Bursitis Of The Foot Physiology
Overview
There are about 160 bursae in the human body. These little, fluid-filled sacs cushion pressure and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis, inflammation of the bursa, movement or pressure is painful. Overuse, injury and sometimes an infection from gout or rheumatoid arthritis may cause bursitis.
Causes
Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.
Symptoms
Symptoms of Achilles bursitis are often mistaken for Achilles tendinitis because of the location of the pain at the back of the heel. When you suffer from Achilles bursitis you will experience some or all of the following symptoms which are most noticeable when you begin activity after resting. High heels can add pressure on the retrocalcaneal bursa, subcutaneous calcaneal bursa, and Achilles tendon.
Diagnosis
Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa. Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.
Non Surgical Treatment
Treatments should involve decreasing swelling, relieving pain and stress on the Achilles, correcting any biomechanical dysfunction (over-pronation or flat feet), treating scar tissue, and then restoring strength and movement. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to prevent further irritation or damage.
Surgical Treatment
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.
There are about 160 bursae in the human body. These little, fluid-filled sacs cushion pressure and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis, inflammation of the bursa, movement or pressure is painful. Overuse, injury and sometimes an infection from gout or rheumatoid arthritis may cause bursitis.
Causes
Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.
Symptoms
Symptoms of Achilles bursitis are often mistaken for Achilles tendinitis because of the location of the pain at the back of the heel. When you suffer from Achilles bursitis you will experience some or all of the following symptoms which are most noticeable when you begin activity after resting. High heels can add pressure on the retrocalcaneal bursa, subcutaneous calcaneal bursa, and Achilles tendon.
Diagnosis
Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa. Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.
Non Surgical Treatment
Treatments should involve decreasing swelling, relieving pain and stress on the Achilles, correcting any biomechanical dysfunction (over-pronation or flat feet), treating scar tissue, and then restoring strength and movement. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to prevent further irritation or damage.
Surgical Treatment
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.
Hammer Toe Pain Elimination
Overview
The smallest four toes of each foot have three bony segments connected by two joints, just as the fingers do. Hammer toes is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments so that the tip of the toe turns downward, making it looks like a hammer or claw. The second toe is affected most often.
Causes
Many people develop hammertoe because they wear shoes that are too tight. Shoes with narrow toe boxes squeeze the toes together, forcing some to bend. This causes the toe muscles to contract. If the toes are forced into this cramped position too often, the muscles may permanently tighten, preventing the toes from extending. Chronic hammertoe can also cause the long bones that connect the toes to the foot, called metatarsals, to move out of position. The misaligned metatarsal bones may pinch a nerve running between them, which can cause a type of nerve irritation called a neuroma.
Symptoms
At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.
Diagnosis
The treatment options Hammer toe vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.
Non Surgical Treatment
Hammer toes may be effectively corrected in different ways. Treatments can be non-invasive and involve physical therapy along with the advice that the person not wear any more shoes that restrict appropriate space for their toes. Appropriate shoes for people who want to avoid hammer toes, or for people who already have them, should be at least half an inch longer than the person's longest toe. High-heeled shoes are something to definitely avoid.
Surgical Treatment
Treatment of a severe hammertoe that has become rigid includes surgery. What is done during the surgery depends on how misshapen and inflexible the toe is. The surgeon may make a cut over your toe and release the tendon by cutting the tendon away from the bone. The surgeon may remove a small piece of bone from the toe. The surgeon may realign the tendons to reposition your toe or fasten the bones with pins. Sometimes the surgeon may have to join the bones in the toe. In this case, you will no longer be able to bend the toe, but the toe will be flat.
Prevention
Avoid wearing shoes that are too short or narrow. Check children's shoe sizes often, especially during periods of fast growth. If you have hammer toe, call for an appointment with your health care provider. If you develop thick blisters or corns on your toes, if your pain gets worse, if you have difficulty walking call for an appointment with your health care provider.
