Monday, January 18, 2016

Flexible Flatfoot in Children

Pediatric Orthopedics
Flexible flatfoot is a condition in which the arch of the foot shrinks or disappears upon standing. Upon sitting or when the child is on tiptoes, the arch reappears. Parents and other family members often worry needlessly that an abnormally low or absent arch is a child's foot will lead to permanent deformities or disabilities. Most children eventually outgrow flexible flatfoot without any problems. The condition usually is painless and does not interfere with walking or sports participation.

A flexible flatfoot has normal muscle function and good joint mobility and is considered to be a variation of normal. As the child grows and walks on it, the foot's soft tissues tighten, shaping its arch gradually. Flexible flatfoot often continues until the child is at least age 5 years or older. If flexible flatfoot continues into adolescence, the child may experience aching pain along the bottom of the foot. A doctor should be consulted if the child's flatfeet cause pain.


To make the diagnosis, the doctor will examine the child to rule out other types of flatfeet that may require treatment. These include flexible flatfoot with tight heel cord, or rigid flatfoot, which is a more serious condition.

The doctor will look for patterns of wear on the child's everyday shoes. Tell the doctor if anyone else in the family is flatfooted, as this may be an inherited condition. It is important to know about any known neurological or muscular disease in the child.

The doctor may ask the child to sit, stand, raise the toes while standing, and stand on tiptoe. He or she will probably examine the child's heel cord (Achilles tendon) for tightness and may check the bottom of the foot for calluses.
Nonsurgical treatment
Treatment for flexible flatfoot is required only if the child is experiencing symptoms of discomfort from the condition.

If the child has activity-related pain or tiredness in the foot/ankle or leg, the doctor may recommend stretching exercises for the heel cord.

If discomfort continues, the doctor may recommend shoe inserts. Soft-, firm-, and hard-molded arch supports may relieve the child's foot pain and fatigue in many cases. They can also extend the life of his or her shoes, which may otherwise wear unevenly. Sometimes a doctor may prescribe physical therapy or casting if your child has flexible flatfoot with tight heel cords.

Surgical treatment
Occasionally, surgical treatment will be necessary for an adolescent with persistent pain. A small number of flexible flatfeet become rigid instead of correcting with growth. These cases may need further medical evaluation.

Sunday, January 3, 2016

No Period, No Problem?

by Sarah Garwood MD
Adolescent Medicine

     While many teenage girls would gladly not experience a menstrual period each month, for pediatricians taking care of them, regular periods provide an important clue about the health and growth of adolescent girls.  For some athletes, intense training without adequate energy intake can lead to a well-known syndrome called the female athlete triad.  The classic triad includes disordered eating, lack of menstrual periods for at least 3 months, and low bone mineral density.  Teens with this syndrome are at risk of persistent eating disorders, stress fractures, and also long-term impacts on bone strength.

     Often the triad starts with a young woman trying to become fit for her sport.  The risk for developing this syndrome is higher in endurance and aesthetic sports such as running, gymnastics, swimming, diving, figure skating, and dancing.  In many athletes, decreased food intake is unintentional.  Appetite suppression is often a result of intense exercise and decreased caloric intake because of time constraints is common in adolescents.  Some teens may also engage in over-exercising to “get rid” of perceived excess caloric intake.  In either case, the common issue of not fueling with adequate calories leads to a negative energy balance.  When this energy imbalance occurs, the hormones from the hypothalamus that regulate menses are disrupted and infrequent/irregular or absent periods result.   Estrogen levels are affected, and this is critical because of estrogen’s affect on bones.  Estrogen both stimulates bone formation and protects the skeleton from bone resorption.  When there is not enough estrogen to allow for normal menses, there is not enough estrogen to stimulate normal increases in bone mineral density.  During young adulthood women are forming most of their bone mass, making lack of periods during this window of growth especially harmful.  Eventually stress fractures may result.

       Early recognition and intervention are key so ask your pediatrician if you have concerns.  For all you female athletes out there…be glad for the (menstrual) pad!