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To Your Good Health: Children and Their Bones

Dear Dr. Roach: I have a family member who thinks infants and older kids, like my 6-year-old son, don’t have bones but only cartilage. Can you explain about bones and cartilage, as well as anything else that has to do with bones growing? — M.P.

Answer: Sharks have only cartilage, and no bones. Little children, like sharks, seem to spend a lot of time eating. Perhaps that’s where the confusion is?

Seriously, it is a concern that some adults are under the misapprehension that children’s bones can’t be broken. It is true that kids’ bones are more flexible than in adults, but they are nonetheless smaller and weaker, so can more easily fracture. Children’s bones contain a growth plate at each end of a long bone, composed of cartilage that slowly becomes bone. This growth plate can be damaged in a fracture. Fortunately, children tend to heal faster as well.

Dear Dr. Roach: I am a 60-year-old female in great health. I’m an avid walker, putting in anywhere from three to five miles a day. I do have bunions on both feet, and the beginnings of hammer toes; however, my feet don’t hurt at all. I recently saw a podiatrist to seek an opinion about what I could do to keep my foot problems from progressing. His opinion was that I should have surgery on both feet to correct the problems. His reasoning is that surgery is inevitable, and to correct now will prevent it from becoming a more complicated procedure and complicated recovery. That seems logical, but it’s also difficult to contemplate having surgery on something that gives me no problems whatsoever. Thoughts? — D.D.

Answer: “Bunion” is a term used for a deformity of the big toe, as it points toward the other toes. It’s not clear what causes it, and there are nonsurgical treatments that can be tried, such as special shoes and orthotics.

These same treatments may be appropriate for hammer toes as well, which are deformities of the second, third or fourth toes. The toes are bent in the middle joint, so the toe resembles a hammer.

Surgery is better than it was, but I still see people who are worse after surgery than before. I would wait until it is bothering you. My surgery tech recommends surgery only for people with pain or difficulty walking.

If you still aren’t certain, get a second opinion from a different podiatrist.

Dear Dr. Roach: I am 93 years old, in good health, but unsteady when walking. I use a cane, but I wonder if there is anything more I can do to help steady myself. — J.H.

Answer: Unsteadiness, especially for someone in his 90s, is quite common and can come from many sources. My experience has been that regardless of the cause, an evaluation by a physical and/or occupational therapist can make sure that your cane is appropriate, properly sized and necessary. This specialist also can get you involved in a balance and strengthening program that can help prevent a fall, which is your biggest enemy. There are many therapies that can help, and modalities like yoga and tai chi have helped many older people with balance. However, since you are already unsteady, I would recommend getting an evaluation before trying a program by yourself. Your doctor can point you to the physical and occupational therapy resources in your area.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.