Non Surgical Hammer Toe Treatment
Overview
A Hammer toes is a deformity that causes your toe to bend or curl downward instead of pointing forward. This deformity can affect any toe on your foot; however, it most often affects the second toe or third toe. Although a hammertoe may be present at birth, it usually develops over time due to wearing ill-fitting shoes or arthritis. In most cases, a hammertoe is treatable.
Causes
But what causes the imbalance of the tendons and muscles in the first place so that they begin to pull and bend the joint? A bad fitting shoe could be the cause but it usually isn?t the primary cause. Many people are genetically predisposed to hammertoe, and the condition begins to progress more quickly when they wear shoes that fit poorly, for example pointy toes, high heels, or shoes that are too short. Hammertoe may also be caused by damage to the joint as a result of trauma.
Symptoms
Symptoms include sharp pain in the middle of the toe and difficulty straightening the toe. People with hammertoe may also develop blisters, which are fluid-filled pockets of skin, because the bent toe is likely to rub against the inside of a shoe. This increased friction may also lead to calluses, which are areas of thickened skin, and corns, which are hard lumps that may form on or between toes. Symptoms may be minor at first, but they can worsen over time.
Diagnosis
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).
Non Surgical Treatment
Treating hammertoe involves straightening the toe, making tendons in the toes flexible again, and preventing the problem from returning. Some simple treatments include splinting the toe to keep it straight and to stretch the tendons of the foot. Using over-the-counter pads, cushions or straps to decrease discomfort Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises) Wearing shoes that fit properly and allow toes Hammer toes plenty of room to stretch out.
Surgical Treatment
If conservative treatments fail and your symptoms persist, the doctor may recommend a surgical option to straighten the toe. The procedures used vary greatly, depending upon the reasons for the hammertoe. There are a number of different operations to correct hammertoes, the most common ones involve Soft tissue corrections such as tendon transfers, tendon lengthening, and joint capsule repairs. Digital arthroplasty involves removal of bone from the bent joint to allow the toe to straighten. The temporary use of pins or K-wires may be necessary to keep the toe straight during the healing period. Joint implants are sometimes used to allow for a better range of motion in the toe following surgery. Digital arthrodesis involves the removal of bone from the bent joint and fusing the toe in a straight position. If the corn is due to a bone spur, the most common procedure used is an exostectomy, in which surgically removing it or filing it down removes the bone spur. Because of the possible complications involved with any surgery, one should be sure to understand the risks that may be involved with surgery to correct hammertoes and remove bone spurs.
Bilateral Hallux Valgus Deformities
Overview
A bunion is a firm, painful bump that forms over a bony bulge at the base of the big toe. In most cases, the big toe joint also is enlarged and has degenerative arthritis. The toe also may be pushed toward the second toe (hallux valgus). Bunions tend to be inherited, but they also are common in the following groups. Women who wear high heels. People who wear shoes that are too narrow or too pointed. People with flatfeet. All of these situations force the big toe to drift toward the little toes, and this can cause bunions to form.
Causes
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.
Symptoms
While bunions may be considered cosmetically undesirable, they are not necessarily painful. In cases where the individual has minor discomfort that can be eased by wearing wider shoes made of soft leather and/or with the aid of spacers-padding placed between the toes to correct alignment-further treatment may not be necessary. (Anti-inflammatory agents can be used to alleviate temporary discomfort at the site of the bursa.) For those who continue to experience pain on a daily basis and who cannot wear most types of shoe comfortably, surgical treatment may be the best choice.
Diagnosis
Most patients are diagnosed to have bunions from clinical history and examination. However, in some cases, X-rays will be performed to determine the extent of damage to the joint. Furthermore, it will enable the treating doctor to decide on the best course of management of the patient.
Non Surgical Treatment
Apply special pads and dressings to protect the bunion from shoe pressure. Inject steroid and local anesthetic around the bunion to reduce inflammation. This is especially useful if there is an associated bursitis. Recommend commercially available or custom made shoes. Prescribe functional orthotics to correct faulty foot function, and help prevent worsening of the deformity. Recommend bunion surgery to correct the deformity. 
