Gout is caused by abnormal metabolism of substances called purines that result in the accumulation of uric acid in the blood stream. Purines are a by-product of cell break down. When the excretion of the uric acid is hampered the accumulated uric acid in the blood stream causes crystalline deposits to form in joints or in the soft tissues. When this happens, there is a sudden onset of extreme pain with associated swelling, redness, and increased warmth to the skin or joint. Classic gout occurs in the big toe joint. It also commonly occurs in the knee joint. Rarely is it seen in more than one joint at a time. Uric acid accumulation in other joints and areas of soft tissue is less common. When gout presents in these areas it, may not be recognized as gout by the treating doctor.

Gout can also mimic an infection. Your doctor will evaluate you for the possability of infection and may treat you for infection as well as gout.

Diagnosis

As the crystalline deposits form in the joints and soft tissue, the uric acid levels in the blood stream can return to normal. Blood tests taken during an attack of gout may demonstrate a normal uric acid level. This can make diagnosis more difficult, and the physician must rely on his or her clinical experience to make the diagnosis. Other areas that gout may present itself are the tops of the foot, the heel and the ankle joint. In the chronic form of the disease, called tophaceous gout, the repeated deposition of uric acid will from nodules about the joints and tendons. These nodules can spontaneously open and drain a chalky like substance. An attack of gout can resemble an infection. An elevated temperature may also be present. This is worrisome to the physician because an infection in a joint can be a very damaging event. Some doctors may wish to take a sample from the joint so that it can be analyzed for gout and cultured for bacteria.

Treatment

Treatment often consists of both medications for gout and for infection. Immobilization of the foot with a removable cast or the use of crutches is useful. Once the proper medication is prescribed the symptoms of gout will start to subside quite rapidly. Left untreated the clinical course may take several days for the gout attack to subside.

Factors that contribute to the onset of gout are alcohol, red meats, asprin and certain medications for high blood pressure. Gout occurs most frequently in men. Women will not get gout until after menopause unless they have had a hysterectomy. Patients with long standing diabetes who may have kidney damage due to their disease, and patients who have kidney disease from other causes can develop gout. These patients may exhibit atypical forms of gout. In these instances, more than one area may be affected; the tops of both feet, for example, may develop gout.(Interossiuos gout)

Typically the onset of gout is sudden and intense. Frequently, the patient will go to bed feeling fine and wake up the next morning in execrating pain. The attacks can become recurrent, and over time cause permanent damage to the affected joint (arthritis). Recurrent gout should be treated with medication to reduce the blood uric acid levels. The most common medication used is Allopurinol. This medication should not be started during an acute attack. If this medication is given during an acute attack it will make the condition worse. Acute attacks of gout are treated with a variety of prescription anti-inflammatory drugs.

Raynaud's Disease is a vasospastic disorder most commonly affecting the hands and feet. A vasospasm occurs when the smooth muscles controlling the small arteries supplying circulation into the hands and feet contract. This smooth muscle contraction, or spasm, makes the arteries so small that blood has difficulty passing through. The most common event causing the vasospasm is exposure to cold temperature. Raynaud's disease must be differentiated from Raynaud's phenomenon. Raynaud's disease is a disease that is not associated with any other specific disease entity. Raynaud's phenomenon has the same findings, as Raynaud's disease except there is an underlying disease associated with the vasospasm. Raynaud's phenomenon may be seen with rheumatoid arthritis, scleroderma, lupus, and other diseases. The condition is aggravated by smoking. A single cigarette may decrease the circulation by one half for more than an hour. Raynaud's disease is most common in young women, and has no known cause. It typically is found in both feet and both hands. It appears that the threshold for vasospasm is lowered in these individuals, and may occur following exposure to cold, or during times of stress.

Diagnosis

The diagnosis of Raynaud's disease is a clinical diagnosis based upon the patients' symptoms and the findings on examination. Patients with Raynaud's disease will often hear the expression, ""Cold hands, warm heart"" when shaking hands with others. This is because the arterial vasospasm decreases blood flow into the hands and feet. In addition to the cold skin temperature, there is a pattern of color changes seen in the fingers and toes. Initially after exposure to cold, the toes and fingers will turn white, then as the oxygen is depleted they become cyanotic which is a blue color, finally the spasm relaxes and there is an excess of blood flow which turns the toes red and warm (reactive hyperemia). This pattern of triphasic color change, white to blue to red, is a hallmark of Raynaud's disease. However, not all individuals will have the triphasic (three-color) change. Some will have a biphasic (two color) change going directly from white to red.

