increase pressure on the front of the foot and contribute to deformities and pain. A podiatrist can diagnose the source of your foot pain and recommend medical treatment, including custom orthotic devices, bracing, or injections to reduce inflammation and relieve pressure. In some cases, surgery may be necessary to correct deformities or repair damaged tissues. If you have foot problems related to aging, it is suggested that you schedule an appointment with a podiatrist for appropriate treatment.
If you need your feet checked, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor will attend to all of your foot and ankle needs and provide you with quality treatment.
Geriatrics and Podiatry
When people age, some common issues that may occur are bone density loss, dry skin, poor circulation, and rough brittle nails. These issues may also affect your foot health if the necessary steps are not taken to alleviate the problems.
It is important to take care of your feet because feet that are injured or diseased can affect your overall health. Having painful feet hinders your ability to do daily activities or may decrease your willingness to do the things that you need to do.
Visiting Your Geriatrician
As we age, health problems become more likely, so it is essential to visit your doctor for check-ups to ensure that you are doing the best you can to take care of your health. It is recommended to check your feet frequently for any possible cuts, bruises, swelling, corns or any other irregularities.
Taking Care of Elderly Feet
Cracked or dry feet can be treated by applying moisturizer often. It is also important not to wear old socks because the older the sock is, the higher the possibility there will be that there is bacteria there. Wear fresh socks and make sure they fit properly.
Proper foot health means that you can have a more active lifestyle and you will not be bogged down by pain. Foot health also leads to good circulation, which is paramount for overall health.
If you have any questions, please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic tools and technology to treat your foot and ankle needs.
Flat Feet
Flatfoot is a foot condition in which the arch of the foot has either partially or totally dropped or has never developed. While it is common in babies and small children, it can become a problem for them in adulthood if the arch never forms. For adults, the development of flat feet can be brought upon by injury, as a result of pregnancy due to increased elasticity, or obesity. Those who have health concerns such as rheumatoid arthritis or diabetes may also be at greater risk for developing the condition.
If you suspect that you have flat feet, it is best to consult your podiatrist. Your foot doctor will examine the suspected foot and observe how it looks while you sit and stand. He or she may take an X-ray to determine how serious the condition is. Some common signs of flatfoot include toe drift, in which the toes and front part of the foot point outward, a short Achilles tendon, and a heel that tilts outwardly while the ankle tilts inward.
Once flatfoot has been diagnosed, your podiatrist may suggest one of several treatment options. Flat feet can be rigid, in which the feet appear to have no arch even when the person is not standing; or flexible, in which the person appears to have an arch while not standing, but once standing the arch disappears. Those with flexible flatfoot may be told to reduce any activities that cause pain and to avoid extended periods of walking or standing. Another suggestion may be weight loss, as excessive weight may be placing pressure on the arches
In few cases, if the condition is severe and all other methods have been exhausted surgery may be required. This is normally avoided, however, due to a lengthy recovery time and high cost.
Causes and Symptoms of Flat Feet in Children

Flat feet in children occur when the arches do not develop properly, leading to the entire sole making contact with the ground. Causes vary and may include hereditary factors, muscle imbalances, or joint flexibility issues. Low muscle tone can prevent proper arch formation, while high muscle tone may cause stiffness and discomfort. Hypermobile joints allow excessive movement, making it difficult for the arch to maintain structure. Obesity places added pressure on the feet, contributing to flattening over time. Symptoms include foot pain, fatigue, difficulty walking long distances, and inward rolling of the ankles. Some children may also experience balance issues or discomfort when standing for extended periods. If your child has symptoms of flat feet, it is suggested that you contact a podiatrist who can offer treatment and relief management tips.
Flatfoot is a condition many people suffer from. If you have flat feet, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor will treat your foot and ankle needs.
What Are Flat Feet?
Flatfoot is a condition in which the arch of the foot is depressed and the sole of the foot is almost completely in contact with the ground. About 20-30% of the population generally has flat feet because their arches never formed during growth.
Conditions & Problems:
Having flat feet makes it difficult to run or walk because of the stress placed on the ankles.
Alignment – The general alignment of your legs can be disrupted, because the ankles move inward which can cause major discomfort.
Knees – If you have complications with your knees, flat feet can be a contributor to arthritis in that area.
Symptoms
- Pain around the heel or arch area
- Trouble standing on the tip toe
- Swelling around the inside of the ankle
- Flat look to one or both feet
- Having your shoes feel uneven when worn
Treatment
If you are experiencing pain and stress on the foot you may weaken the posterior tibial tendon, which runs around the inside of the ankle.
If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Wound Care
Diabetics must be wary of all wounds, regardless of depth or size. Diabetes, a chronic disease in which the body cannot properly use glucose the way it normally would, causes various complications that make wounds difficult to heal. Nerve damage or neuropathy will cause diabetics to have trouble feeling the pain of a blister or cut until the condition has significantly worsened or become infected. A diabetic’s weakened immune system can make even the most minor of wounds easily susceptible to infection. Diabetics are also more prone to developing narrow, clogged arteries, and are therefore more likely to develop wounds.
