Typical or Atypical Flatfoot in Children?

Photo by Kimber Hansen Photography

A common foot concern among parents is whether or not their child has flat feet and if it is an indication that the child will have problems further on down the road. Are there things that they can do as parents that can decrease the chance that their child will be unable to participate in sports and someday, maybe someday, become a collegiate or professional athlete if they want? I know I envision my kids running along side of me on various adventures someday in the future and the thought of my child growing up developing a deformity that  prevents this from happening scares me to death! (I am trying to empathize with you, but seriously I think about this).  Here is the low down on flatfoot deformity in children.



Flatfoot is common in children.

A child's structural support begins as cartilage, which is flexible and soft. This is true also in the foot. The midfoot, or the area above the arch, is one of the last areas of the foot to ossify, or convert to bone. Because of this it isn't uncommon for children to have less structure to their feet when they are young. This is often normal. A child's foot doesn't completely convert to bone until around the age of 7 yrs. That being said there are still times when concern is warranted.

There are times when it is wise to seek a professional's opinion on the matter.

• Pain. If the child is having pain that is preventing them from being a kid then they should be evaluated. .
• Difficulty walking and running. If your child is falling a lot more than others, walks with a limp, favors one leg over the other or is more apprehensive about getting up and running around than normal, the problem could be their feet.  
• Noticeable deformity. If things just don't look right when you compare the shape of your child's feet to other kids then an evaluation is advised. 

I know....these guidelines are so broad and gray. Many conservative parents want to get their child checked just in case. If you are on the fence about seeking medical attention a few more things that could put your child at risk for greater problems include obesity, family history of painful flat feet, history of trauma or sex (males are more at risk). If your child is on the low end of the scale you may consider just monitoring the situation because many times they will resolve on their own. If your child is presenting with one or all of the above symptoms a visit to a podiatrist should be considered to obtain treatment and rule out more serious problems such as Cerebral Palsy, Muscular Dystrophy, Skewfoot and Juvenile Idiopathic Arthritis.

Treatment is usually simple.

Often times simply just wearing supportive shoes or getting a kiddie-thotic(supportive insert) can reduce pain and discomfort and get them back into action. If a more serious condition is discovered then surgical intervention may be considered but this is not common.

There is no clinical proof that orthotics worn as a child prevent flatfoot in adults. 

I am not saying that wearing orthotics as a child won't prevent flatfoot, because it might, but it also might cause other deformities(probably not, but possible). There just isn't conclusive evidence currently that shows much benefit to a child unnecessarily wearing orthotics or supportive shoes. My best advice is to just let kids be kids. I personally plan on letting my kids spend the majority of their time barefoot and if they have pain then I will consider intervening. While I am not totally on the naturalist bandwagon (because there are a lot of illogical things that happen under the "Natural" banner), I do see some wisdom in allowing feet to function the way they evolved to (this statement is in no way endorsing barefoot running off the couch BTW). Also, remember the risk factors that I pointed out earlier. If your child is at increased risk then more frequent use of supportive shoe gear and possibly orthotics can be considered.

Maybe I would put my kid in these....baby climbing shoes!!!

Matthes Crest: Alternate Perspective

I was pleasantly surprised to see that Sebastion, a German guy from Berkley that we met climbing on Matthes Crest a few weeks ago, sent me some shots that he got of me and Binh. We had agreed to swap shots. It is always cool to see yourself from a distance, especially on an awesome spine like this. Enjoy!

Morning with The Devil

Photo credit Wikipedia

My Utah buddies would scoff at this mountain, but Mount Diablo is the high point of the Bay Area, coming in at 3,864ft. The mountain is a challenge for hikers, road bikers, mountain bikers and runners to name a few. For 10 bucks there is a paved road all the way to the top for those wanting to drive and just going for the views. I met up with Richard Byler, a fellow podiatry student, to run it.

We started running around 7:55am at the Summit Trail TH outside of the pay gate. The sky was a bit overcast but after a few miles we were in the sun. It was a beautiful morning and a great run. The majority of the route was trail but we ended up putting down few miles of road. This is it for Bay Area elevation training.

Power walkin' above the clouds.

Summit.

Run statistics:
C2C time: 2:27 (7min rest on summit).
Elevation gain: 3446 ft
Distance: 13.0 miles

Matthes Crest

I have been living in Oakland for 3 yrs and just now made only my second climbing trip to Yosemite. Not something that I am proud of saying. Anyways, I pulled a single day trip with Binh Ta, fellow podiatry student, up to the Tuolumne Meadows area in Yosemite to climb a crazy cool long knife edge ridge called Matthes Crest. The ridge goes at 5.7 but the majority of it is 4th class. The views of the feature and the surrounding landscape was fantastic!

We left the Bay Area around 8:30pm and slept on the ground just outside of the park. We hit the trail for the approx 5 mile hike in around 7:30am and were at the base of the climb by 10:30.

Hiking in we pass Cathedral Peak, seen in the background.

The climb was PACKED! As I approached the South end, where we were going to start, I could hear and see many parties already up on the ridge and at the base of the first section there were at least 5 different parties either waiting or working their way up the face. We even had the privilege of celebrating one guy's birthday by eating some of his birthday cake that one of his friends hauled up for him. Everyone was just happy to be where they were.

Some of the parties as the base of the south ridge start. We by passed some of them by starting to the left, out of view. The birthday boy is in blue.  

