The Department of Foot and Ankle Surgery at Kaiser Permanente Santa Rosa will often recommend initiation of non-surgical treatment measures in a child that a) has symptomatic (painful) pes plano valgus or b) in cases where symptoms may be minor or absent, but the foot alignment abnormality is significant. Surgery is not commonly recommended and often reserved for children over age 5 or adolescents that have continuing symptoms (pains), despite a non-surgical care program. Modify activities. Decrease the time spent in activities that put added stress on the feet (PE, sports, play). Convert impact exercise to non-impact exercise – stationary cycling, swimming, and pool running are acceptable alternatives. This is due to inflammation and degeneration of the tibialis posterior tendon. This leads to gradual pain, swelling and flattening of the arches of the foot (flat foot). It is often missed and may lead to serious permanent disability. Osteoarthritis of the joints (tarso-metarso and subtalar joint). The reasons for arthritis of these joints may be trauma, inflammatory or degenerative but if left over time will lead to pain and progressive deformity. Most patients with flat foot canbe treated with orthotic footwear. Flexible flat foot can conform to inner soles worn in the shoes. Insoles can be custom made to correct the flatten arches of the foot. Figure 2. In this case, a skeletally immature child with a flexible flatfoot was treated with a subtalar joint arthroereisis and open Tendo Achilles lengthening. The metallic implant prevents the rearfoot from collapsing. The preoperative and postoperative radiographs demonstrate improvement of the alignment of the rearfoot (blue line) and forefoot (yellow line). Stretching. Because a tight calf muscle (equinus – contracture of the gastrocnemius and/or soleus) has been long associated with flexible flatfoot, a stretching program is a simple intervention aimed at counteracting this foot-deforming force. Most stretching efforts are centered on stretching the more superficial calf muscle, the gastrocnemius. Flat feet are a condition where the arch of the foot appears flattened. This causes the foot to roll inwards as it contacts with the floor in support of the weight of the body, and is the main clinical feature of excessive pronation. A flat foot is a condition in which the foot doesn’t have a normal arch. It may affect one foot or both feet. Acquired flat foot, develops over time, rather than at birth and is likely to cause pain and other symptoms – sometimes including the development of arthritis in the feet. Causes of Flat Feet Cervical discectomy and cervical fusion are two surgical techniques designed to address pain and instability in the bones (vertebrae) of the neck. Surgeons frequently use the two procedures in combination. Diseases of the spine are more common than you might think. There are several forms of bone diseases of the spine that range from mild to life threatening. These diseases can occur at any time in your life from inherited factors, age and environment. Spine diseases can also occur spontaneously without any particular causes. These factors make it vitally important to be aware of different spine diseases and how they can affect your health. The problems podiatrists deal with include things like those resulting from bone and joint disorders for example arthritis and soft-tissue and muscular pathologies along with neurological and circulatory illnesses. Podiatrists can also diagnose and treat any kind of complications of the above that impact the lower limb, such as skin and nail disorders, corns, calluses and ingrown toenails. Foot injuries and infections gained as a result of sport or other activities are also diagnosed and treated by podiatrists. Private health insurance funds include podiatry services under their ancillary tables. Government-funded services may be found in some public hospitals, community health centres along with other publicly funded utilities. Dr. Fitzgibbons and his colleagues conducted a small prospective study to measure the effectiveness of subtalar arthroereisis screw placement as an adjunct to symptomatic tarsal coalition resection in patients with associated flatfoot deformity. Each of the four patients (aged 11, 13, 16, and 26 years; two male, two female) underwent tarsal coalition resection and placement of a subtalar arthroereisis screw between November 2007 and June 2009. The standard surgical approach for middle facet or calca-neonavicular coalition resection was used on each patient, and the arthroereisis screw was inserted using the sinus-tarsi approach (Fig. 1).