MY CHILD HAS FLAT FEET ..... TO TREAT OR NOT TO TREAT??

MY CHILD HAS FLAT FEET....TO TREAT OR NOT TO TREAT??

Much controversy exists among medical specialists and parents of children with "flat feet." As there is much debate in the medical literature whether treatment of children with a non-painful, but an obvious and visible flatfoot deformity can prove beneficial.
A normal foot can be described as one having an arch, which is that space between the big toe and the heel on the inside of both feet. This area should be elevated off of the ground while standing, and shaped like a cave or arch. There should be enough space there that you could slide a couple of fingers underneath of your foot, as if your fingers are entering the 'cave.' This gentle curvature of the arch is also visible while the foot is off of the ground/not standing or walking. Those individuals with flatfeet are missing that cave or arch, and this side of the foot touches the ground, sometimes so incredibly flat that the foot actually makes a suction-type sound with every step! In extreme cases, the arch is so collapsed that one may walk on the inside of the ankle!
Depending on the severity of the flatfeet, there are many treatment options. Options include, in specific cases, serial casting (a series of casts applied over time to babies in hopes of correcting the deformity), over-the-counter arch supports or custom orthotics, and surgical reconstruction in the most painful & deformed cases.
A common misunderstanding is that All flatfeet should be treated with arch supports or custom orthotics. This is false. The most import consideration is age of the patient. Many parents present to the pediatrician or podiatric surgeon requesting orthotics for their child's flatfeet. Newsflash! Childrens' feet appear flat until the age of 4 or 6! Prior to, the arch is not fully developed, and often masked by "baby fat.'' It is not uncommon for parents to begin noticing and become concerned about the flattened appearance of the feet during this time. Parents being parents, present their complaint, and oftentimes their children are prescribed orthotics without a flatfoot deformity at all. We end up 'treating the parents,' when orthotics were not necessary to begin with, disrupting the natural growth of the soft tissues and bones in the child's foot, which could prove detrimental in the future.
Next we enter children after age 6, when the arch begins to appear. During this age, usually, either the children are complaining of pain in the arches during and/or after play, OR, parents notice the flattened appearance of the foot. Over the counter inserts or custom orthotics would of course be indicated in the children complaining of pain. And in the most extreme cases, surgery. But what about those without pain, but with obvious flatfeet?? This is where it becomes tricky. An important question to ask is "Does mom or dad, brothers or sisters, grandmother or grandfather have flatfeet? Any were these flatfeet problematic?" Flatfeet are hereditary. If there is a relative with symptomatic flatfeet, then the likelihood of the child developing symptomatic flatfeet is increased. However, that is Not Always the case. There is some medical literature that supports custom orthotics to stop the progression of flatfeet in children. It is certainly worth a try!
Some children have SEVERELY painful flatfoot deformities that require surgical reconstruction for pain-relief. These cases are few and far in between, but do exist in every podiatry practice.
In summary, some of the most famous professional athletes have flatfeet. Some of them are painful, others are not. Some need treatment, others do not. The decision is purely individual in each case. The answer cannot be found in any medical journal, informational blog or reading material. If there is a concern, the child needs to be examined.
To have your child examined for the severity of their flatfeet, email Dr. Malinoski via her website at www.podiatristofnaples.com

GOUT IN MY FOOT/TOE!!!!???

GOUT IN MY BIG TOE....???

Everyone has heard of the term GOUT.  But not many individuals are familiar with what Gout truly is, unless they've experienced gout's agonizing pain personally, or watched a loved-one temporarily suffer the symptoms.

Gout is a disorder of metabolism.  It all starts with something called Purines.  Purines are found in the foods that we eat.  Purine-rich foods include such indulgences like alcohol, particularly beer, meats, seafood, and certain vegetables and legumes.  These purines are naturally broken down via metabolism in the human body, into a product called Uric Acid.  The Uric Acid is excreted through our kidneys. The breakdown of purines into uric acid is a natural process in human metabolism.  BUT, when our body has difficulty excreting the uric acid, That is exactly when gout flare-ups begin.  This excess of uric acid builds up into certain joints of the body, and in the foot, the most common location is in the big toe joint.

Why does the body have difficulty excreting the uric acid??  Most frequently, after ingestion of these protein-rich foods, the body cannot keep up with excreting the extra uric acid, and these uric acid levels build up.  Sometimes, there is a defect in one's metabolism where the individual is missing a certain enzyme that breaks the purines down into uric acid, resulting in excessive uric acid build-up with nowhere to go!

This abundance of uric acid likes to live in certain locations in the human skeleton, like knees, elbows, ears, and in the big toes!  Once settled into their favorite location, the area becomes extremely red, swollen, and painful!  So painful that a common description of pain is "so uncomfortable that a bedsheet touching my toe is excruciating!!"

Again, the initial presentation of gout in the big toe presents as a red, hot, and swollen toe/joint that is significantly painful.  Xrays are usually taken in the office, but it takes approximately 10 years for xrays to show xray signs.  So remember that they xrays probably won't show anything at all, but soft tissue swelling. 

Gout is a diagnosis based on your doctors clinical suspicion.  In other words, we suspect gout when the patient presents with the red, hot, swollen joint,  has a history of gout, has eaten purine-rich foods recently, and sometimes when they've bumped or stubbed the toe.  ( That's right, sometimes trauma can precipitate a gout attack!). 

What treatment should you expect if you present to your foot doctor with gout?  Simply stated.....xrays, possibly a cortisone injection into the joint to break up inflammation and pain, an oral medication specifically prescribed for acute gout, and labwork to review your uric acid levels.   That's it!  Usually, the symptoms are improved in a day or two, and resolved in 5-7 days.  Sometimes patients are prescribed gout medications to take daily for life to protect you from future gout flare-ups. 

What can you do to protect yourself from another painful gout flare-up?  First and foremost...diet control!  Limit those purine-rich foods mentioned above!  Gout is nicknamed "The Rich Man's Disease."  Why??  Because those purine-rich foods like meat and seafood are expensive!  Secondly, take your gout medication daily to prevent a new flare-up.

Although gout has a predilection for certain populations, it can affect anyone.  We are seeing patients with symptomatic gout in surprisingly young ages recently.

For more information about Gout and any other lower extremity question or problem, email Dr. Malinoski via her website at www.podiatristofnaples.com