Fallen arches, also known as flat feet or pes planus, may be present at birth or develop later in life. The midfoot normally exhibits a slight arch, keeping this region raised during walking. Absence of the normal arch causes flattening of the sole. Many people with fallen arches have no associated symptoms, while others experience foot pain or fatigue. Treatment for fallen arches depends on the severity of the condition and associated symptoms. Orthotics The intermetatarsal angle should be normally < 10 degree. It is identified as the intersection line that passes through the first and second shaft of the metatarsal bone. Cyclo-oxygenase-2 (COX-2) inhibitors, drugs which specifically target the COX-2 isoenzyme, were developed as an alternative to traditional NSAIDs due to their potential for less gastrointestinal toxicity. However, as an increase in cardiovascular disease was seen with certain agents, rofecoxib was withdrawn from the worldwide market in September 2004. The other COX-2 inhibitors and traditional NSAIDs are currently under close scrutiny for the emergence of data suggesting similar effects.2 Intra-articular corticosteroid injections, following joint aspiration, are frequently used with excellent response and minimal side effects. Sepsis must be excluded prior to injection, with urgent Gram stain and culture of synovial fluid if infection is considered a possibility. Second degree pronation is simply morerotation to the midline. Some minor leg aches at night, justafter you go to sleep may occur. Shoes do turn, and heel wear isworse. Some may complain of arch pain or pressure in the innerknee. For flat feet, pes planus, just weargood solid shoes that do not bend in the arch. If you arepronating with it, look for solid heel counters in shoes to helphold you erect. If in pain, consult a doctor. They usually startwith a stronger shoe, and then may add a pre-fab arch support orgo directly to a custom arch support. Diffuse musculoskeletal pain syndromes are characterised by disturbed sleep patterns (initial insomnia, exhausted wakening and napping during the day), tenderness over the soft tissue 'trigger' points with facial grimacing and a sharp intake of breath if touched, and the absence of other findings to suggest organic disease. It may be part of chronic fatigue syndrome. Pre and post operative radiographs of a patient with Flat Feet. The radiographs show a dorsilateral peritalar subluxation (the arrows). The radiograph of the right shows the reconstructed deformity with the midfoot fusion bolt and x-plate. Physical therapists help people with injuries or disease to have better function and mobility. They do this by using certain kinds of exercise, electrical stimulation, ultrasounds and massage. Physical therapy programs offer master's degrees and doctoral degrees, which qualify students who graduate to work in hospitals, clinics, schools or homes. These programs teach students to give each patient a personalized treatment program to improve his health. Secondary hypogonadism, also known as hypogonadotropic hypogonadism, is a condition wherein the testes or ovaries do not function properly due to a malfunctioning hypothalamus or pituitary gland. Treatment is dependent on the sex of the individual and comes in a variety of forms.