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An in-depth report on the causes, diagnosis, treatment, and prevention of foot pain.
Bunions; Corns; Hammertoe; Plantar fasciitis; Tarsal tunnel syndrome; Flat feet
Risk Factors
Medical Conditions Causing Foot Pain
Foot pain is very common. About 75% of people in the United States have foot pain at some time in their lives. Most foot pain is caused by shoes that do not fit properly or that force the feet into unnatural shapes (such as pointed-toe, high-heeled shoes).
The foot is a complex structure of 26 bones and 33 joints, layered with an intertwining web of more than 120 muscles, ligaments, and nerves. It serves the following functions:
Because the feet are very small compared with the rest of the body, the impact of each step exerts tremendous force upon them. This force is about 50% greater than the person's body weight. During a typical day, people spend about 4 hours on their feet and take 8,000 to 10,000 steps. This means that the feet support a combined force equivalent to several hundred tons every day.
Foot pain generally starts in one of three places: the toes, the forefoot, or the hindfoot.
The Toes. Toe problems most often occur because of the pressure imposed by ill-fitting shoes.
The Forefoot. The forefoot is the front of the foot. Pain originating here usually involves one of the following bone groups:
The Hindfoot. The hindfoot is the back of the foot. Pain originating here can extend from the heel, across the sole (known as the plantar surface), to the ball of the foot (the metatarsophalangeal joint).
Recommended Footwear
Toe Pain
Corns and calluses
Around toes, usually little toe, bottom of feet or areas exposed to friction.
Hard, dead, yellowish skin.
Wide (box-toed) shoes; soft cushions under heel or ball of foot, or customized or gel insoles for calluses. Doughnut-shaped pads for corns.
Ingrown toenails
Nail curling into skin causes pain, swelling, and, in extreme cases, infection.
Sandals, open-toed shoes.
Bunions and bunionettes (tailor's bunion)
Big toe (bunions) or little toe (bunionettes).
The following can occur alone or in combination:
Metatarsus primus varus. The first (big toe) metatarsal bone shifts away from the second, and the big toe points inward.
Medial exostosis. This is a bony bump at the base of the big toe, which protrudes outward. Area next to bony bump is red, tender, and occasionally filled with fluid. Toe joint may be inflamed.
Hallux valgus. This is a deformity in which the bone and joint of the big toe shift and grow inward, so that the second toe crosses over the big toe.
Soft, wide-toed shoes or sandals. Bunion shields or splints. Thick doughnut-shaped moleskin pads, custom-made orthotics or foot slings, if necessary. Avoid shoes with stitching along the side of the "bump."
Morton's neuroma (also called interdigital neuroma)
Inflammation of the nerve, usually between the third and fourth toes and bottom of the foot near these toes.
Cramping and burning pain, or electric-shock sensation. The condition may produce a thick protective sheath around the nerve that feels like a ball. This may be detected by pressing top to bottom on the top of the foot using one hand and moving the other hand from side to side. Morton's neuroma is aggravated by prolonged standing and relieved by removal of the shoes and forefoot massage.
Wide (box-toed) shoes. Orthotic or insole with pad that reduces stress on the painful area.
Hammertoe or claw toe
Usually second toe, but may develop in any or all of the three middle toes.
Toes form hammer or claw shape. In hammertoe, the first knuckle of the toe is mainly affected. In claw toe the entire toe is deformed. No pain at first, but pain increases as tendon becomes tighter and toes stiffen.
Wide (box-toed) shoes. Toe pads or specially designed shields, splints, caps, or slings. (Splints or slings are not for people with diabetes.)
Front-of-the-Foot Pain
Ball of the foot.
Acute, recurrent, or chronic pain without a known cause.
Wide (box-toed) shoes. Orthotic with pad that reduces metatarsal pressure. Gel cushions. Metatarsal bandage.
Stress fracture
Most often in the area beneath the second or third toe.
Sudden pain (which persists) when injury occurs.
Low-heeled shoes with stiff soles.
Ball of foot beneath big toe.
Pain and swelling.
Low-heeled shoe with stiff sole and soft padding inside.
Heel and Back-of-the-Foot Pain
Plantar fasciitis or heel spurs
Back of the arch right in front of heel.
At onset, some people report a tearing or popping sound. Pain is most severe with first steps after getting out of bed. Pain decreases after stretching, returns after inactivity.
Over-the-counter foot insole (cut quarter-size hole surrounding painful area). Possible night splints. Orthotics if necessary.
Bursitis of the heel
Center of the heel.
Pain, with warmth and swelling. Increases during the day.
Heel cup.
Haglund's deformity ("pump bump")
Fleshy area on the back of the heel.
Tender swelling aggravated by shoes with stiff backs.
Soft shoes. Heel pads. Possible orthotic to support heel.
Achilles tendinitis
Achilles tendon: area along the back between calf muscles and heel.
Pain worsens during physical activities (particularly running), after which the tendon usually swells and stiffens. If it ruptures, popping sound may occur followed by acute pain similar to a blow at the back of the leg.
Insoles, tendon strap, heel cups.
Arch and Bottom-of-the Foot Pain
Tarsal tunnel syndrome
Anywhere along the bottom of the foot.
Numbness, tingling, or burning sensations, pain, most commonly felt at night.
Specially designed orthotics to relieve pressure.
"Flat feet" or posterior tibial tendon dysfunction (PTTD)
The arch.
No arch. Often no pain or discomfort. Three stages in PTTD:
Pain and weakness in the tendon.
The arch flattens but is still flexible.
The foot becomes rigid and possibly painful at the ankle. Sometimes people report fatigue, pain, or stiffness in the feet, legs, and lower back.
For children, possible custom-made insoles.
High arches ("hollow feet")
High arches. Lower back pain, possible tendency to lower limb injuries.
Nearly all causes of foot pain can be grouped under one of the following:
Arthritic Conditions. Arthritic conditions, particularly osteoarthritis and gout, can cause foot pain. Although rheumatoid arthritis almost always develops in the hand, the ball of the foot can also be affected.
Diabetes. Diabetes is an important cause of serious foot disorders. [For more information, see In-Depth Report #9: Diabetes - type 1 and In-Depth Report #60: Diabetes - type 2.]
Obesity. Obesity can cause foot and ankle pain.
Pregnancy. Pregnancy can cause fluid buildup and swollen feet. The increased weight and imbalance of pregnancy contributes to foot stress.
Medications. Some medications, such as calcitonin and drugs used for high blood pressure, can cause foot swelling.
A risk factor is anything that increases your chances of getting a disease or condition. The following are factors that increase your risk for foot pain.
Elderly people are at very high risk for foot problems. As you age, your feet widen and flatten, and the fat padding on the sole of the foot wears down. The skin on the feet also becomes dryer. Foot pain in older adults may be the first sign of age-related conditions, such as arthritis, diabetes, and circulatory disease. Foot problems can also impair balance and function in this age group.