Surgical Treatment
Several surgical procedures are available to the podiatric physician The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.
Prevention
Here are some tips to help you prevent bunions. Wear shoes that fit well. Use custom orthotic devices. Avoid shoes with small toe boxes and high heels. Exercise daily to keep the muscles of your feet and legs strong and healthy. Follow your doctor?s treatment and recovery instructions thoroughly. Unfortunately, if you suffer from bunions due to genetics, there may be nothing you can do to prevent them from occurring. Talk with your doctor about additional prevention steps you can take, especially if you are prone to them.
Overpronation Of The Foot
Overview
Over-pronation occurs when the foot collapses too far inward stressing the plantar fascia (the area underneath the arch of the foot.) Normally, one pronates every time he/she walks, but excessive pronation is called over-pronation. When this occurs it can cause pain in the feet, knees, hips, low back and even the shoulder.
Causes
There are many biomechanical issues that can contribute to excessive pronation, including weak foot intrinsic muscles, limited ankle dorsiflexion mobility and calf flexibility, weak ankle invertor muscles (e.g. posterior tibialis), weak forefoot evertor muscles (peroneus longus), poor hip strength and control, Anterior pelvic tilting, heel InversionIn a person who overpronates, the heel bone goes into an everted position meaning that it turns out away from the midline of the body. The opposite motion of eversion is inversion. Inversion is a motion that needs to be controlled to prevent the foot from excessively pronating.
Symptoms
If you overpronate, your symptoms may include discomfort in the arch and sole of foot. Your foot may appear to turn outward at the ankle. Your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running.Unfortunately, overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions (hallux valgus) patello femoral pain syndrome, heel spurs, metatarsalgia. You do not have to be a runner or athlete to suffer from overpronation. Flat feet can be inherited, and many people suffer from pain on a day-to-day basis. Flat feet can also be traumatic in nature and result from tendon damage over time. Wearing shoes that do not offer enough arch support can also contribute to overpronation.
Diagnosis
If you cannot afford to get a proper gait analysis completed, having someone observe you on a treadmill from behind will give you an idea if you are an overpronator. It is possible to tell without observing directly whether you are likely to be an overpronator by looking at your foot arches. Check your foot arch height by standing in water and then on a wet floor or piece of paper which will show your footprint. If your footprints show little to no narrowing in the middle, then you have flat feet or fallen arches. This makes it highly likely that you will overpronate to some degree when running. If you have low or fallen arches, you should get your gait checked to see how much you overpronate, and whether you need to take steps to reduce the level to which you overpronate. Another good test is to have a look at the wear pattern on an old pair of trainers. Overpronators will wear out the outside of the heel and the inside of the toe more quickly than other parts of the shoe. If the wear is quite even, you are likely to have a neutral running gait. Wear primarily down the outside edge means that you are a supinator. When you replace your running shoes you may benefit from shoes for overpronation. Motion control or stability running shoes are usually the best bet to deal with overpronation.
Non Surgical Treatment
Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.
Prevention
Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.
Over-pronation occurs when the foot collapses too far inward stressing the plantar fascia (the area underneath the arch of the foot.) Normally, one pronates every time he/she walks, but excessive pronation is called over-pronation. When this occurs it can cause pain in the feet, knees, hips, low back and even the shoulder.
Causes
There are many biomechanical issues that can contribute to excessive pronation, including weak foot intrinsic muscles, limited ankle dorsiflexion mobility and calf flexibility, weak ankle invertor muscles (e.g. posterior tibialis), weak forefoot evertor muscles (peroneus longus), poor hip strength and control, Anterior pelvic tilting, heel InversionIn a person who overpronates, the heel bone goes into an everted position meaning that it turns out away from the midline of the body. The opposite motion of eversion is inversion. Inversion is a motion that needs to be controlled to prevent the foot from excessively pronating.
