Orthopedic Procedures Help With Flat Feet

By Ron Hollowell

It’s not unusual for children to decide against pursuing an extracurricular activity at school because the additional hours they must devote to the activity may cramp their style.

If your child is avoiding activities because of constant fatigue and cramping in their legs, then it’s time to pursue an orthopedic surgeon who can properly diagnose and correct the problem.

Fatigue and cramping in the legs are usually symptomatic of a child with flat feet. Flat feet and in-toeing are two of the most common children’s foot problems. Children who have flat feet generally show signs of the problem between the ages of 3 and 4, said Dr. Atta J. Asef, a podiatric surgeon with Sole Perfection Cosmetic Foot Surgery in Willoughby. Children may outgrow the condition, but those who do not must be evaluated and have the problem corrected by a podiatric surgeon.

“A flatfoot condition should not be taken lightly,” Dr. Asef said. “Eventually, a child with this condition will develop knee and back problems as well. About 70 percent of adults who have a knee surgically repaired had some type of flat foot problem as a child.”

Most children with flatfoot have no symptoms, but some children have one or more symptoms, according to the American College of Foot and Ankle Surgeons. When symptoms occur, they vary according to the type of flat foot.

A child with a flat foot condition has toes that point outward. When the child stands straight, a dropped arch can be detected and there is a lumpy appearance to the inside of the foot. As a child grows, their bones get larger, yet the condition of the feet does not change. Dr. Asef said the medical community places little emphasis on the importance of having children properly examined for foot disorders.

“We take our children to the dentist twice a year and to the eye doctor for a yearly exam,” Dr. Asef said. “But no one is telling parents to have their child’s feet examined yearly, or in some cases semiannually.”

A typical examination with a podiatrist includes a basic study of how a child walks. While watching the child walk, Dr. Asef looks to see if the child has a dropped arch or lumpiness on the inside of their foot. The problem of flat feet generally can be corrected with custom-made orthotics. If a child’s condition does not respond to orthotics, then he or she may be a candidate for flatfoot reconstructive surgery.

Flatfoot reconstruction consists of raising and realigning the foot to the lower leg. The realignment process is accomplished by means of fusing bones in the foot through triple arthrodesis, isolated fusion, or by placing an implant in the subtalar joint.

“A majority of the children who have flat feet, I’d say 95 percent of them, do not need any form of reconstructive surgery,” Dr. Asef said. “These children seem to do well with the implant that we put into the subtalar joint in the foot.”

The implant holds together the major joint in the foot so the foot can remain in one position. As the foot grows, the muscle tissue and bone grows into the correct position of the foot. Children who have flatfoot reconstruction require custom-molded orthotics that they must wear for the rest of their life.

“Flatfoot reconstruction is classified as either flexible or rigid,” Dr. Asef explained. “There are several flatfoot procedures available to pediatric patients The flexible form is more commonly seen in pediatric patients while the rigid form is seen in the adult population.” The surgical option for a subtalar joint implant is a small soft-threaded titanium device that is inserted into an opening called the sinus tarsi. The placement of the implant restores the arch by preventing the displacement of the talus and by preventing the foot from rolling in. Tissue grows normally around the implant and helps to hold the implant in place. The outcome of the procedure is proper anatomical alignment of both extremities and reduction of muscle fatigue and weakness. After the surgery has been performed, children are much more able to pursue extracurricular activities because they no longer have the fatigue and cramped feeling that they experienced before surgery.

So if extracurricular activities literally cramp your child’s style, procedures are available to help them to get a leg – or a foot -- up on the competition.

Dr. Asef has been in private practice since 1998. He is Board Certified in Podiatric Surgery and is a member of the American College of Foot and Ankle Surgeons and a diplomat of the American Board of Podiatric Surgery. Dr. Asef's specialties are podiatric surgery, trauma and foot and ankle cosmetic and reconstruction surgery.