Taking fashion to extreme limits, some people have turned to cosmetic surgery as a drastic way to fit into high-heeled shoes. Procedures include surgical shortening of the toes, narrowing of feet, or injecting silicone into the pads of the feet. Such methods may increase your risk for future foot pain. The American Orthopaedic Foot and Ankle Society (AOFAS) and other foot-related medical associations have expressed concern over this trend. The AOFAS strongly advises against cosmetic foot surgery and urges consumers to carefully consider the relative risks and benefits of undergoing unnecessary surgical procedures.
Women are at higher risk than men for severe foot pain, probably because of high-heeled shoes. Severe foot pain appears to be a major cause of general disability in older women.
An estimated 120,000 work-related foot injuries occur every year, about a third of them involving the toes. Many foot problems -- including arthritis of the foot and ankle, toe deformities, pinched nerves between the toes, plantar fasciitis, adult-acquired flat foot, and tarsal tunnel syndrome -- have been attributed to repetitive use at work (for example, walking long distances or standing for many hours). No studies, however, have scientifically distinguished between injuries due to work versus those due to regular use. This is an important issue because of its potential impact on disability claims.
Pregnant women have an increased risk of foot problems due to weight gain, swelling in their feet and ankles, and the release of certain hormones that cause ligaments to relax. These hormones help when bearing the child, but they can weaken the feet.
People who engage in regular high-impact aerobic exercise are at risk for plantar fasciitis, heel spurs, sesamoiditis, Achilles tendinitis, and stress fractures. Women are at higher risk for stress fractures than men.
Gaining weight puts added stress on the feet and can lead to foot or ankle injuries. The added pressure on the soft tissues and joints of the foot in overweight people increases the likelihood of developing tendinitis and plantar fasciitis.
A corn is a protective layer of dead skin cells that forms due to repeated friction. It is cone-shaped and has a knobby core that points inward. This core can put pressure on a nerve and cause sharp pain. Corns can develop on the top of, or between, toes. If a corn develops between the toes, it may be kept pliable by the moisture from perspiration and is therefore called a soft corn.
Corns develop as a result of friction from the toes rubbing together or against the shoe. They often occur from the following:
Calluses are composed of the same material as corns. Calluses, however, develop on the ball or heel of the foot. The skin on the sole of the foot is ordinarily about 40 times thicker than the skin anywhere else on the body, but a callus can even be twice as thick. A protective callus layer naturally develops to guard against excessive pressure and chafing as people get older and the padding of fat on the bottom of the foot thins out. If calluses get too big or too hard, they may pull and tear the underlying skin.
Risk factors for calluses include the following:
Of note, in people with diabetes, the presence of calluses is a strong predictor of ulceration, particularly in those who have a history of foot ulcers.
Preventing Corns and Calluses and Relieving Discomfort. To prevent corns and calluses and relieve discomfort if they develop:
Removing Corns and Calluses. To remove a corn or callus, soak it in very warm water for 5 minutes or more to soften the hardened tissue, then gently sand it with a pumice stone. Several treatments may be necessary. Do not trim corns or calluses with a razor blade or other sharp tool. Unsterile cutting tools can cause infection, and it is easy to slip and cut too deep, causing excessive bleeding or injury to the toe or foot.
Medicated Solutions and Pads. There are numerous over-the-counter pads, plasters, and medications for removing corns and calluses. These treatments commonly contain salicylic acid, which may cause irritation, burns, or infections that are more serious than the corn or callus. Use caution with these medications. The following people should not use them:
A bunion is a deformity that usually occurs at the end of one of the five long bones (the metatarsal bones) that extend from the arch of the foot and connect to the toes. Most often bunions develop in the first metatarsal bone (the one that attaches to the big toe). A bunion may also develop in the bone that joins the little toe to the foot (the fifth metatarsal bone), in which case it is known as either a bunionette or a tailor's bunion.
A bunion typically develops in the following way:
People born with abnormal bones in their feet are more likely to form a bunion. In addition, wearing narrow-toed, high-heeled shoes, which put enormous pressure on the front of the foot, may also lead to a bunion formation. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe.
Flat feet, gout, arthritis, and occupations (such as ballet) that place undue stress on the feet can also increase the risk for bunions.
Shoes and Protective Pads. Pressure and pain from bunions and bunionettes can be relieved by wearing appropriate shoes, such as the following:
A thick doughnut-shaped, moleskin pad can protect the protrusion. In some cases, an orthotic can help redistribute weight and take pressure off the bunion. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may offer some pain relief.
Surgery. If discomfort persists, surgery may be necessary, particularly for more serious conditions, such as hallux valgus. There are more than 100 surgical variations, ranging from removing the bump to realigning the toes.
The most common surgery, an office procedure known as bunionectomy, involves shaving down the bone of the big toe joint. In one procedure the surgeon uses a very small incision, through which the bone-shaving drill is inserted. The physician shaves off the bone, guided by feel or x-ray. This technique is not a cure, but patient satisfaction is high and results are long-lasting.
More extensive surgeries may be required to realign the toe joint. Although there are variations of each, they generally involve one or more of the following:
In severe cases, surgeons are testing bone grafts to restore bone length in patients who have had previous bunion surgeries or damage from osteoarthritis.
Complications, though uncommon in even the most complex procedures, can include:
Recovery from more invasive procedures, such as arthrodesis or osteotomy, may take 6 to 8 weeks, and it can be that long before a patient can put full weight on the foot. In such cases, the patient will need to wear a cast or use crutches. Elderly patients may need wheelchairs.
A hammertoe is a permanent deformity of the toe joint, in which the toe bends up slightly and then curls downward, resting on its tip. When forced into this position long enough, the tendons of the toe shrink, and the toe stiffens into a hammer- or claw-like shape.
Hammertoe is most common in the second toe, but it can develop in any or all of the three middle toes if they are pushed forward and do not have enough room to lie flat in the shoe. The risk is increased when the toes are already crowded by the pressure of a bunion. Conditions that increase the risk of hammertoe include:
Treatment for Hammertoe. At first, a hammertoe is flexible, and any pain it causes can usually be relieved by putting a toe pad, sold in drug stores, into the shoe. To help prevent and ease existing discomfort from hammertoes, shoes should have a deep, wide toe area. As the tendon becomes tighter and the toe stiffens, other treatments, including exercises, splints, and custom-made shoe inserts (orthotics) may help redistribute weight and ease the position of the toe.
Surgery. Patients with severe cases of hammertoe may need surgery. If the toe is still flexible, only a simple procedure that releases the tendon may be involved. Such procedures sometimes require only a single stitch and a Band-Aid. If the toe has become rigid, surgery on the bone is necessary, but it can still be performed in the doctor's office. A procedure called PIP arthroplasty involves releasing the ligaments at the joint and removing a small piece of toe bone, which restores the toe to its normal position. The toe is held in this position with a pin for about 3 weeks, and then the pin is removed. The procedure seems to have a high, lasting success rate.
Ingrown toenails can occur on any toe, but they are most common on the big toes. They usually develop when tight-fitting or narrow shoes put too much pressure on the toenail and force the nail to grow into the flesh of the toe. Incorrect toenail trimming can also contribute to the risk of developing an ingrown toenail. Other causes include:
An ingrown toenail is a condition in which the edge of the toenail grows into the skin of the toe. The big toe is most commonly affected. Symptoms include pain, redness, and swelling around the toenail.