Symptoms
If you overpronate, your symptoms may include discomfort in the arch and sole of foot. Your foot may appear to turn outward at the ankle. Your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running.Unfortunately, overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions (hallux valgus) patello femoral pain syndrome, heel spurs, metatarsalgia. You do not have to be a runner or athlete to suffer from overpronation. Flat feet can be inherited, and many people suffer from pain on a day-to-day basis. Flat feet can also be traumatic in nature and result from tendon damage over time. Wearing shoes that do not offer enough arch support can also contribute to overpronation.
Diagnosis
If you cannot afford to get a proper gait analysis completed, having someone observe you on a treadmill from behind will give you an idea if you are an overpronator. It is possible to tell without observing directly whether you are likely to be an overpronator by looking at your foot arches. Check your foot arch height by standing in water and then on a wet floor or piece of paper which will show your footprint. If your footprints show little to no narrowing in the middle, then you have flat feet or fallen arches. This makes it highly likely that you will overpronate to some degree when running. If you have low or fallen arches, you should get your gait checked to see how much you overpronate, and whether you need to take steps to reduce the level to which you overpronate. Another good test is to have a look at the wear pattern on an old pair of trainers. Overpronators will wear out the outside of the heel and the inside of the toe more quickly than other parts of the shoe. If the wear is quite even, you are likely to have a neutral running gait. Wear primarily down the outside edge means that you are a supinator. When you replace your running shoes you may benefit from shoes for overpronation. Motion control or stability running shoes are usually the best bet to deal with overpronation.
Non Surgical Treatment
Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.
Prevention
Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.
Severs Disease Physiotherapy
Overview
Sever?s disease is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 14 years of age. Sever?s disease will go away on its own when it is used less or when the bone is through growing, but it can recur (for example, at the start of a new sports season). Traditionally, the only known cure was for children to outgrow the condition, with recurrences happening an average of 18 months before this occurs.
Causes
Sever's Disease is a repetitive strain injury caused by the following. High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis. Tight calf muscles. Poor mechanics, structure and function of the foot. Excessive pronation. Rapid growth spurt. The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone). It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age. In extreme cases the growth plate can become separated from the calcaneus.
Symptoms
Symptoms include Heel Pain. Pain at the back of the heels when walking or running. Possibly a lump at the back of the heel, although this might be minimal. Pain and tenderness at the back of the heels, especially if you press on it, or give it a squeeze from the sides. Tight calf muscles resulting in reduced ankle range of motion.
Diagnosis
Sever's disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.
Non Surgical Treatment
The following are different treatment options Rest and modify activity. Limit running and high-impact activity to rest the heel and lessen the pain. Choose one running or jumping sport to play at a time. Substitute low-impact cross-training activities to maintain cardiovascular fitness. This can include biking, swimming, using a stair-climber or elliptical machine, rowing, or inline skating. Reduce inflammation. Ice for at least 20 minutes after activity or when pain increases. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help. Stretch the calf. Increase calf flexibility by doing calf stretches for 30 to 45 seconds several times per day. Protect the heel. The shoe may need to be modified to provide the proper heel lift or arch support. Select a shoe with good arch support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem. Take it one step at a time. Gradually resume running and impact activities as symptoms allow. Sever?s disease usually goes away when the growth plate (apophysis) matures, which should be by age 12 to 13 years in females and 13 to 14 years in males.
Recovery
Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.
Sever?s disease is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 14 years of age. Sever?s disease will go away on its own when it is used less or when the bone is through growing, but it can recur (for example, at the start of a new sports season). Traditionally, the only known cure was for children to outgrow the condition, with recurrences happening an average of 18 months before this occurs.
Causes
Sever's Disease is a repetitive strain injury caused by the following. High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis. Tight calf muscles. Poor mechanics, structure and function of the foot. Excessive pronation. Rapid growth spurt. The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone). It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age. In extreme cases the growth plate can become separated from the calcaneus.
