#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 described by Morton of Philadelphia (1876), is a neuralgia on the area of the anterior metatarsal arch, specially located in the region of the heads of the third and fourth metatarsal bones. It is most often met with in adults between thirty and forty, is commoner in women than in men, and is often combined with flat-foot. The patient complains of a dull aching or of intense cramp-like pain in the anterior part of the foot. The pain is usually relieved by rest and by taking off the boot. It may be excited by pressing the heads of the metatarsals together or by grasping the fourth metatarso-phalangeal joint between the finger and thumb. In advanced cases the pain may be so severe as to cripple the patient, so that she is obliged to use a crutch. On examination, the sole may be found to be broadened across the balls of the toes, and there may be corns over the heads of the third and fourth metatarsals. Skiagrams may show a downward displacement of the head of one or other of these bones, and prints of the foot may show an increased area of contact in the region of the balls of the toes. The affection is of insidious development, and is usually ascribed to sinking of the transverse arch of the foot--pes transverso-planus--the result of weakness or of wearing badly fitting boots. The intense pain is believed to be due to stretching of, or pressure upon, the interdigital nerves or the communicating branch between the medial and lateral plantar nerves; Whitman believes it is due to abnormal side pressure on the depressed articulations. [Illustration: FIG. 156.--Radiogram of Spur on under aspect of Calcaneus.]