The length of vasospasm may last from several minutes to several hours. This may be accompanied by pain, or more commonly by numbness. In severe cases there may damage to the skin on the tips of the toes and fingers with an appearance similar to frostbite. These areas may develop into ulcers (sores) which can be very painful.

Treatment

In mild forms of Raynaud's disease the simplest treatment is to protect the hands, and feet from cold exposure. Since cold is the cause of the vasospasm, preventing exposure to cold will prevent the spasm from occurring. This may require insulated boots and thick warm socks in colder climates. Dressing in layers, with new polyester liners and new insulating materials may be helpful. Most sporting goods stores that stock hiking or camping equipment will be able to help in this regard. Cigarette smoking contains nicotine, which is known to cause vasospasm. Discontinuation of cigarette smoking will be a definite benefit for the individual with Raynaud's disease. In more severe cases, or in those with recurrent episodes, medications are available to help relax the arterial smooth muscle. Medications that have been used successfully in some individuals include phenoxybenzamine, prazosin, nifidipine, pentoxyphylline, and guanethidine. These medications are only available by prescription, and patients must be monitored for potential side effects.

Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin. It is characterized by round, reddish, dry scaling patches covered by grayish white or silvery white scales. The lesions have a predilection for the nails, scalp, elbows, shins and feet. On the feet, it can be difficult to distinguish it from athlete's foot, and the nail appearance may be confused with fungal infections of the toenails. The nail appearance does have a unique characteristic; it may have a pitting appearance. A characteristic feature of the condition is pinpoint bleeding when the scaled areas are brushed off. A variant of psoriasis is called pustular psoriasis. This form of the disease is characterized by small pustules or blisters filled with clear or cloudy fluid. This can mimic acute athlete's foot. It characteristically does not itch or burn. It is distinguished from athlete's foot by negative fungal cultures. The picture can become confusing because a secondary fungal infection is possible. In this instance both conditions are present at the same time.

Psoriasis can also affect the joints of the feet and lower extremities causing a painful arthritis. X-rays will show characteristic erosions of the bones in the toes. Treatment consists of anti-inflammatory medications, steroids, and other medications specific for the treatment of psoriasis.

Proper footwear is crucial not only in the prevention of foot and toe problems but also in treating these problems.  A comfortable, properly-fitted shoe can help in preventing a toe joint problem from returning after surgery, relieving pain in the foot or toe or preventing a foot or toe problem from developing or getting worse. 

You can develop a foot or toe problem such as a bunion, plantar fasciitis, callus or hammertoe for a number of reasons, but your footwear can play a large role in how bad your foot condition becomes.  

Try these tips when shopping for your next pair of shoes:

-Stand up while getting fitted for your shoe and walk around the store to make sure the shoe fit feels right.
-Shoe size, especially width can change with age, so have both of your feet measured  when buying new shoes.
-If you have orthotics or shoe inserts, make sure you bring them when trying on new shoes.
-Try on shoes at the end of the day when your feet are at their largest due to normal swelling.
-If a shoe feels snug, ask the salesperson to stretch it out for you.  With that said, you should not have to break in shoes if they fit properly.

The type of shoe selected is vital for maintaining a healthy foot.  Make sure you pick a shoe that laces up as opposed to slips on and has a flexible sole that allows your toes to bend as you walk.  Avoid high heeled, narrow or pointed-toe shoes, as these increase pressure on the front of your foot and on the toe joints.  If you must wear heels, selects shoes that are no more than 2 inches high.  Shoes that breathe when your feet sweat are best so avoid plastic or vinyl shoes.  Look for a shoe with a wide and deep toe box that allow you to wiggle your toes while they are in the shoe and avoid shoes with seams, as they may rub against or irritate the skin around your foot problem.  

When you are at home, wear sandals, soft-leather flat shoes or slippers or even go barefoot if possible. 

Be sure to discuss all of the above tips with us before shopping for new footwear.  We will be able to offer you our recommendations depending on your specific needs.  

