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Innovative Solutions for Your Health Care Business Akron n Cleveland n Lorain County n www.brouse.com Collective Experience. Collaborative Culture. Creative Solutions. With a keen understanding of the operations, market trends and economics of the health care industry, Brouse is poised to proactively counsel and advise a wide array of health care clients, including: ■ n Multi - & Single - Physician Groups ■ n Hospitals & Health Systems ■ n Ancillary Service Providers ■ n Long Term Care Facilities ■ n Home Health Care Providers ■ n Medical Device Companies ■ n Mental Health Service Providers ■ n Durable Medical Equipment & Supply Companies For more information, please contact: Daniel K. Glessner, Esq., Practice Chair 330.535.5711 x316 dglessner@brouse.com Christopher M. Huryn, Esq., Partner 330.535.5711 x389 churyn@brouse.com J. Ryan Williams, Esq., Partner 216.830.6830 x592 rwilliams@brouse.com T HE FOOT WITH sustained peri-talar pronation in a skeletally immature patient, aka the pediatric flatfoot, typically presents to a medical office as one of three variations. The first variation is the most common. It is the flexible and minimally symptomatic deformity which may be managed with an appropriate arch support or orthotic but often does not need treatment. The other two variations are considered pathologic, are typically more painful and more resistant to external support, and often require surgical intervention. The Severe Flexible Deformity This deformity retains hindfoot and peri-talar motion but involves such a severe collapse of structure that medial arch strain, lower leg fatigue, and lateral hindfoot impingement are often inevitable. More often than not surgical reconstruction via joint-preserving calcaneal and medial arch osteotomies is enough to correct this deformity in a sustainable manner. The Rigid Flatfoot Deformity Talocalcaneal and calcaneonavicular coalitions (bony or fibrous bridges) are congenital occurrences in the foot that leave the hindfoot in a more rigid, pronated position. These deformities are often very painful with normal gait. The typical age for onset of symptoms correlates with mature ossification at the different coalition sites (approximately 8–16 years of age) 1 . Surgical management with either a simple coalition resection in younger patients or a more complex reconstructive procedure of the hindfoot in older patients is necessary for pain reduction in most pediatric patients with this type of flatfoot. Dr. Jeffrey Whitaker is board certified by the American Board of Foot and Ankle Surger y and a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor, Division of Podiatric Surgery, at Kent State University College of Podiatric Medicine, in Independence, OH. Reference 1. Kumai T, Takakura Y, Akiyama K, Higashiyama I, Tamai S. Histopathological study of nonosseous tarsal coalition. Foot Ankle Int. 1998. 19(8): 525-531. ■ Managing the Pediatric Flatfoot: By Jeffrey M. Whitaker, DPM, FACFAS Current Perspectives +++++++++++++++++++++++++++++++++++ +++ + +++ + +++++++++++++++++++++++++++++++++++ ❮ SPECIAL SECTION: PEDIATRICS