Iowa doctor rushes toward injured at Boston Marathon


DES MOINES -- For podiatrist Kirk Neustrom who was working his 19th year in the medical tent at the finish line of the Boston Marathon, his responsibility morphed Monday into a tragically more intense duty.


View the USA Today video featuring Kirk and his experience in Boston.

Waterloo Cedar Falls Courier - Wednesday, December 9, 2009

Sure-Footed: Implants Correct Flat Feet In Kids

CEDAR FALLS - Last winter, Angie Donaldson noticed abnormal wearing in her daughter's snowboots. "I was getting on her thinking she was standing weird in them," recalled Donaldson of Hudson. But she found the same thing happening to Cheyenne's other shoes.

Cheyenne's arches were falling, and her feet were tipping inward. She was developing flat feet, in her case a genetic deformity. She displayed no other common signs, like pain, fatigue, foot cramping, clumsy gait or loss of activity. Flat feet, sometimes mistakenly associated with growing pains, misalign the body's posture and can strain the ankles, knees, hips and back. "She never complained about anything," Donaldson said. "She ran very fast."

Cheyenne, 7, had subtalar MBA implant surgery on one foot in July and on the other in November. The minimally invasive treatment involves a small titanium device inserted into a natural space between the ankle and heel bones, which restores arch formation and influences foot development. "You can see it locks the foot in neutral," said Cheyenne's podiatrist, Dr. Philip Morreale of Cedar Valley Podiatry Foot & Ankle Center in Cedar Falls. "Before you could really torque the foot way out."

Flat feet can be diagnosed with a clinical gait analysis to determine how the foot functions and treatment options, Morreale said. X-rays reveal bone structure.

Implants more permanently correct severe cases of flat feet. Conservative measures like physical therapy, over-the-counter shoe inserts or custom orthotics provide temporary relief or delay progression. But supportive therapies "just take away the discomfort," said Dr. Ron Kane, a podiatrist at Covenant Medical Center. "They're not going to change the architecture of the foot."

"As much as I'd like to say she's only going to wear a tennis shoe with ties every day for the rest of her life, we know that that's not the case," Donaldson added. Implant surgery is designed for flexible flat feet before bones mature in kids ages 5 to 18. The procedure, performed as a brief outpatient surgery, typically involves two weeks in a weight-bearing cast with gradual return to normal activity.

The sooner flat feet are addressed, the better the results. "Even 2 years old is a good age to put them in an orthotic," Morreale said. Flat feet are more prevalent in males and can be linked to obesity, he said. Causes also include ligament laxity, neuromuscular or superstructural abnormalities, collagen disorder, medical conditions, knock knee and trauma. Those with rigid deformities and arthritis require more extensive procedures, like reconstruction of bones, tendons or ligaments.


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