Pigmented lesions should always be inspected and observed. Most pigmented areas are nothing but freckles and moles. However a potentially deadly pigmented lesion that can occur on the foot and lower extremity is Malignant Melanoma. A physician should evaluate any pigmented lesion that suddenly occurs or a pigmented lesion that starts to change its appearance. These changes are usually subtle and may consist of increased size and depth of color, onset of bleeding, seepage of clear fluid, tumor formation, ulceration and formation of satellite pigmented lesions. The color is usually not uniform but is likely to be scattered irregularity, being brown, bluish black or black. An increase in pigmentation may precede enlargement of the lesion by several months. Although any part of the body may be affected, the most frequent site is the foot, then in order of frequency, the remainder of the lower extremity, head and neck, abdomen, arms and back. Malignant melanoma may also form under the nails of the feet and hands. The thumb and big toe are more commonly affected than the other nails. Quite often the adjacent skin to the nail is ulcerated. Usually a fungal infection is suspected and antifungal treatment may be administered for months before the true nature of the lesion is discovered. A black malignant melanoma of the toe can also be mistaken for gangrene. Overall, the incidence of malignant melanoma is quite low.

Actinic Keratosis

Another cancer causing lesion that can occur on the feet are called Actinic Keratosis. Although most commonly found in sun-exposed areas of the body such as the face, ears, and back of the hands, these lesion can also occur on the foot. They are characterized as either flat or elevated with a scaly surface. They can either be reddish or skin colored. On the foot they are frequently mistaken for plantars warts. These lesions are the precursor of epidermoid carcinoma. Treatment for these lesions should be through as they are definitely precancerious. Treatment consists of freezing the lesions with liquid nitrogen or sharp excision.

Kaposi's Sarcoma

Yet another cancerous lesion that can occur on the foot is called Kaposi's Sarcoma. These lesions occur most commonly on the soles of the feet They are irregular in shape and have a purplish, reddish or bluish black appearance. They tend to spread and form large plaques or become nodular. The nodular lesions have a firm rubbery appearance. The appearance of these lesions is an ominous sign. In the late 1970's and early 1980's an outbreak of Kaposi's sarcoma occurred in San Francisco, California. It was later learned that the disease was associated with AIDS infection. It can occur without the concurrent AIDS infection but this is very rare.

Chronic athlete's foot can cause an increased pigmentation to the bottom of the foot. It is associated with dry scaling skin and may have a reddish appearance.

Venous Stasis

Generalized increased pigmentation occurs for a variety of other reasons. Dark patches of skin occur about the ankles and lower legs in persons who suffer from Venous Stasis. Venous stasis is caused by an accumulation of fluid in the lower extremities. This is due to poor venous return of blood to the heart. Venous blood flow back to the heart occurs by way of the veins in the feet and legs. Venous stasis is associated with varicose veins that do a poor job of returning blood to the heart. As a result the blood flow is slowed, becomes stagnant, and fluid accumulates in the ankles and lower legs. As the fluid accumulates in the lower legs, the small and medium-sized veins break or leak fluid into the tissues. As blood cells break up in the tissue, they deposit the iron that is part of hemoglobin in the blood cell. The iron stains the skin causing a light to dark brownish appearance. With time, the skin and subcutaneous fat becomes thinned and will break down creating weeping venous stasis ulcerations. At times, blistering will form with a clear, watery fluid weeping from the skin. This condition requires professional attention by a physician.

Diabetic Dermopathy

Another cause of generalized increased pigmentation is diabetes. The condition termedDiabetic Dermopathy occurs most frequently on the shins and lower legs. They may have the appearance of small scars. Their appearance may precede the diagnosis of diabetes by several years. The actual cause of diabetic dermopathy is not well understood, but it does not cause any particular problem or pose any particular health threat.

Small, spider-like areas of increased pigmentation on the ankles are caused by the break down of small veins in the area and are called Spider Veins; they also pose no health risks.

A flatfoot deformity is where the arch on the inside border of the foot is more flat than normal. Flatfoot deformities can occur in all age groups, but appear most commonly in children. Some of these children grow up into adults who have feet with normal arches, but many of these children have pain related to their flatfoot deformity throughout their lives. It is very important that children with flatfoot deformity be evaluated by a podiatrist to determine if they need treatment to prevent future pain or deformity in their feet.

