DEAR DR. DONOHUE: My 12-year-old daughter has flat feet. Our doctor’s only suggestion was for her to wear good, solid shoes and put arch supports in her shoes. She wants to wear sandals like everyone else, but she gets terrible ankle pain when she does. Walking long distances, even in good sneakers, causes ankle pain. Any suggestions? – D.O.

ANSWER: There are two kinds of flat feet, and each carries a different significance.

A flexible flat foot is one whose arch collapses when a person stands but re-forms when the person sits. People with a flexible flat foot rarely have pain. If they do, then an arch support is a good idea.

The other, more problem-causing kind of flat foot is a rigid flat foot. There is no arch in the foot even when a person sits. Rigid flat feet can bring on foot, ankle or leg pain. The pain intensifies the longer such people are on their feet.

Shoe inserts are often effective for rigid flat feet, too. However, many times custom-made inserts – orthotics – will be needed. An impression in plaster or foam casts provides the pattern to construct the orthotic. This special insert keeps the flat foot from turning inward when the foot strikes the ground. Inward turning – pronation – puts stress on the feet, the ankles and the knees and can cause pain in any or all of those places.

In extreme cases, when rigid flat feet result from the fusion of foot bones, surgical correction might even be necessary. Those cases are rare.

Why not get a second opinion for your daughter’s feet? An orthopedic surgeon or a podiatrist can tell you if orthotics would help her.

DEAR DR. DONOHUE: I have a 17-year-old son who devotes himself to bodybuilding. He spends five and more hours a day in the gym. As a result, his grades are suffering, and he is losing all his friends. He has put himself on a diet where about all he eats is protein. He has a well-developed body, but he constantly complains about his skinny arms and legs. What is wrong with him? – K.F.

ANSWER: He might have fallen into a disorder that is being recognized with greater frequency. It’s called muscle dysmorphic disorder, and it’s a variant of a more inclusive syndrome called body dysmorphic disorder. In the latter disorder, people are preoccupied with what they erroneously perceive as an unattractive body part – nose, mouth, eyes, breasts, etc. With muscle dysmorphic disorder, the focus is on muscles and their supposed inadequacy.

This problem affects mostly young men who are driven to exercise constantly to build bigger and bigger muscles. They often adopt bizarre diets, just as your son has done. They view themselves as having a scrawny body. It’s quite like people who develop an eating disorder because they see themselves as obese when they truly are emaciated.

Consumed with this obsession, these young men abandon all other pursuits. If they are still in school, their grades suffer. Their friends drift away.

Your and your husband should talk to your son and let him know that you are worried about him. Tell him he is laboring under a delusion about his body and that it is disrupting his life and is unhealthy. If you’re not able to convince him, speak with the family doctor. Ask him or her for a therapist who could help your son adjust his distorted thinking.

Depression often lies at the bottom of muscle dysmorphic disorder, and that is an even more compelling reason for you to seek professional help for your son.

DEAR DR. DONOHUE: Many senior citizens use a whirlpool or Jacuzzi. Do they soften bones in any way? – M.B.

ANSWER: No. Why would they?

DEAR DR. DONOHUE: One morning two weeks ago, I woke up feeling fine – until I saw myself in the mirror. My face sagged on one side. I couldn’t blink the eye on that side, and saliva was dripping out the corner of my mouth. My husband took me to the emergency room because we thought I’d had a stroke. I hadn’t. I have Bell’s palsy. I am not taking any medicine. Should I be? – R.K.

ANSWER: Yours is the typical Bell’s palsy story, and yours is the typical reaction to it. Everyone who is stricken thinks it’s a stroke. It’s an inflammation of the nerve that serves facial muscles. The result is that the eyelid on the affected side will not close. All facial creases on that side are ironed out. Saliva might drip from one side of the mouth. It is impossible to draw the mouth into a smile position on the involved side.

What causes the inflammation is a matter of debate. Some feel it is an immune assault on the nerve. Others claim it is a viral infection. Still others confess their ignorance and say they do not know.

The medicine question is another issue of contention. Those who subscribe to the inflammation theory give their patients prednisone, one of the cortisone drugs. The doctors who are convinced it is a viral infection, specifically with the herpes virus prescribe the antiviral medicine Zovirax. Those who are unconvinced that either is the cause let their patients wait for time to take its course. If it is going to be used, medicine should be started quickly after the diagnosis has been made. You are beyond that period, but you are not likely to suffer because you didn’t have any treatment.

Most people make a complete recovery and do so in four to six weeks.

Infrequently, there is an associated disease that seems to precipitate Bell’s palsy. Lyme disease, shingles and sarcoidosis are examples.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.