I lead the first pitch. We took a variation of the normal start to by pass the crowds. It was a wandering crack up a semi-vertical face. We almost made it to the ridge but had to set up belay behind a group in front of us.

Top of pitch one. One of the only two pitches that should really be considered climbing. 

Binh took the second pitch that brought us to the ridge line. Once on the ridge the options were to simul climb or free solo. Simul climbing is where two people are tied together on a shorter rope and the leader places pieces occasionally while the follower cleans up the pieces as they both climb at the same time. We felt that the best option was to go free because the majority of the ridge was 4th class or low 5th class climbing. The ridge was beautiful! We passed many parties made it to the northern notch where the majority of people bail. There was a bunch of people there and we decided to continue up the North Summit. I led a pitch up the north summit above the notch and while climbing I hear "ROCK" as something buzzes past my head. It didn't sound like a rock and I instantly knew that is was the GoPro of a guy who I met on the first pitch. The guy dropped his glasses on the first pitch and we talked about how lucky he was that it wasn't his boss's GoPro. Bad day for that guy. I watched it blow out of it's case as it bounced down the mountain.

Binh Ta. New Balance climbing shoes in action. 

We soloed past all of them.

We hoped to get off Matthes early enough that we could climb another route on the way out. We probably could have if we would have bailed at the notch when we had the chance but we didn't!  It was a bit of a cluster getting down off of the North Summit because of all of the people. We signed the summit registry, AKA a small box with a notebook in it.We teamed up with another party to do the rappel because we only brought one rope and made the hike out.

The climb was great! I could have gone without the crowds and added another climb in on the way out but in a way it was nice to chat with random climbers from all over the world. We met climbers from California, Brazil and Italy.

The shadow above is the north notch where we descended. 

We were home by about 10:30pm. It really is awesome that from where am I living now I can pull a day trip to Yosemite. We will see what other trips I can pull before I end up moving in about a year.

As you probably noticed, I got a lesson in Lightroom from Kimber on the basics of photo editing and she gave my blog a bit of a face lift. Enjoy. 

Lipolysis, Ketosis, Blood Sugar Levels, Insulin and Their Role in Endurance Energy

I recently viewed a video by a doctor named Peter Attia who presented a great summary on how the body reacts to various forms of sugar during endurance exercise and how the body can transition to using fat for energy. He endorses a substance called UCAN which I have no experience with but his explanation as to why it is beneficial is awesome! The gist of his message is:

• The simpler the sugar (glucose most simple) the greater the spike in blood sugar and insulin levels.
• Spiked insulin impedes lipolysis and causes dips in blood sugar which makes you feel like crap and eat more sugar causing a downward spiral
• Lipolysis is the most effictive form of energy in the body. 

I was also recently introduced to his blog entitled The Eating Academy where he lays out ketosis and how we can tap into fat stores. This is an area that I feel has a lot of potential in performance during endurance activities. 

Vedauwoo Trip Number Two & Trek Home

We stopped at the 1.4 billion year old granite climbing playground of Vedauwoo as part of our trek back to Oakland after finishing up a month at the Denver Veterans Hospital podiatry program. Kimber flew back out from Oakland to spend the last week with me there, see the area, spend time with friends and drive home with me. We love Colorado! Much of the week was spent with Brody and Kiley Hatch who also joined us for out Vedauwoo pit stop, along with Salomon the dog.

We setup up camp and hiked from our campsite to do some climbing. Our objective was the 5.8 Satterfield's Crack. The climb has been recommended from friends who had done it. I took the lead with Kiley, Kimber and Salomon on cheer squad and Brody on the belay. I was able to do the entire climb in one pitch and could have used a few more larger cams but made do.

The first section was a bit awkward with two side by side cracks and a smooth face in a corner. I sewed it up tight to reduce anxiety of my cheer squad and to eliminate the chance of decking if I were to take a fall.

The second section was a widening crack that was encroaching on the off width status near the top. I was looking for a wider piece to place but had used them to stitch up the lower section. I kept my cool and ran it out a bit with no problems.

The final section included a smooth chimney that narrowed at the top and popped out onto a huge chock stone to belay from. This required some chicken winging and using my leg as a Big Bro cam to top out.

Brody followed me up showing his enjoyment with the occasional grunt and curse word. He topped out with a smile.

We spent the night around the campfire which we hadn't done in way to long. There is something about a campfire that just makes life awesome.

Emergency fireside wedge resection of an ingrown. They hurt so much worse in climbing shoes!

Saturday morning we set out to climb Oslund's Delight but found people just starting the route so ended up on Silver Surfer, a single pitch 5.9 crack. Our approach to the climb was about the least direct route possible. We just considered our inefficiency in getting to the climb as part of the learning process that occurs at any new area. Silver Surfer has two sections, the first an awkward (word used often in Vedauwoo)  chimney up to a chock-stone and into a diagonal hand crack. I took the lead with my usual cheering squad and made it look really hard so that Kimber would think that I was cooler. We set up a top rope and Brody had a lap. It was a great climb.

We had a quick lunch and departed ways. The 17hr journey back to Oakland was broken up by a birthday dinner for me in Salt Lake City with my parents and Amie and Matt and their family. It was a good stop and great to see them again. We ended up sleeping in the car somewhere past Elko Nevada. Coming back into the Bay Area was a breath of fresh air, literally the air quality is so fresh and cool! Nice to be home.