When the young child starts to first walk at about the age of 9-15 months of age, the foot has a fat or chubby appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity.

At the ages of two and three, the child's foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has a flatfoot deformity at the ages of two to three, then it is wise to have the foot examined by a foot specialist such as a podiatrist. The reason that it is important to have the feet examined at this age is because the young foot is still largely made of cartilage, with less bone than would be present in the adult foot. Since cartilage is relatively soft, the abnormal forces caused by a flatfoot deformity may cause permanent structural alterations to the bones and joints of the foot that will persist into adulthood.

The flatfoot deformity in children causes a number of changes to the structure of the foot which is easily recognizable by the trained podiatrist. Flatfoot deformity causes the inside arch to be flattened, causes the heel bone to be turned outward, and causes the inside aspect of the foot to appear more bowed outward than normal. Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity.

Since the flatfoot deformity causes some instability of the foot during gait, children with flatfoot deformity may have complaints in the foot such as arch, heel, or ankle pain which is generally associated with increased standing, walking, or running activities. However, since the excessive rolling inward of the arches of the foot also make the leg and knee more turned inwards, children with flatfeet may also complain of pain in the low back, hip, knee, or leg due to the abnormal mechanics of the foot which is created by the flatfoot deformity.

Diagnosis

As mentioned above, the pediatric flatfoot deformity can be diagnosed at a very early age, but is unlikely to be properly diagnosed unless the doctor is a foot specialist, like a podiatrist, and is familiar with the intricacies of the structure and biomechanics of the foot. After speaking with the parent and child, the podiatrist will examine the foot both while the child is not bearing weight but also while the child is standing, walking or running. Often, the family history is also taken since the foot should be examined closely if the child has a close relative who had a painful flatfoot deformity as a child or adult.

During the examination of the child, the podiatrist is looking for abnormal structure or function of the foot and lower extremity, which could lead to either problems during childhood or adulthood. X-rays may be taken of the foot if a significant pathology is noted or suspected. The more severe the flatfoot deformity and the more significant the complaints in the foot or lower extremity, then the more likely the podiatrist will recommend specific treatment for the flatfoot deformity.

Treatment

If the child has a mild flatfoot deformity and no symptoms, then generally no treatment is recommended other than possibly yearly check-ups by the podiatrist. If, however, the child has a moderate to severe flatfoot deformity of has significant symptoms in the foot or lower extremity, then treatment is indicated.

Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity. More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by functional foot orthotics. Functional foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities which helps not only improve the appearance and function of the foot, but also greatly reduces the symptoms in the foot or lower extremities. Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child's symptoms worse.

If the child has a severe flatfoot deformity and disabling symptoms which does not respond to foot orthotics, shoes and/or stretching, then surgery to correct the flatfoot deformity may be indicated.

These children may be candidates for a 15 minute outpatient procedure to correct the flexible flatfoot deformity which is referred to as hyperpronation. The procedure is called a Subtalar Arthroereisis. It involves the placement of an implant in the space under the ankle joint (sinus tarsi) to prevent only the abnormal motion, but still allowing normal motion. This brief procedure only requires very little recovery time, and is completely reversible, if necessary. Your surgeon can consult you about this exciting, life-changing procedure.

Circulation disorders includes a large number of different problems with one thing in common, they result in poor blood flow. Specifically, the term peripheral vascular disease refers to blood flow impairment into the feet and legs (although it could include the arms and hands as well).

Blood is circulated throughout the human body by the strong, muscular pump called the heart. With each heartbeat, blood is pushed along through blood vessels called arteries that carry the oxygen and nutrient rich blood to all parts of the body including the legs and the feet. The individual cells in the body take up the oxygen and nutrients. Then a second set of blood vessels known as veins carry the oxygen depleted blood back to the heart and lungs to get more oxygen, and again be pumped throughout the body. Peripheral vascular disease may refer to arterial inflow disorders, (arterial insufficiency) or venous outflow disorders (venous insufficiency).