Symptoms
Symptoms include Heel Pain. Pain at the back of the heels when walking or running. Possibly a lump at the back of the heel, although this might be minimal. Pain and tenderness at the back of the heels, especially if you press on it, or give it a squeeze from the sides. Tight calf muscles resulting in reduced ankle range of motion.
Diagnosis
Sever's disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.
Non Surgical Treatment
The following are different treatment options Rest and modify activity. Limit running and high-impact activity to rest the heel and lessen the pain. Choose one running or jumping sport to play at a time. Substitute low-impact cross-training activities to maintain cardiovascular fitness. This can include biking, swimming, using a stair-climber or elliptical machine, rowing, or inline skating. Reduce inflammation. Ice for at least 20 minutes after activity or when pain increases. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help. Stretch the calf. Increase calf flexibility by doing calf stretches for 30 to 45 seconds several times per day. Protect the heel. The shoe may need to be modified to provide the proper heel lift or arch support. Select a shoe with good arch support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem. Take it one step at a time. Gradually resume running and impact activities as symptoms allow. Sever?s disease usually goes away when the growth plate (apophysis) matures, which should be by age 12 to 13 years in females and 13 to 14 years in males.
Recovery
Although Sever's disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child's growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.
Surgery For Flat Feet In Adults
Overview
Adult-acquired flatfoot is a challenging condition to treat. It is defined as a symptomatic, progressive deformity of the foot caused by loss of supportive structures of the medial arch. It is becoming increasingly frequent with the aging population and the obesity epidemic. Patients commonly try to lose weight by exercising to improve the condition. This often leads to worsening of symptoms and progression of the disorder. Early recognition of this complex disorder is essential, if chronic pain and surgery are to be avoided. 
Causes
Obesity - Overtime if your body is carrying those extra pounds, you can potentially injure your feet. The extra weight puts pressure on the ligaments that support your feet. Also being over weight can lead to type two diabetes which also can attribute to AAFD. Diabetes - Diabetes can also play a role in Adult Acquired Flatfoot Deformity. Diabetes can cause damage to ligaments, which support your feet and other bones in your body. In addition to damaged ligaments, uncontrolled diabetes can lead to ulcers on your feet. When the arches fall in the feet, the front of the foot is wider, and outer aspects of the foot can start to rub in your shoe wear. Patients with uncontrolled diabetes may not notice or have symptoms of pain due to nerve damage. Diabetic patient don?t see they have a problem, and other complications occur in the feet such as ulcers and wounds. Hypertension - High blood pressure cause arteries narrow overtime, which could decrease blood flow to ligaments. The blood flow to the ligaments is what keeps the foot arches healthy, and supportive. Arthritis - Arthritis can form in an old injury overtime this can lead to flatfeet as well. Arthritis is painful as well which contributes to the increased pain of AAFD. Injury - Injuries are a common reason as well for AAFD. Stress from impact sports. Ligament damage from injury can cause the bones of the foot to fallout of ailment. Overtime the ligaments will tear and result in complete flattening of feet.
Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.
Diagnosis
Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.
Non surgical Treatment
Although AAF is not reversible without surgery, appropriate treatment should address the patient?s current symptoms, attempt to reduce pain, and allow continued ambulation. In the early stages, orthotic and pedorthic solutions can address the loss of integrity of the foot?s support structures, potentially inhibiting further destruction.3-5 As a general principle, orthotic devices should only block or limit painful or destructive motion without reducing or restricting normal motion or muscle function. Consequently, the treatment must match the stage of the deformity. 
Surgical Treatment
If initial conservative therapy of posterior tibial tendon insufficiency fails, surgical treatment is considered. Operative treatment of stage 1 disease involves release of the tendon sheath, tenosynovectomy, debridement of the tendon with excision of flap tears, and repair of longitudinal tears. A short-leg walking cast is worn for 3 weeks postoperatively. Teasdall and Johnson reported complete relief of pain in 74% of 14 patients undergoing this treatment regimen for stage 1 disease. Surgical debridement of tenosynovitis in early stages is believed to possibly prevent progression of disease to later stages of dysfunction.
