Excessively pronated feet: a health hazard to developing children

There is a serious misconception on the part of the public as well as amongst a great number of professionals to equate the problem of flatfoot with excessively pronated feet in growing children. This is a matter of grave concern since flatness of the arch of the foot can be a normal or abnormal finding in foot posture, whereas the excessively pronated foot is flattened as part of a pathological structural malposition. This inherent biomechanical defect is commonly present in the great majority of human children and is the basic reason for most postural pathology of the lower extremity.Excessive pronation of the feet in children should in no way be interpreted as a normal condition to be automatically outgrown. As a matter of fact, Whitman, the famous Orthopaedic Surgeon, noted in 1917 in his text Orthopaedic Surgery that pronation of the feet commonly seen in children is more likely to worsen than improve over the years. This paper presents the probable cause of the condition, treatment and prevention of the problem and recommendations for the future.The deforming foot posture known as excessive pronation is familiar to Podiatric Medicine and to Medicine generally. Yet, in spite of this familiarity, only an insignificant number of the millions of children in our country receive the simple available help required to minimize the problem.The Podiatric profession has within its grasp the wherewithal to correct this situation, through education and counseling of parents, through cooperation with pediatricians and other professionals and by utilizing technological advances in children's footgear and orthotics. It is the intention of this paper to provide an overview of the literature and history associated with the problem of excessive pronation in children, as well as to suggest some simple techniques for improving this situation.Dr. Tax is an international renowned consultant to many Podiatric Hospital amon which is the Veterans Administration in New Jersey, New York College of Podiatric Medicine, Ohio College of Podiatric Medicine. He has written and lectured extensively on the subject of children and problems with their feet.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

Bi-racial identity: Children born to African-American and white couples

The quest for self-identity has been more complex for African-Americans than for all the groups in American society. This quest has been especially troubling for children where one parent is African-American and the other parent is white. The scholarly literature is replete with themes on black identity and self-esteem, but this literature does not speak to the issue of biraciality since societal attitudes decree that any person with a drop of black blood is black. There is a move afoot by bi-racial (black and white) young adult children to claim both parts of their ethnic heritage. This paper suggests that the issue of bi-racial identity must be revisited and re-examined.     

The effect of war on marriage,divorce and birth rates

The impact of war on marriage, divorce, and birth rates in the United States from 1933 to 1986 is explored. The author concludes that "the involvement of the nation in military activities was accompanied by a decrease in marriage and birth rates but not by any change in divorce rates. Mobilization of the armed forces and demobilization had no discernible impact on divorce, marriage or birth rates."     

Pastoral care in Candyland. Maintaining power and life in a world of illness

Wrestling with ghosts and staging fatal accidents with Matchbox cars allow a critically ill six-year-old to come to terms with the fears prompted by his illness.     

The health care system should produce health

Reform of the U.S. health care system along the lines to be proposed by the Clinton Administration will not be an easy task, and it will not be accomplished quickly. A fundamental objective of the changes should be a health system whose purpose is improvement in the health of U.S. citizens, and not just the provision of services to all. This column is jointly edited by Kevin M. Fickenscher, MD, and David A. Kindig, MD, PhD, chair and member, respectively, of the College's Forum on National Health Policy. Dr. Fickenscher is participating in various advisory capacities on health care in the Clinton Administration, and Dr. Kindig is Senior Advisor to HHS Secretary Donna Shalala.     

Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system

5he purpose of this study was to determine whether or not suspected variables affected a surgery clerk's chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptor's predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptor's status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.     

Immigration reform,American style

This article reviews the background of the proposed Immigration and Reform Act (also known as the Simpson-Mazzoli bill), which seeks to overhaul US immigration law for the first time since 1952. This bill is consistent with President Reagan's hard line on border enforcement and mandates stiff penalties for those who transport illegal aliens for commercial advantage or private profit. It further offers Mexico preferential treatment in immigration (40,000 additional visas/year). It includes an amnesty program to offer legal status to qualified illegal residents. The bill directs the President to develop a secure national worker identification system and would create a large-scale temporary foreign agricultural program for perishable commodities. Agricultural workers' families would not be eligible to accompany them unless they also obtain temporary visas. Foreign temporary workers, employable only in cases where local domestic workers are not available, must be provided with wages and working conditions equal to those prevailing among domestic workers. Stiff penalties are stipulated for employers who fail to abide with the terms of the program. In the author's opinion, this bill fails to appreciate the global character of international migration and its complexity. It relects a fundamental ambivalence about a strictly controlled main gate versus a back door approach to immigration as well as the conflicting images of the US as a nation of immigrants versus the historical reality of American nativism and xenophobia. Needed are comprehensive initiatives whose mutually reinforcing components can address the multiple dimensions of the immigration problem within a framework that does not ignore workers who have contributed to the economic well-being of the US, regardless of their legal status.