Arterial Insufficiency

Arterial inflow disorders are categorized by the size of the artery involved. If a large artery in the thigh or behind the knee becomes blocked by cholesterol deposits this is referred to as large vessel disease or atherosclerosis. The result may be a painful ischemic foot, which means there is a severe lack of arterial blood flow from the heart into the foot. If smaller arteries like those in the lower leg or foot is blocked, this is referred to as small vessel disease, or arteriosclerosis. This too can result in ischemia of the foot. Small vessel disease is seen more often in diabetics, but can affect non-diabetics as well. If the skin of the feet or legs lacks adequate blood flow a sore will develop which may be difficult to heal. These sores are known as ischemic ulcers. Any blockage to arterial inflow will result in a circulation problem to the body tissues down stream. Occasionally a small blockage will occur in the small arteries that supply blood to a toe. This is known as a "Blue Toe Syndrome." Another arterial inflow problem may result when the smooth muscles that control the size of the arteries go into spasm. The arterial muscle spasm can block the blood from circulating into the foot. One common vasospastic disorder is called Raynaud's Syndrome. A second vasospastic disorder is called acrocyanosis.

Venous Insufficiency

Venous outflow disorders refer to problems getting blood from the foot back to the heart. There are two sets of veins in the feet and legs to help bring the blood back toward the heart. The superficial venous network refers to veins located just beneath the skin. The deep venous networks are veins located closer to the bones and are not visible when looking at the foot or legs.

Varicose veins refer to an enlargement of the veins and a loss in the ability of the vein to properly maintain blood flow back toward the heart. When this occurs blood can collect in the feet and legs. Superficial varicose veins may appear as unsightly cords or a small bunch of grapes, which usually appear on the tops of the feet, around the ankles and may extend upward to the knees and thighs. Deep varicose veins while usually not visible will result in chronic swelling of the feet, ankles and legs. When the blood is not circulated from the feet back to the heart gravity will cause the fluid to collect in the feet and ankles. This results in swelling, called edema. Chronic edema over a long period of time may cause a discoloration of the skin around the ankles. The skin can become inflamed, and is know as venous stasis dermatitis. If left untreated the skin will become weakened and a weeping sore will develop, usually on the inside of the ankle called a venous stasis ulcer.

A potentially serious consequence of blood collecting in the feet and legs is the formation of blood clots in the veins. A superficial vein blood clot will result in a painful, inflamed superficial vein called superficial phlebitis. When a blood clot forms in a deep vein, it is called deep venous thrombosis, or deep phlebitis. This is a serious condition that causes painful swelling of the leg and may result in part of the clot breaking free. If the clot should travel back up to the heart and get caught in the lungs, it is referred to as a pulmonary embolus which can be life threatening and requires emergency treatment.

There are several causes of pain on the top of the foot. The type of pain and its location help the doctor in determining the cause of the pain and helps to direct them in the best treatment for the patient

Pain of sudden onset without the occurrence of injury on the top of the foot just behind the toes may be a stress fracture of a metatarsal bone. There is frequently swelling in the area and it is painful to the touch.

Another common area of pain occurs near the middle of the top of the foot, generally a bit to the outside of the foot. In this area of the foot the tendons that go to the toes can become inflamed. This is called extensor tendonitis. One cause of this condition is excessive tightness of the calf muscle. When the calf muscle is tight it places excessive stress on the tendons on the top of the foot that pull the foot upward and against the tightness of the calf muscles. Wearing a shoe with a one-inch heel will help to take the stress off of the tendons on the top of the foot. Aggressive stretching of the calf muscle is also very helpful. Oral anti-inflammatory medications can help. When these measures do not work a functional orthotic should be tried. The orthotic corrects the alignment of the foot taking the stress off of the tendons on the top of the foot.

More generalized pain on the top of the foot with swelling or a "thickness" to the foot may be caused by degenerative arthritis. This is seen in people with flatfeet or a slowly collapsing arch.

