Arch supports, surgery are options for flat feet

MEDICAL MATTERS

September 02, 2005|By JUDY FOREMAN

Is there anything that can be done for flat feet?

Yes, there are lots of options, from simple arch supports to custom-made orthotic devices to foot reconstruction surgery -- decidedly a last resort.

Flat feet are normal in kids under 3. Those chubby little feet simply haven't had time to develop fully, so kids have fat where adults have arches. Not until adolescence -- or earlier if a child chronically complains of tired or achy feet -- it is a good idea to consult a doctor about flat feet.

If you're an adult, flat feet may need medical attention if they cause pain and fatigue or if the feet tip so far inward that you feel strain and pain up through the knee, hip or back.

In severe cases, this condition, also called fallen arches, can lead to feet "as flat as a pancake," said Dr. Lloyd Smith, a podiatrist in Newton, Mass., and immediate past president of the American Podiatric Medical Association.

In adults with painful flat feet, what sometimes happens is that the tendon that runs down the inside of the ankle to the arch "becomes inflamed, weakened and in some cases, becomes incompetent," said Dr. Kris Di Nucci, an Omaha, Neb., ankle surgeon and spokesman for the American College of Foot and Ankle Surgeons.

To reduce inflammation in the arch tendon, nonsteroidal anti-inflammatory drugs such as ibuprofen can help, said Dr. Michael Lee, a foot and ankle surgeon in Des Moines, Iowa, leader of a team that wrote flat foot guidelines for the foot and ankle surgeons' group.

If arch supports, orthotic devices (which cost $200 to $500) and exercises don't work, you can try surgery, but it may involve moving bones and inserting a plastic screw -- not a trivial undertaking.

Is there such a thing as a safe trampoline for kids?

No, at least not those designed for home use -- neither the big ones for backyards nor the little ones put indoors.

The only safe way to use a trampoline is in an athletic facility with the jumper hooked into a harness that a certified athletic trainer can yank upward if the athlete is about to fall, and with spotters scattered around the edge to push the jumper back toward the center if he or she is about to fly off the device entirely.

A study published in July in the journal Pediatrics found that both full-size and "mini" trampolines are dangerous, especially for kids under 6. That's partly because little kids are top heavy, which means that when they fall, they tend to land on their heads and cut them, said Brenda Shields, the lead author and research coordinator at the Center for Injury Research and Policy at Columbus Children's Hospital in Ohio.

When older people fall, they're more likely to injure (and break) their legs.

Using data from the National Electronic Surveillance System, run by the Consumer Product Safety Commission, Shields' team studied trampoline injuries reported between 1990 and 2002.

There were many more injuries on big "tramps," but both are dangerous, she said. On big trampolines, having multiple users at the same time is a major hazard, she noted, as is placing the trampoline near fences, trees, electric wires and hard ground surfaces.

With little trampolines, tipping over adds to the danger from falling.

The American Academy of Pediatrics recommends that trampolines never be used in the "home environment," in routine physical education classes or outdoor playgrounds.

"Trampolines are not safe for kids. Don't use them," advised Kristi Kangas, head of the Injury Prevention Program at Children's Hospital in Boston.

Send your questions to fore man@baltsun.com.

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