Caring for Toenails. Trim toenails straight across and keep them long enough so that the nail corner is not visible. If the nail is cut too short, it may grow inward. If the nail does grow inward, do not cut the nail corner at an angle. This only trains the nail to continue growing inward. When filing the nails, file straight across the nail in a single movement, lifting the file before the next stroke. Do not saw back and forth. A cuticle stick can be used to clean under the nail.
Treatments. To relieve pain from ingrown toenails, try wearing sandals or open-toed shoes. Soaking the toe for 5 minutes twice a day in a warm water solution of salt, Domeboro or Betadine can help. People who are at increased risk for infections, such as those with diabetes, should have professional treatment.
Antibiotic ointments may help treat ingrown toenails that are infected. Apply the ointment by working a wisp of cotton under the nail, especially the corners, to lift the nail up and drain the infection. The cotton will also help force the toenail to grow out correctly. Change the cotton daily, and use the antibiotic consistently.
In severe cases, more intensive treatments are needed. Surgery involves simply cutting away the sharp portion of ingrown nail, removing the nail bed, or removing a wedge of the affected tissue. Orthonyxia is a technique that implants a small metal brace into the top of the nail. Nonsurgical methods can also treat ingrown toenails.
One technique uses chemicals to remove the skin. Both sodium hydroxide and phenol may be used, but research shows that sodium hydroxide produces a better outcome and faster recovery than phenol. Phenol may be used along with surgery, and it may make the surgery more effective in preventing recurrence. Other nonsurgical methods include using cauterization (heating), or lasers, to remove the skin.
A review of studies evaluating treatments for ingrown nails found that surgical procedures are more effective than non-surgical therapies in preventing recurrences.
Forefoot pain refers to pain and discomfort felt toward the top of the foot. The rate of forefoot pain and deformity increases with age. When a cause cannot be determined, any pain on the ball of the foot is generally referred to as metatarsalgia.
Forefoot pain may be due to:
A neuroma usually means a benign tumor of a nerve. However, Morton's neuroma, also called interdigital neuroma, is not actually a tumor. It is a thickening of the tissue surrounding the nerves leading to the toes. Morton's neuroma usually develops when the bones in the third and fourth toes pinch together, compressing a nerve. It can also occur in other locations. The nerve becomes enlarged and inflamed. The inflammation causes a burning or tingling sensation and cramping in the front of the foot. Other causes of this condition include:
Treatment for Neuromas. Pain from Morton's neuroma can be reduced by massaging the affected area. Roomier shoes (box-toed shoes), pads of various sorts, and cortisone injections in the painful area are also helpful. A combination of cortisone injections and shoe modifications provides better immediate relief than changes in footwear alone. Ultrasound-guided injection of alcohol might also provide relief from Morton's neuroma, research finds.
If these treatments are not effective, the enlarged area may need to be surgically removed. Success rates for this procedure seem to be high and provide long-term relief. Some numbness is common afterward, but it rarely bothers patients. Occasionally, the nerve tissue may re-grow and form another neuroma.
Sesamoiditis is an inflammation of the tendons around the small, round bones that are embedded in the head of the first metatarsal bone, which leads to the big toe. Sesamoid bones bear much stress under ordinary circumstances; excessive stress can strain the surrounding tendons. Often there is no clear-cut cause, but sesamoid injuries are common among people who participate in jarring, high-impact activities, such as ballet, jogging, and aerobic exercise.
Treatment for Sesamoiditis. Rest and reducing stress on the ball of the foot are the first lines of treatment for sesamoiditis. A low-heeled shoe with a stiff sole and soft padding inside is all that is usually required. In severe cases, surgery may be necessary.
A stress fracture in the foot, also called fatigue or march fracture, usually results from a break or rupture in any of the five metatarsal bones (mostly the second or third). These fractures are caused by overuse during strenuous exercise, particularly jogging and high-impact aerobics. Women are at higher risk for stress fracture than men.
A fracture in the first metatarsal bone, which leads to the big toe, is uncommon because of the thickness of this bone. If it occurs, however, it is more serious than a fracture in any of the other metatarsal bones because it dramatically changes the pattern of normal walking and weight bearing.
Treatment for Stress Fractures. Patients should seek treatment if pain persists for 3 weeks. Treatment after that time may reduce the chances of returning to previous level of functioning. Surgery may be needed if conservative measures fail. In most cases, however, stress fractures heal by themselves if you avoid rigorous activities. Some health care providers recommend moderate exercise, particularly swimming and walking. It is best to wear low-heeled shoes with stiff soles. Occasionally, a health care provider may recommend wearing a walking "boot" (brace) to reduce pain and facilitate healing.
The heel is the largest bone in the foot. Heel pain is the most common foot problem and affects 2 million Americans every year. It can occur in the front, back, or bottom of the heel. Types of heel pain include:
Each type of heal pain is described in more detail below. General treatment guidelines are as follows:
Achilles tendinitis is an inflammation of the tendon that connects the calf muscles to the heel bone. It is caused by small tears in the tendon from overuse or injury. This condition is most common in people who engage in high-impact exercise, particularly jogging, racquetball, and tennis.
Of the people who engage in these activities, those at highest risk for this disorder are the ones with a shortened Achilles tendon. Such people tend to roll their feet too far inward when walking, and may bounce when they walk. A shortened tendon can be due to an inborn structural abnormality, or it can develop from regularly wearing high heels.
An inflamed or torn Achilles tendon causes intense pain and affects mobility.
Evidence is inconclusive about the best way to treat either acute or chronic Achilles tendinitis. Some approaches include:
Treatments to Relieve Pain and Reduce Inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), may help ease pain and reduce inflammation. It is also helpful to apply ice for 20 to 30 minutes, four or five times a day. (Note: Corticosteroid injections should not be used, because they increase the risk for rupture of the tendon.)
Gentle Stretching. Gentle calf muscle stretches may also help reduce pain and spasms. If the calf is swollen, elevate the leg. Exercise is safe when the heel is no longer swollen or tender, even if pain is still present. If pain increases with exercise, stop immediately.
Surgery vs. Nonsurgical Treatment. Chronic inflammation may lead to rupture of the Achilles tendon. If pain continues, the ruptured tendon will require a cast and perhaps surgery, called tendon transfer. Although some experts believe a cast without surgery is a sufficient treatment for such rupture, there is a chance the tendon may rupture again in the future, even after it heals. Some experts suggest surgery for active people and nonsurgical treatment for older people.
Surgery requires a long incision with a postoperative period of immobilization that can average 6 weeks. Complications can include a significant surgical scar, infection, and muscle atrophy, although surgery reduces pain and preserves foot function in the long term.
Bursitis of the heel is an inflammation of the bursa, a small sack of fluid beneath the heel bone. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), and steroid injections will help relieve pain from bursitis. Applying ice and massaging the heel are also beneficial. A heel cup or soft padding in the heel of the shoe reduces direct impact when walking.
Pronation is the normal motion that allows the foot to adapt to uneven walking surfaces and to absorb shock. Excessive pronation occurs when the foot has a tendency to turn inward and stretch and pull the fascia. It can cause not only heel pain but also hip, knee, and lower back problems.
