The affections of the heel in order of their importance are:

1. Tenosynovitis (inflammation of the heel tendon and sheath).

2. Bursitis (inflammation of the little sac lying over the heel tendon).

3. Periostitis (inflammation of the covering of the heel bone at the point of attachment of the heel tendon)

4. Exostoses (outgrowths of bone commonly clue to a previous infection of gonorrhea).

The cause of these conditions is usually mechanical; being due to badly fitting shoes or leggings causing friction and pressure In tenosynovitis, which by the way is very common in foot troops, there is swelling and tenderness along the tendon associated with a grating sound which may be elicited if the hand is placed on the tendon involved and the foot moved up and down. Where bursitis exists there are tenderness, swelling, and signs of fluid; in periostitis, there is usually not much swelling but extreme tenderness is found at the attachment of the heel tendon into the heel bone and may involve the surrounding bone. Exostoses may or may not be felt. Diagnosis usually made by x-ray, chronicity and previous history of gonorrhea. Treatment. Remove primarily the excessive pressure or friction by new shoes or leggings or adjustment or the same. Strap pads of feeling or cotton to the leg just above toe point involved when the tendon is affected and just below when the bursa or tendon attachment is involved, Alternately immersing the foot in hot and cold water—" contrast baths "—often does well. strapping adhesive tape two to three layers thick transversely across the tendon is of benefit in tenosynovitis. The heel may

Treatment. Remove primarily the excessive pressure or friction by new shoes or leggings or adjustment or the same. Strap pads of feeling or cotton to the leg just above toe point involved when the tendon is affected and just below when the bursa or tendon attachment is involved, Alternately immersing the foot in hot and cold water—" contrast baths "—often does well. strapping adhesive tape two to three layers thick transversely across the tendon is of benefit in tenosynovitis. The heel may be raised, to relieve the strain, one-half to one-quarter of an inch. In acute cases where the pain is exquisite and walking impossible, rest is imperative; which, combined with hot compresses and massage of the neighboring parts, avoiding

safety shoes

the irritated area itself, is of benefit. Symptoms are sometimes slow in disappearing but patience must be practiced and care taken if a recurrence is to be avoided. Cases associated with infection are very stubborn and should be referred to the surgeon.