Wounds should be taken care of immediately after discovery, as even the smallest of wounds can become infected if enough bacteria build up within the wound. To remove dirt, wounds should be first rinsed under running water only. Soap, hydrogen peroxide, or iodine can irritate the injury and should be avoided. To prevent infection, apply antibiotic ointment to the wound and cover it with a bandage. The bandage should be changed daily. The skin around the wound may be cleaned with soap.
To prevent further exacerbation, see a doctor—especially if you have diabetes. Minor skin conditions can become larger problems if not properly inspected. As the wound heals, make sure to avoid applying pressure to the affected area.
Debridement of Foot Wounds and Ulcers

Debridement is the process of removing dead or infected tissue from foot wounds or ulcers to help the body restart the healing process. When unhealthy tissue is present, it can delay healing and increase the risk of infection. By clearing out this tissue, debridement encourages the growth of healthy skin, reduces the chance of complications, and may minimize long-term scarring. There are several types of debridement, including enzymatic, autolytic, mechanical, and sharp methods. The method chosen often depends on the severity and condition of the wound, as well as a patient’s overall health. In some cases, surgery may be required, particularly for deep or severely infected wounds that do not respond to conservative options. A podiatrist can evaluate the wound and determine the most effective way to promote healing. Podiatrists are trained to manage foot, toe, and ankle wounds safely and effectively, and they provide continued monitoring throughout recovery to help prevent further issues. If you have foot wounds or ulcers that are not healing properly, it is suggested that you schedule an appointment with a podiatrist for an exam and ongoing wound care.
Wound care is an important part in dealing with diabetes. If you have diabetes and a foot wound or would like more information about wound care for diabetics, consult with John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor will assess your condition and provide you with quality foot and ankle treatment.
What Is Wound Care?
Wound care is the practice of taking proper care of a wound. This can range from the smallest to the largest of wounds. While everyone can benefit from proper wound care, it is much more important for diabetics. Diabetics often suffer from poor blood circulation which causes wounds to heal much slower than they would in a non-diabetic.
What Is the Importance of Wound Care?
While it may not seem apparent with small ulcers on the foot, for diabetics, any size ulcer can become infected. Diabetics often also suffer from neuropathy, or nerve loss. This means they might not even feel when they have an ulcer on their foot. If the wound becomes severely infected, amputation may be necessary. Therefore, it is of the upmost importance to properly care for any and all foot wounds.
How to Care for Wounds
The best way to care for foot wounds is to prevent them. For diabetics, this means daily inspections of the feet for any signs of abnormalities or ulcers. It is also recommended to see a podiatrist several times a year for a foot inspection. If you do have an ulcer, run the wound under water to clear dirt from the wound; then apply antibiotic ointment to the wound and cover with a bandage. Bandages should be changed daily and keeping pressure off the wound is smart. It is advised to see a podiatrist, who can keep an eye on it.
If you have any questions, please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot care needs.
Heel Pain Can Be Treated!
Ingrown Toenail Care
An ingrown toenail is a toenail that grows sideways into the nail bed, causing pain and swelling. Ingrown toenails can worsen and cause drainage, turning into a serious infection.
Several factors affect whether a person is at risk from an ingrown toenail. The many causes include being overweight, diabetes, participating in sports, having a fungal infection of the toe, and cutting your nails too short. Ingrown toenails also have a genetic predisposition, causing some people to be more prone to receive the condition than others. Other causes include improperly fitting shoes and shoes that keep the feet damp.
Ingrown toenails can be preventable with certain measures. For starters, allowing your toe nails to grow slightly longer in length will help prevent them from becoming ingrown. If you have already developed an ingrown toenail, soak the affected toe in warm water. This will alleviate the pain and help prevent an infection from forming. Antibiotic soap or Epsom salts may be added to further help the relieving process and avoid infection. Placing cotton beneath the affected area is also suggested, as this may help the toenail grow upwards and not into the nail bed. Swelling and redness can be reduced by resting with your feet elevated.
A podiatrist should be seen if the pain becomes so serious that it prevents you from doing your everyday activities. If a red streak running up your leg appears or if you suspect your infection has spread, contact a podiatrist immediately. Fast treatments can be undertaken to lessen your pain and have you walking comfortably.
An ingrown toenail can be easily treated with a Band-Aid. Simply wrap the affected toe with a Band-Aid to prevent infection and keep the nail from growing out at a painful angle.
In more serious cases, your podiatrist may decide to make a small incision to remove a portion of your toenail. To prevent the nail from growing back, medication will be placed directly into the nail bed. This procedure would be performed under local anesthesia and is a faster method to alleviate discomfort from an ingrown toenail. Post-procedure directions will have you stay off the affected foot for a day. Afterwards, normal activities can be resumed.