Haglund's deformity, known medically as posterior calcaneal exostosis, is a bony growth surrounded by tender tissue on the back of the heel bone. It develops when the back of the shoe repeatedly rubs against the back of the heel, aggravating the tissue and the underlying bone. It is commonly called pump bump because it's often linked to wearing high heels. (It can also develop in runners, however.)
Treatment for Haglund's Deformity. Applying ice followed by moist heat will help ease discomfort from a pump bump. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), will also reduce pain. Your doctor may recommend an orthotic device to control heel motion. Corticosteroid injections are not recommended because they can weaken the Achilles tendon.
In severe cases, surgery may be necessary to remove or reduce the bony growth. Studies show, however, that recovery from surgery is very long, and success rates vary. Experts advise patients to try all conservative measures before choosing surgery.
Plantar fasciitis is a common foot problem that accounts for 1 million office visits per year. Plantar fasciitis occurs from small tears and inflammation in the wide band of tendons and ligaments that stretches from the heel to the ball of the foot. This band, much like the tensed string in a bow, forms the arch of the foot and helps serve as a shock absorber for the body.
The term plantar means the sole of the foot, and fascia refers to any fibrous connective tissue in the body. Most people with plantar fasciitis experience pain in the heel with their first steps in the morning. The pain also often spreads to the arch of the foot. The condition can be temporary, or it may become chronic if ignored. Resting can provide relief, but only temporarily.
Heel spurs are calcium deposits that can develop under the heel bone as a result of inflammation. Heel spurs and plantar fasciitis are sometimes blamed interchangeably for pain, but plantar fasciitis can occur without heel spurs, and spurs commonly develop without causing any symptoms at all.
Causes of Plantar Fasciitis. The cause of plantar fasciitis is often unknown. It is usually associated with overuse during high-impact exercise and sports. Plantar fasciitis accounts for up to 9% of all running injuries. Because the condition often occurs in only one foot, however, factors other than overuse are likely to be responsible in many cases. Other causes of this injury include poorly-fitting shoes, lack of calf flexibility, or an uneven stride that causes an abnormal and stressful impact on the foot.
Treatment Goals. The three major treatment goals for plantar fasciitis are:
Embarking on an exercise program as soon as possible and using NSAIDs, splints, or heel pads, as needed, can help relieve the problem. Pain that does not subside with NSAIDs may require more intensive treatments, including leg supports and even surgery.
Exercises to Restore Strength and Flexibility. Stretching the plantar fascia is the mainstay therapy for restoring strength and flexibility. One exercise involves the following:
With stretching treatments, the plantar fascia nearly always heals by itself but it may take as long as a year, with pain occurring intermittently. A moderate amount of low-impact exercise (such as walking, swimming, or cycling) also seems to be beneficial.
Treatment. Inflammation and pain is most commonly treated with ice and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. NSAIDs reduce pain and disability in people with plantar fasciitis when used with other techniques, such as night splints and stretching.
Corticosteroids are powerful anti-inflammatory agents. An injection of a steroid plus a local anesthetic (such as Xylocaine) may provide relief in severe cases of plantar fasciitis. (Steroid injections are not used for pain that is only due to heel spurs). For athletes or performers who need immediate relief, an effective method is to administer the steroid dexamethasone using a procedure called iontophoresis, which introduces the drug into the foot's tissue using an electrical current.
Several non-drug approaches can relieve pressure on the heel, including:
"Flat foot," or pes planus, is a defect of the foot that eliminates the arch. The condition is most often inherited. Arches, however, can also fall in adulthood, in which case the condition is sometimes referred to as posterior tibial tendon dysfunction (PTTD). This occurs most often in women over age 50, but it can occur in anyone. The following are risk factors for PTTD:
Some research suggests that flat feet in adults can, over time, actually exert abnormal pressure on the ankle joint that can cause damage. One indirect complication of flat arches may be urinary incontinence or leakage during exercise. The less flexible the arch, the more force reaches the pelvic floor, jarring the muscles that affect urinary continence. Nevertheless, whether flat feet pose any significant problems in adults is unknown.
Treatment for Flat Feet in Children. Doctors usually can't diagnose flat feet until a child is 6 years old. Children with flat feet typically don't have symptoms, and often outgrow the condition. Children who are experiencing symptoms might need to change shoes or wear arch supports. In rare cases, minimally invasive joint insert surgery may be an option.
Treatment for Flat Feet in Adults. In general, conservative treatment for flat feet acquired in adulthood (PTTD) involves pain relief and insoles or custom-made orthotics to support the foot and prevent progression.
In severe cases, surgery may be required to correct the foot posture, usually with procedures called osteotomies or arthrodesis that typically lengthen the Achilles tendon and adjust tendons in the foot. One procedure uses an implant to support the arch. These procedures have potential complications. Try conservative methods first.
An overly-high arch ("hollow foot") can also cause problems. Army studies have found that recruits with the highest arches have the most lower-limb injuries and that flat-footed recruits have the least. Contrary to the general impression, the hollow foot is much more common than the flat foot.
Clawfoot, or pes cavus, is a deformity of the foot marked by very high arches and very long toes. Clawfoot is a hereditary condition, but it can also occur when muscles in the foot contract or become unbalanced due to nerve or muscle disorders.
Claw toe is a deformity of the foot in which the toes are pointed down and the arch is high, making the foot appear claw-like. Claw toe can be a condition from birth or develop as a consequence of other disorders.
Tarsal tunnel syndrome results from compression of a nerve that runs through a narrow passage behind the inner ankle bone down to the heel. It can cause pain anywhere along the bottom of the foot. It can occur with:
Magnetic resonance imaging (MRI) and the dorsiflexion-eversion test can diagnose this syndrome.
Treatment for Tarsal Tunnel Syndrome. Specially designed shoe inserts called orthotics can relieve pain from tarsal tunnel syndrome because they help redistribute weight and take pressure off the nerve. Corticosteroid injections may also help. Surgery is sometimes performed, particularly if symptoms persist for more than a year, although its benefits are a matter of debate. Tarsal tunnel syndrome caused by known conditions, such as tumors or cysts, may respond better to surgery than tarsal tunnel syndrome of unknown cause. It can take months after this surgery for a person to recover and resume normal activities. Only experienced surgeons should perform tarsal tunnel syndrome surgery.
If you suspect that you have broken or fractured bones in a toe or foot, call a doctor, who will probably order x-rays. Even if you can walk, you still might have a fracture. People are often able to walk even if a foot bone has been fractured, particularly if it is a chipped bone or a toe fracture.
Over-the-counter NSAIDs are commonly used to treat mild pain caused by muscle inflammation. Aspirin is the most common NSAID. Others include ibuprofen (Motrin, Advil, Nuprin, Rufen), ketoprofen (Actron, Orudis KT), naproxen (Aleve, Naprelan), and tolmetin (Tolectin). A gel containing ibuprofen can be applied to sore joints. Acetaminophen (Tylenol) is not an NSAID, and although it is an effective pain reliever, it will not reduce inflammation. It is important to note that high doses or long-term use of any NSAID can cause gastrointestinal disturbances with sometimes serious consequences, including dangerous bleeding. NSAIDs can also increase the risk of heart disease and stroke. This risk increases the longer you use them. No one should take NSAIDs for prolonged periods of time without consulting a doctor.
