In the paediatric population, the degree of ligamentous laxity of the foot results in relative pes planus that resolves over time 5 Within the first decade there is spontaneous development of a strong arch. Pes planus may occur in as many as 20% of the adult population. Although, the majority of patients are asymptomatic and require no treatment. There is some evidence to suggest that flat feet protects against stress fracture. The longitudinal arch of the foot must be assessed on a weightbearing lateral foot radiograph If the patient is unable to stand or weightbear, a simulated weightbearing radiograph should be obtained. Weightbearing lateral Congenital vertical talus is the most serious pathological flat foot. The diagnosis must be established as soon after birth as possible, and often requires surgical treatment. Congenital vertical talus may occur in association with other congenital anomalies, such as myelomeningocele, arthrogryposis, and developmental dysplasia of the hip. It may also occur in motor neuron disorders 4 . Evaluation The deformity reveals a rigid flat foot. The heel is in equino-valgus with contracture of the triceps surae muscles. The forefoot is dorsiflexed and everted; the arch is convex, because the head of the talus projects into the plantar aspect of the foot Fig. 3. When muscle wasting is discussed, often the hand is not the first thought. However, in certain conditions, the hand muscles can waste away, leaving an individual with a weak grip and a lack of coordination. Rhabdomyolysis is a potentially serious condition characterized by abnormal breakdown of the fibers of skeletal muscle tissue. In turn, muscle breakdown triggers the release of the protein pigment myoglobin into the blood and urine. Thoracic spondylosis (disc degeneration) generally occurs in older persons. Narrowing of the discs between vertebrae in the thoracic region of the spine will cause a variety of symptoms including tingling, numbness and pain to the mid-section. While there are some rare causes of pes plano valgus in children and adolescents, and still other common causes in adults, the cause of pes plano valgus in the majority of children and adolescents is hereditary factors, such as bone and joint alignment, ligament laxity (hyperflexible joints), or a tight calf muscle. While being overweight does not necessarily cause pes plano valgus, it can contribute to these feet being symptomatic (painful). The shoes should also be examined. Ordinarily, there is heel wear on the lateral side. Shoes without heel wear may indicate a tight Achilles tendon. Radiographs are rarely indicated for flexible asymptomatic flat feet. Treatment When people reach 40 or 50, poor foot function will start to show and over-pronation will take its toll. Many years of over-pronation will result in wear and tear in the feet, ankle and knee joints and lower back. People will simply accept these common aches and pains as a sign of ageing. Very few people realise these complaints have a lot to do with their fallen arches! With over-pronation the foot continues to roll inwards, when it should be pushing off and outwards. When the foot rolls inwards the lower leg will follow and rotate internally and stay in this position (instead of rotating externally with supination). A stoma irrigator sleeve is used to guide waste into the toilet when you need to irrigate your colostomy. Irrigating the stoma involves directing fluid into it so that you can empty your bowel. Irrigation allows colostomy patients to control their bowel movements so that they do not have to wear a pouch over their stomas. Instead, they place a cap over the stoma to absorb fluids and vent gas from the area. Irrigating and using your stoma irrigator sleeve properly is extremely important. Using an ankle brace or an orthotic device will limit the range of motion of the subtalar joint, thereby speeding up the healing process. If your child has flat feet , there may be no need for worry – it could be normal for their age. Many parents become concerned when they notice that their child has flat feet Depending on the age of your child, it may be nothing to worry about or it may indicate fallen arches, which Podiatrists call pes planus Remember, wear arch supports if you are standing, exercising, shopping, working, and always at home. A number of products are available in stores near you. Start today, and you'll be amazed at how much better you will feel. Doctors commonly prescribe shoe inserts, or orthotics, to support the arch. These devices make walking and standing more comfortable for a person with fallen arches, reports the American Academy of Orthopaedic Surgeons. Orthotics are typically worn with closed shoes. They are available over-the-counter or can be custom-made. Foot Strengthening Anti-inflammatory medications such as ibuprofen and aspirin can provide short-term relief from foot pain associated with fallen arches, notes the American Academy of Orthopaedic Surgeons. Doctors sometimes inject the foot with a corticosteroid medication, which acts as an anti-inflammatory, to relieve acute pain. Although medications can provide symptom relief, they do not correct the underlying foot abnormality. Immobilization Related to plantarfasciitis is a heel pain or spur. The longitudinal ligament hasit's origin on the plantar anterior surface of the calcaneum(heel) bone. When the ligament is stretched too far, it pulls onthis attachment area. It can become inflamed and sore. If theproblem persist, the body may try to heal it by reinforcing theattachment area by adding bone. This is just as the body heals afractured bone. A hormone is secreted that is drawn to theinflammation site. Chemically this hormone draws calcium out ofthe blood stream and deposits it in layers over time to theinjured area. If the process continues long enough a spur of bonemay be laid down.