As with any injury, effective treatment starts with proper diagnosis. Treatment of patellofemoral pain starts with activity modification or total rest and ice, depending on the severity of the injury. Ice is an effective, inexpensive natural anti-inflammatory and analgesic and can be used whenever there is pain, no matter if it's a day or few months after the injury. Gentle stretching and mobility exercises should be started as soon as tolerated and include most muscles of the hip, thigh and calf. Stretching improves patellar alignment and reduces compression forces on the kneecap. Follow this with appropriate strengthening of the same muscle groups and a gradual return to training. Many patients are not adequately controlled on monotherapy and so combinations of DMARDs have been utilized with synergistic effect without a concomitant rise in toxicity. Various combinations have been studied, the best described being that of methotrexate, sulfasalazine and hydroxychloroquine. In practice, rheumatologists use various combinations of antirheumatic drugs in order to achieve the optimal response. A surgical synovectomy and debridement/arthroplasty procedure involves excision of excess synovial tissue and rough surfaces of the joint. An alternative to surgical synovectomy is the use of the radioactive compound yttrium which, when injected intra-articularly, induces a chemical synovectomy. Details of surgical procedures are presented in the section on regional joint disease. Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website at So why does having a collapsed inner arch cause ankle and knee pain? Well, if the inner arch is collapsed, it can force your ankles to turn inward, which throws off the alignment of your legs and can influence the knees just above. Apart from using orthotics the podiatrists also suggest surgical procedures that can have some important benefit in restoring the arch and decreasing the pain that accompanies arch breakdown. You should remember that these surgeries should only be performed by expert podiatric surgeons. Surgeries with proper orthotics can be the best treatment for flat foot problems. Undeveloped Arches. For infants and toddlers, it is a common fact that they would not have an arch yet and this should not worry the parents. The undeveloped arch usually develops through the toddler years. For the undeveloped arches, baby fat is a common reason why the flat footed condition exists for infants and toddlers. Here you go, straight out of the regulation. Pes Planus is the official name for flat feet, which is listed below. Again, I think the doctors at MEPs will judge your flat feet and determine how severe they are and base their decision off that evaluation. With you being able to function properly with flat feet, you should be good. But again, contact a recruiter for an official answer. In a similar finding, a 2007 study looked at muscle strength associated with knee osteoarthritis. This study, reported in the journal of Musculoskeletal Disorders, found that hip strengthening helped to reduce knee joint stress as well as arthritis knee pain symptoms. Using a golf ball, have the step on the golf ball. Have the athlete lean some weight onto the ball then massage up and down the sole of the foot, between the balls of the feet, and at the back of the heel. This will help to break up unwanted scar tissue that accumulates from repetitive overuse. It is often assumed that flat feet mean a life sentence of pain from the waist down. In this article we will discuss some of the common contributors to flat feet and whether they are the cause of discomfort or the result of poor conditioning. Custom-made foot orthoses. Custom foot orthoses are not a covered benefit of the Kaiser Health Plan. However, custom foot orthoses are available through the Department of Foot and Ankle Surgery on a fee for service basis. Custom foot orthoses may be prescribed when symptoms are not eliminated with pre-fabricated orthoses or in older children and adolescents with significant foot alignment abnormality. The current fee is $275. The examination should begin by observing general limb alignment, foot progression angle, and the degree of bow leg or knock knee exhibited while the child is walking with the parent. On standing, the foot appears flat and the heel may show mild valgus Fig.1. As the ankle shifts inside, you maynotice a gap between the foot and the outside wall of slip onshoes. If bad enough, even tie shoes will show this shift. Thefarther the shift. the more problems that are created. Pronation or valgus is rated as first,second and third degree, just like burns. First degree is a smallamount of medial displacement, usually no pain or chronicproblems. You may have a gap in some of your shoes, some extracallous formations (usually at the ball of the foot or out sideof the heel), and you may turn your shoes and wear down theoutside edge of your heel. Rarer associations include lymphadenopathy and amyloidosis with deposition of serum amyloid A protein manifesting as proteinuria or malabsorption). Rheumatoid vasculitis may lead to nail fold infarcts in the periphery and leg ulceration. Renal involvement in rheumatoid disease is rare. Osteoporosis may occur as a result of the disease, immobility or corticosteroid therapy. There is an increased incidence of infections in patients with rheumatoid disease. Felty's syndrome (rheumatoid factor positive rheumatoid arthritis, splenomegaly and pancytopenia, most frequently neutropenia) may lead to recurrent bacterial infections, chronic leg ulcers and increased mortality. Yes, ugly orthopedic shoes. I know! I know! Orthopedic used to be synonymous with ugly. No more my bunion afflicted friend!