The acronym RICE stands for rest, ice, compression, and elevation -- the four basic elements of immediate treatment for an injured foot.
Minor injuries like sprains may be treated at home if broken bones are not suspected. The acronym RICE is helpful for remembering how to treat minor injuries: "R" stands for rest, "I" is for ice, "C" is for compression, and "E" is for elevation. Pain and swelling should decrease within 48 hours, and gentle movement may be beneficial, but don't put pressure on a sprained joint until the pain is completely gone (one to several weeks).
The American Podiatric Medical Association offers the following tips for preventing foot pain:
Skin creams can help maintain skin softness and pliability. A pumice stone or loofah sponge can help get rid of dead skin.
Taking a warm footbath for 10 minutes two or three times a week will keep the feet relaxed and may help prevent mild foot pain caused by fatigue. Adding 1/2 cup of Epsom salts may increase circulation and add other benefits. Taking footbaths only when the feet are painful is not as helpful.
In addition to wearing proper shoes and socks, walking often -- and properly -- can prevent foot injury and pain. The head should be erect, the back straight, and the arms relaxed and swinging freely at the side. Step out on the heel, move forward with the weight on the outside of the foot, and complete the step by pushing off the big toe.
Exercises specifically for the toe and feet are easy to perform and help strengthen them and keep them flexible. Helpful exercises include the following:
Early Development. The first year of life is important for foot development. Parents should cover their babies' feet loosely, allowing plenty of opportunity for kicking and exercise. Change the child's position frequently. Children generally start to walk at 10 to 18 months. They should not be forced to start walking early. Wearing just socks or going barefoot indoors helps the foot develop normally and strongly and allows the toes to grasp. Going barefoot outside, however, increases the risk for injury and other conditions, such as plantar warts.
Shoes. Children should wear shoes that are light and flexible, and since their feet tend to perspire, their shoes should be made of materials that breathe. Replace footwear every few months as the child's feet grow. Footwear should never be handed down. Protect children's feet if they participate in high-impact sports.
In general, the best shoes are well cushioned and have a leather upper, stiff heel counter, and flexible area at the ball of the foot. The heel area should be strong and supportive, but not too stiff, and the front of the shoe should be flexible. New shoes should feel comfortable right away, without a breaking-in period.
Well-fitted shoes with a firm sole and soft upper are the best way to prevent many problems with the feet. They should be purchased in the afternoon or after a long walk, when the feet have swelled. There should be 1/2 inch of space between the longest toe and the tip of the shoe (remember, the longest toe is not always the big toe), and the toes should be able to wiggle upward.
Stand when being measured, and have both feet sized, buying shoes that fit whichever foot is largest. Wear the same socks as you would regularly wear with the new shoes. Women who are accustomed to wearing pointed-toe shoes may prefer the feel of tight-fitting shoes, but with wear their tastes may adjust to shoes that are less confining and properly fitted.
Ideally, the shoe should have a removable insole. Thin, hard soles may be the best choice for older people. Elderly people wearing shoes with thick inflexible soles may be unable to sense the position of their feet relative to the ground, significantly increasing the risk for falling.
High heels are the major cause of foot problems in women. Although people believe that foot binding is a problem limited to Chinese women of the past, many fashionable high heels are designed to constrict the foot by up to an inch. Women who insist on wearing high-heeled shoes should at least look for shoes with wide toe room, reinforced heels that are relatively wide, and cushioned insoles. They should also keep the amount of time they spend wearing high heels to a minimum.
The way shoes are laced can be important for preventing specific problems. Laces should always be loosened before putting shoes on. People with narrow feet should buy shoes with eyelets farther away from the tongue than people with wider feet. This makes for a tighter fit for narrower feet and a looser fit for wider feet. If, after tying the shoe, less than an inch of tongue shows, the shoes are probably too wide. Adjust tightness both at the top and bottom of the shoe. If shoes with high arches cause pain, skip a few eyelets when lacing them. This should relieve pressure.
If shoes need breaking in, place moleskin pads next to areas on the skin where friction is likely to occur. Once a blister occurs, moleskin is not effective. Change shoes during the day, and rotate between different pairs of shoes. As soon as the heels show noticeable wear, replace the shoes or their heels.
Avoid extreme variations between exercise, street, and dress shoes.
Exercise and Sports. Shoes purchased for exercise should be specifically designed for a person's preferred sport. For instance, a running shoe should especially cushion the forefoot, while tennis shoes should emphasize ankle support. Athletic socks are almost as important as shoes. Experts often recommend padded acrylic socks.
Occupational Footwear. Because a number of occupations put the feet in danger, workers in high-risk jobs should be sure their footwear is protective. For example, non-electric workers at risk for falling, or whose work involves rolling objects or risk of shoe punctures, should wear shoes with steel toes and possibly other metal foot guards. Electric workers should wear footgear with no metal parts (or insulated steel toes) and rubber soles and heels. Chemical workers should wear shoes made of synthetics or rubber, not leather.
Aerobic Dancing
Sufficient cushioning to absorb shock and pressure, which should be many times greater than shock from walking. Arches that maintain side-to-side stability. Thick upper leather support. Box toe. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.
Rigid support across the arch to prevent collapse during pedaling. Heel lift. Cross-training or combo hiking/cycling shoes may be sufficient for the casual biker. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance the forefoot.
Sufficient cushioning to absorb shock and pressure. Fully bendable at the ball of the foot. Enough traction on the sole to prevent slipping. Consider insole or orthotic with arch support for problem feet.
Allows side-to-side sliding. Low-traction sole. Snug fitting heel with cushioning. Padded toe box with adequate depth. Soft-support arch.
Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch anklebone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.
Insoles are flat cushioned inserts that are placed inside the shoe. They are designed to reduce shock, provide support for heels and arches, and absorb moisture and odor. In general, they can be very helpful for many people.
People respond very differently to specific insoles. What may work for one person may not work for another. Consider the thickness of socks when purchasing insoles to be sure they do not squeeze the toes up against the shoes. Insoles can be purchased in athletic and drug stores. Shoe stores that specialize in foot problems often sell customized, but more expensive, insoles. In general, over-the-counter insoles offer enough support for most people's foot problems. Most well-known brands of athletic shoes have built-in insoles.
Brands and Materials. There are many types of insoles available. They are composed of various materials, such as cork, leather, plastic foam, and rubber. Effective insoles (such as Sorbothane, Airplus, Spenco, Dr. Scholl's Massaging Gel, and others) are now made from viscoelastic polymerses, which are gel-like materials that act both as liquids and solids.
Heel Cushions for Shortened Achilles Tendons. People who have developed short, tightened Achilles tendons (usually women who have worn high-heeled shoes for prolonged periods) should consider using heel cushions. Like insoles, heel cushions are inserted inside the shoes. They should be at least 1/8 inch thick, but not more than 1/4 inch thick.
For severe conditions, such as fallen arches or structural problems that cause imbalance, podiatrists or physicians may need to fit and prescribe orthotics, or orthoses, which are insoles produced to fit the patient's foot and match his or her clinical needs Orthotics are usually categorized as rigid, soft, or semi-rigid.
