his variety is very unsightly and disabling;
it is treated by supra-malleolar osteotomy of the tibia and fibula.

#Other Forms of Flat-foot.#--Flat-foot is sometimes met with in
rickety children, in association with knock-knee or curvature of the
bones of the leg, and is treated on the same lines as other rickety
deformities. It may follow upon an attack of acute rheumatism or upon
diseases in the region of the ankle and tarsus, such as gonorrhoea,
arthritis deformans, tuberculosis, and Charcot's disease; the
gonorrhoeal flat-foot is extremely resistant to treatment. There is a
congenital form in which the sole is convex and the dorsum concave,
the result of the persistence of an abnormal attitude of the foetus
_in utero_. Lastly, there is a racial variety, chiefly met with in the
negro and in Jews, which is inherited and developmental, and which,
although unsightly, is rarely a cause of disability.

#Pes Transverso-planus.#--Lange describes under this head a sinking or
flattening of the anterior arch formed by the heads of the metatarsal
bones, of which normally only the heads of the first and fifth rest on
the ground. In this condition all may be on the same level or the arch
is actually convex towards the sole. It may coexist along with the
common form of flat-foot, or it may be associated with the neuralgic
pain known as metatarsalgia.

#Painful Affections of the Heel.#--These include inflammation of the
bursa between the posterior aspect of the calcaneus and the lower end
of the tendo Achillis, inflammation of the tendon itself and its
sheath of cellular tissue, and the presence of a spur of bone
projecting from the plantar aspect of the tuberosity of the calcaneus.
The spur of bone is the source of considerable pain on standing and
walking, and tenderness is elicited on making pressure on the plantar
aspect of the heel; it is well demonstrated by the X-rays (Fig. 156).
The condition is usually bilateral. Complete relief is obtained by
removing the spur by operation.

Sever of Boston calls attention to a painful condition of the heel met
with in children, and associated with changes in the epiphysial
junction, allied to those met with in the epiphysis of the tubercle of
the tibia in Schlatter's disease. The changes in the epiphysial
junction can be demonstrated in skiagrams. Treatment is conducted on
the same lines as in teno-synovitis of the tendo Achillis.

#Metatarsalgia.#--This affection, which was first d