Another area of degenerative arthritis that causes pain on the top of the foot is in the area of the big toe joint. Jamming of the joint will cause bone spurring to occur on the top of the foot. Pressure from the shoe can cause pain. Treatment for these conditions consists of taking oral anti-inflammatory medications and functional foot orthotics. Surgery can be an option for the degenerative arthritis about the big toe joint. (See hallux limitus)

Generalized pain in the top of the foot that occurs in children and young adults may be due to a condition called Tarsal Coalition. This pain tends to occur on the outside portion of the top of the foot. A tarsal coalition is the abnormal fusion of two or more bones in the rear portion of the foot. It can be hereditary. It tends to get worse with activity. If not treated in its early stages it can cause significant arthritis in the foot causing a limitation in the person's activity. Early diagnosis is made using x-rays and a MRI or CT scan. Treatment is with the use of functional orthotics and on occasion surgery. Early diagnosis and treatment is very important.

Pain can also occur on the top and inside of the foot. In people who are very active in sporting activities can develop pain in this area. The pain can be due to a stress fracture of one of the bones (Navicular bone) in this area. Diagnosis can sometimes be difficult. X-rays are generally negative and if a stress fracture is present the diagnosis may require abone scan or MRI. Treatment consists of rest with a limitation of activity, oral anti-inflammatory medications, below the knee walking casts, functional orthotics or rarely surgical exploration of the area.

Yet another area of pain on the top of the foot is just below the ankle joint on the outside portion of the top of the foot. In this area of the foot there is a small fleshy area. This fleshy area is a small muscle called the Extensor Digatorum Brevis. Underneath the muscle there is a small canal between two bones. This area is called the Sinus Tarsi. In this area there are three small ligaments that can become inflamed. A common cause of this pain is due to a flattening of the foot, which pinches these small ligaments. Sometimes there is actual jamming of two bones causing the pain. Treatment consists of stretching the calf muscles to reduce it effect of flattening the foot, oral anti-inflammatory medication, cortisone injections, functional orthotics and occasionally surgical exploration.

Knee pain in children may be caused by a variety of conditions. Some of these conditions may be rare but can be quite serious in nature. Knee pain in children should be evaluated by your doctor.

Osgood-Schlatter's Disease

A common cause of knee pain in a growing child is injury to a growth plate in the front of the knee. This may be accompanied by swelling in the area. This condition is called Osgood-Schlatter's disease. It occurs most commonly in children between the ages of 10 -14. It is often associated with playing sports and aggressive bicycle riding. It is felt that the condition is primarily caused by an abnormal pull of the tendon that attaches into the painful area from the kneecap. This tendon is called the patellar tendon.

Treatment of Osgood-Schlatter's Disease

Treatment consists of avoiding activities that aggravate the condition such as kneeling or excessive flexion of the knee. Icing the area and anti-inflammatory medications such as Tylenol or Advil may provide temporary relief. Often the abnormal knee function is due to the way the foot functions. In this instance the foot causes the lower leg to rotate slightly inward. This causes the patellar tendon to pull in an abnormal direction where it attaches in front of the knee causing damage to the growth plate in this area. If this is the cause of the problem then treatment might consist of a custom fitted shoe insert called an orthotic. The orthotic corrects the underlying foot condition that is affecting the lower leg and knee. A podiatrist trained in the use of functional orthotics should be able to evaluate the cause of the problem and if it is caused by abnormal foot function adequately treat the condition.

Sever's Disease

The spontaneous development of pain in children generally indicates some form of injury to the growth plate of a growing bone. This can occur without a specific memorable event. When pain occurs in the heel of a child the most likely cause is due to injury of the growth plate in the heel bone. This is called Sever's disease. A condition that may mimic Sever's disease is Achilles tendonitis. Achilles tendonitis is inflammation of the tendon attached to the back of the heel. A tight Achilles tendon may contribute to Seiver's disease by pulling excessively on the growth plate of the heel bone. This condition is most common between the ages of 8 - 15 years of age and boys tend to be affected more than girls. It is frequently seen in the active soccer, football or baseball player. Sport shoes with cleats seem to aggravate the condition. It is believed that the condition is due to an underlying mechanical problem with the way the foot functions.

Treatment

Home treatment consists of calf muscle stretching exercises, heel cushions in the shoes, and/or oral anti-inflammatory medications like Tylenol or Advil. Icing the area may provide some temporary relief. If the condition persists the child should be evaluated by a podiatrist for abnormal foot function. In severe cases a below the knee walking cast may be required. Treatment may require the use of custom-made shoe inserts called orthotics. Orthotics work by correcting foot function and will fit into most normal shoes.