Before seeking prescription orthotics, people with less severe problems should consider testing the lower-priced, over-the-counter insoles.
Types of orthotics include:
Baer GS, Keene JS. Tendon injuries of the foot and ankle. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009. Pp. 2171-2205:section D.
Del Toro, DR. Tibial Neuropathy (Tarsal Tunnel Syndrome). In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008. pp. 479-482.
Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28:20-23.
Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database Syst Rev. 2012;4:CD001541.
Frey C, Zamora J. The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int. 2007;28:996-999.
Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46:348-357.
Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. 2008;16:(3):CD006801
Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;79(4):303-8.
Hughes RJ, Ali K, Jones H, Kendall S, Connell DA. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. Am J Roentgenol. 2007;188:1535-1539.
Kruijff S, van Det RJ, van der Meer GT, van den Berg IC, van der Palen J, Geelkerken RH. Partial matrix excision or orthonyxia for ingrowing toenails. J Am Coll Surg. 2008;206:148-153.
Lee SY, McKeon P, Hertel J. Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys Ther Sport. 2009;10:12-18.
The Ankle and Foot. In: Mercier, LR. Mercier: Practical Orthopedics, 6th ed. Philadelphia, Pa: Mosby; 2008. pp.243-273.
Pasquina PF, Foster LS. Plantar fascitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008. pp. 469-473.
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text: The sun, the snow, the sights. It all happened at Mammoth Mountain this past weekend. Opening weekend at Mammoth is more than just a weekend of snowboarding. It's a weekend when friends from all over get together to snowboard, party, and just celebrate that the season's finally here. This year was no exception. From riding fresh snow in the California sun, to seeing the Black Lips tear it up on stage, there was really nothing but amazing times this past weekend. If you couldn't make it, well then check out this giant photo gallery, and this video and pretend that you were there.

subset: commoncrawl


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A California man whose young daughter was abducted and strangled 19 years ago has dedicated the intervening years to helping find children who go missing.
Marc Klaas operates on the principle that a sustainable search for a missing child depends on the momentum of the loved ones closest to the absent family member.
Parents are the best advocates for a missing kid, Marc Klaas said Thursday from Sausalito, Calif. If the family gives up hope, what hope is there?
Dylan Redwine, 13, dropped out of sight Nov. 19 while on a court-ordered visit to his father, Mark Redwine, in Vallecito.
The coordinator of the volunteer search teams looking for Dylan Redwine said Friday that community interest in the case remains fairly high.
This is still a heartache for (the community), and having no answers is scary, Denise Hess said. There is very high awareness. I feel (interest) might be waning a little bit. The momentum has definitely slowed down, but it is still pretty high.
Klaas founded KlaasKids Foundation in 1994 as a result of the kidnapping and murder of his 12-year-old daughter, Polly, the year before. Polly was abducted at knife point at a slumber party on Oct. 1, 1993, and strangled. The killer gave information that led to the discovery of her body about three months later.
KlaasKids promotes child safety. In 2001 he co-founded BeyondMissing Inc., a federally funded nonprofit that distributes information about missing children. He speaks extensively across the country.
Its up to family members and advocates to keep public attention focused on a missing child, Klaas said. They can use the professional media and social networking, he said.
I think Facebook now has 1 billion subscribers, Klaas said. We can still grab media attention, too.
Klaas said that despite the arrest of a suspect in the March 16 abduction of Sierra LaMar, 15, while she was waiting for a school bus in Morgan Hill (15 miles south of San Jose), an active search for her continues.
Eight months after Sierra disappeared, 40 people still turn out every Saturday to search for her, Klaas said. But we dont give out specifics about their activities.


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Professor of Law
J.D., Yale Law School, 2009
Ph.D., Yale University, 2011
B.S., Ohio State University, 2002
B.A., Ohio State University, 2002
Quinn Curtis joined the law faculty in 2011. He teaches corporations, securities and real estate law. His research focuses on empirical law and finance and includes work on mutual funds, corporate governance and corporate litigation.
Curtis received his undergraduate degrees in philosophy and physics magna cum laude from Ohio State University, where he was elected to Phi Beta Kappa. He received his J.D. from Yale Law School, where he served as an articles editor on the Yale Law Journal. He received his Ph.D. in finance from Yale School of Management in 2011. Prior to attending law school, Curtis worked as a software engineer at Microsoft Corporation.
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erythromycin topical (generic name)
Romycin (brand name)
It is used on the skin to treat acne
(er ith roe MYE sin)
Table of Contents
Top Learning Centers(Recursos en Español)
What is this medicine?ERYTHROMYCIN (er ith roe MYE sin) is a macrolide antibiotic. It is used on the skin to treat acne.
What should I tell my health care provider before I take this medicine?They need to know if you have any of these conditions:
How should I use this medicine?This medicine is for external use only. Do not take by mouth. Follow the directions on the prescription label. Wash hands before and after use. Wash the affected area with warm water and soap, rinse, and dry completely before applying. Wait 30 minutes after shaving or washing before applying the gel. This preparation contains alcohol and may sting. Apply a thin film to cover the affected area. Do not get this medicine in your eyes. If you do, rinse out with plenty of cool tap water. Use your doses at regular intervals. Do not use your medicine more often than directed. Use this medicine for the full course prescribed by your doctor or health care professional, even if you think your condition is better. Do not stop using except on your the advice of your doctor or health care professional.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
What if I miss a dose?If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.
What may interact with this medicine?
What should I watch for while using this medicine?Tell your doctor or health care professional if your skin does not improve after 3 to 6 weeks of use. It can take 8 to 12 weeks of treatment to see the full effects of this medicine.
Do not wash your face more than 2 to 3 times a day. Frequent washing can make your skin very dry, scale or peel. Let your doctor or health care professional know if this happens. Do not use any soothing cream or ointment without advice.
You can use makeup while using this medicine. Only use water based products and apply lightly.
What side effects may I notice from receiving this medicine?Side effects that you should report to your doctor or health care professional as soon as possible:
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
Where should I keep my medicine?Keep out of the reach of children.
Store at room temperature between 15 and 25 degrees C (59 and 77 degrees F). This medicine contains alcohol and can catch fire. Keep away from heat, lighted matches, cigarettes and other naked flames. Throw away any unused medicine after the expiration date.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.


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There are a number of reasons why you could be here. The first being, you have no idea how to use the Interwebz. Shame on you!
The second being we've misplaced it. We assure you the person responsible for this is getting reprimanded as we speak! We're taking them to the center of town for a good old fashion public humiliation. Quick, sound the Flute of Shame!


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Buy Viktor & Rolf Magic Collection Dirty Trick Online
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|Viktor & Rolf Magic Collection Dirty Trick (2017)
|Group: Oriental Floral
|Odor: woody, powdery, balsamic
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Have you got the pool skills required?
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Before the final showdown in the Elite field, the Collegiate races were held on the last day of the US National Cyclocross Championships on Sunday. The temperatures had warmed up and the some of the water on the infield has been drained but it was still a sloppy mess for the riders.
Collegiate Women. The 2009 U23 cyclocross national champion, Ashley James (Appalachian State University), attacked from the gun in the D1 women's race and built her lead in the first two laps to a solid 40 seconds over Marian University's Kaitlin Antonneau and Lees McRae's Erica Zaveta and Carla Swart, who traded off places throughout the race.
James maintained her lead throughout for a dominating win. Antonneau took a 20-second lead over the Lees McRae women to claim second, while Swart, the 2008 national collegiate cyclo-cross champ, bested Zaveta for third.
In the D2 women's race, strong efforts from Eastern Collegiate Cycling Conference powerhouse riders Arielle Filiberti (Dartmouth) and Laura Ralston (MIT) couldn't match the surprise ride from the strongwoman from the University of Tennessee-Chattanooga, Kimberly Flynn who led most of the race. Western Washington University's Courtenay Mcfadden claimed third behind Ralston, while Filiberti took fourth and perennial favorite Lindsy Campbell (University of Montana) finished fifth.
Collegiate Men. After finishing second in heated battle in the U23 race the day before, Zach McDonald (University of Washington-Seattle) came out swinging to earn back-to-back Stars-and-Stripes in the Division I collegiate men's race. Brady Kappius (University of Colorado-Boulder) attacked early and held a strong lead until reigning champ McDonald inched his way to the front on the second lap with Kappius fading to fourth.
From there it was McDonald and Eric Thompson (Lees-McRae College) fighting one-on-one in a matchup reminiscent of 2009's duel between McDonald and Fort Lewis' Sonntag. Thompson, however, was taken out halfway through a lap with a derailleur that fell apart in the middle of the day's horrifically sticky mud. From there it was McDonald's race to lose, and he did not give up the lead the rest of the day. Chris Hurst (University of Colorado-Boulder) surged to a late second-place finish, with Brad Perley (Lees-McRae College) claiming third.
In the D2 men's race the Western Washington University duo of Steve Fisher and Logan Wetzel overcame an early attack from 2009 winner Ryan Leech (Savannah College of Art & Design) to take control of the race in the second lap and never let go. Leech managed to hold on for third ahead of Mesa State College's Mullervy brothers, Conor and Kevin.
Collegiate Omniums. With the most points earned in both the men and women's races, Lees McRae walked away handily with the overall D1 omnium win, thanks to dominating top-10 finishes in both races. Fort Lewis played the numbers game well, placing numerous riders in the top ten of each race, as well, and it earned them second place on the weekend, one step down from last year.
Marian University continued their climb in the world of cyclocross, claiming third, just ahead of Appalachian State University, a newcomer to the Division 1 field (having just surpassed 15,000 students, ASU moved from DII to DI this year). University of Washington rounded out the podium in fifth
In the D2 competition, five top-10 finishes this weekend allowed Western Washington University to take a commanding victory, with up-and-coming Mars Hill College claiming second. MIT took third with more top individual finishes and MIT was fourth. Local favorite Central Oregon Community College rounded out the top five.
Top 5 D1 Collegiate Women
1. Ashley James (Dousman, Wis./Appalachian State University) 0:39:10
2. Kaitlin Antonneau (Racine, Wis./Marian University) 0:40:14
3. Carla Swart (Banner Elk, NC/Lees-McRae College) 0:40:43
4. Erica Zaveta (Erwinna, Penn./Lees-McRae College) 0:40:48
5. Sarah Sturm (Durango, Colo./Fort Lewis College) 0:43:44
Top 5 D2 Collegiate Women
1. Kimberly Flynn (Hixson, Tenn./UT-Chattanooga) 0:43:34
2. Laura Ralston (Cambridge, Mass./MIT) 0:44:21
3. Courtenay McFadden (Bellingham, Wash./Western Washington University) 0:44:54
4. Arielle Filiberti (Worcester, Mass./Dartmouth) 0:45:49
5. Lindsy Campbell (Missoula, Mont./University of Montana) 0:46:10
Top 5 D1 Collegiate Men
1. Zach McDonald (Bainbridge Island, Wash./University of Washington-Seattle) 0:41:30
2. Chris Hurst (Lake Geneva, Wisc./University of Colorado-Boulder) 0:41:38
3. Bradford Perley (Banner Elk, N.C./Lees-McRae College) 0:41:43
4. Braden Kappius (Littleton, Colo./University of Colorado-Boulder) 0:42:14
5. Eric Thompson (Banner Elk, N.C./Lees-McRae College) 0:42:19
Top 5 D2 Collegiate Men
1. Steve Fisher (Bellingham, Wash./Western Washington University) 0:42:56
2. Logan Wetzel (Renton, Wash./Western Washington University) 0:42:58
3. Ryan Leech (Savannah, Ga./Savannah College of Art & Design) 0:43:55
4. Conor Mullervy (Boise , Idaho/Mesa State College) 0:44:26
5. Kevin Mullervy (Littleton, Colo./Mesa State College) 0:44:44
DI Team Omnium
1. Lees-McRae College 188
2. Fort Lewis College 156
3. Marian University 129
4. Appalachian State University 113
5. University of Washington-Seattle 107
DII Team Omnium
1. Western Washington University 188
2. Mars Hill College 146
3. Massachusetts Institute of Technology 121
4. Mesa State College 121
5. Central Oregon Community College 95
Photo Gallery. Click for larger images or View [autoviewer id="99″ width="1000″ height="540″ link="slideshow"]


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Ca-Mg Antacids/Sodium Polystyrene Sulfonate Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
When these two medicines are taken together, they may bind together in your intestine.
What might happen:
Sodium polystyrene sulfonate may not work as well at lowering your potassium level. You may also experience a disturbance in the acid balance in your blood.
What you should do about this interaction:
If you experience breathing difficulty, chest pain, slow or irregular heartbeat, confusion, muscle weakness, or numbness and tingling of the hands and feet, contact your doctor. It may be necessary to adjust the times of day that you take one or both medicines. Your doctor may stop your antacid or change you to a different medicine. This interaction may be worse if you have kidney disease.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Schroeder ET. Alkalosis resulting from combined administration of a "nonsystemic" antacid and a cation-exchange resin. Gastroenterology 1969 May;56(5):868-74.
- 2.Fernandez PC, Kovnat PJ. Metabolic acidosis reversed by the combination of magnesium hydroxide and a cation-exchange resin. N Engl J Med 1972 Jan 6; 286(1):23-4.
- 3.Ziessman HA. Alkalosis and seizure due to a cation-exchange resin and magnesium hydroxide. South Med J 1976 Apr;69(4):497-9.
- 4.Baluarte HJ, Prebis J, Goldberg M, Gruskin AB. Metabolic alkalosis in an anephric child caused by the combined use of Kayexalate and Basaljel. J Pediatr 1978 Feb;92(2):237-9.
- 5.Madias NE, Levey AS. Metabolic alkalosis due to absorption of "nonabsorbable" antacids. Am J Med 1983 Jan;74(1):155-8.


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|NC State Wolfpack vs Louisville Cardinals football photos by sports photographer Gene Galin.
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|Total images: 153 | Last update: 10/7/17 12:00 PM | ACC Football News | ACC Football Photos | Help
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Your tax invoice can be downloaded on flysaa.com under Manage & Fly 72 hours after the e-ticket has been issued.
If a Tax Invoice has been successfully generated from the South African Airways Tax Invoice System, the onus rests on the recipient to ensure that his/her mailbox has enough space to receive an e-mail - with a PDF attachment; and that his//her service provider or exchange server allows for delivery of such e-mails. South African Airways, can not take responsibility for undelivered e-mails due to any other reasons beyond our control including the above.
Prescribed details required from the South African Revenue Service on a tax invoices
Tax invoices must ordinarily reflect the following details as prescribed by the South African Revenue Service Act, 1997 (Act No. 34 of 1997):
Johannesburg, South African Airways (SAA) has won Global Traveler's highest honor, being named "Airline of the Year" by the venerable publication for global business travelers and fans of luxury travel. SAA received the award at its annual awards gala that honours the best in travel. In naming the recipient of the award, the magazine cited SAA as a "perennial favorite" among its readers and the "perfect representative of South Africa's personality, promise and culture." It also added that SAA "is a standout in all aspects of the industry." At the Dec. 12th awards ceremony held in Los Angeles, Executive Vice President of North America Todd Neuman was joined by fellow SAA executives, as well as a representative from the Consulate General of South Africa and key travel industry and corporate partners – each of whom were on hand to celebrate this prestigious win with South Africa's national airline.
"South African Airways would like to thank the Global Traveler 'Year Committee' for the great honor of being named 'Airline of the Year.' We would also like to thank the readers of the magazine for voting SAA as 'Best Airline in Africa,'" said Neuman. "These awards, plus the 'Best White Wine International Business Class,' are indicative that our efforts are working," said Neuman.
Global Traveler's recognition of SAA as "Best White Wine International Business Class" was for the Driehoek Sauvignon Blanc 2011, chosen by SAA and a panel of international judges during the airline's annual comprehensive wine selection process, which is meant to showcase South African wines throughout the globe, while also complementing a carefully-designed selection of on-board cuisine and its accompanying services.
"Enhancements have been made to our onboard product for Premium Business Class customers, with added comfort to our flat-bed Premium Business Class seats, new menu choices from South African star chefs, expanded entertainment options and our award-winning South African wine cellar in the sky," added SAA's Neuman. "Our enhancements in these areas will continue, as we strive to offer the fastest, most convenient and comfortable service to Africa for both business and leisure customers."
South African Airways has introduced new service to cities such as Brazzaville (Republic of Congo), Abidjan (Ivory Coast) and Cotonou (Benin), among other cities that it has added to its already-extensive route network on the African continent. It is also featuring meal selections from South African star chefs, first with Chef Reuben Riffel, and now with Chef Benny Masekwameng, a judge on South Africa's Master Chef TV series.
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About SAA
South African Airways (SAA) is the leading carrier in Africa, serving 26 destinations across the continent, as well as major destinations within South Africa and internationally from its Johannesburg hub. It is a member of the largest international airline network, Star Alliance. SAA's core business is the provision of passenger airline and cargo transport services together with related services, which are provided through SAA and its four wholly owned subsidiaries: SAA Technical; Mango its low cost carrier; Air Chefs, the catering entity of SAA and South African Travel Centre (SATC). SAA is the winner of the 'Best Airline in Africa' Award in the regional category for ten consecutive years and the winner of 'Service Excellence Africa' for three consecutive years. Mango and SAA hold the number one and number two successive spots as South Africa's most on - time airlines.
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Give us an old Harley-Davidson or other motorcycle T-shirt and we'll give you a new Indian Motorcycle tee - FREE! We'll donate all collected apparel to the Salvation Arny. While supplies last.
EagleRider Motorcycle Sales is committed to adhering to privacy principles and requirements in compliance with all applicable laws. It is our policy to safeguard all individually identifiable information entrusted to us. Use of this information enables us to provide you with superior customer service and offer products, programs, and services that may be of interest to you. We have developed this privacy notice to explain to you our practices regarding individually identifiable information.
This Privacy Notice applies to the practices of EagleRider Motorcycle Sales, with respect to the individually identifiable information we collect about you in connection with assisting you in obtaining financing when you use the finance application on our web site.
I certify that the information provided in this Application is complete, correct, and true to the best of my knowledge. I authorize EagleRider and their agents to pull my credit report from the credit reporting agencies and to investigate my credit, employment, and income records. I agree that you may obtain credit and employment information about me by any means, including obtaining information from check or credit-reporting agencies and from other sources. I also authorize you to obtain my consumer report (credit report) for any reason and from time to time in the future when updating, renewing or extending my lease contract.
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Our Chinese learning materials are unique in the following ways:
- Cater for children of all ages (including early learning for babies and toddlers).
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Photo Gallery of the NorCal Spring Classic Copperopolis. Photos from the morning categories: Men Cat 1/2/Pro, Men Category 3, Men Category 4, Men Jr 17-18, Men Category 5, Men Masters 35+ 1/2/3, Men Masters 45+ 1/2/3, Women Cat1/2, Women Category 3, Junior Women 15-18 and Men Jr 15-16.
Ben Jacques-Maynes (BISSELL) won the Men Pro/1/2 race in a 3-up sprint with Jesse Moore (CalGiant) second and Nate English (Yahoo! Cycling) third. Rebecca Werner (Webcor/Alto Velo) outsprinted the Fremont Bank Cycling teammates Susannah Breen and Beth Newell for the win in the Women 1/2 race. (Complete Results here)
These photos and more from the day can be purchased here
Click for larger images or View [autoviewer id="170″ width="1000″ height="540″ link="slideshow"]


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HD Background – Amazing Ocean Custom Wallpaper 2560x1600
Download this cool PC wallpaper in high resolution for free. Get HD Wallpaper and make this wallpaper for your desktop, tablet and smartphone device.
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Welcome to the Beaney Eshop
Welcome to Beaney's E-Shop. Here you will find a selection of products from event and exhibtion tickets to souvenirs and gifts available to purchase.
This product is no longer available in this eShop.
Gift Aid
If this is a personal purchase and you are a UK taxpayer*, can increase the value of your purchase without costing you a penny. If you tick the 'Reclaim Gift Aid' box and fill in your full name and home address details, will be able to claim at least 25% extra from the Government on top of your purchase made through Canterbury website. Your name and address will be forwarded to in this case to allow them to claim the Gift Aid.
*You must have paid UK tax this year at least equal to the 25% will claim.


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call out www.yu.edu
Sorry, the page you are looking for cannot be found or has moved. Frustrating, I know. Please try visiting the home page or using the search box at the top of this page.
Please use the navigation structure above to find the page in our new web site design.
Want to speak to someone directly? You can email us or use our Contact List.
Yeshiva University
500 West 185th Street
New York, NY 10033
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KMeleonWiki > Resources > Translation and Localization
Welcome to the Translation and Localization page. Here you'll find translation packages that make K-Meleon speak your language. Please be encouraged to submit your own translations.
The only part of K-Meleon that is easily translatable today is the menu system. (You can actually translate the tooltips too, but this will then have to be redone for each new theme that you install.) When/If K-Meleon gets full localization support you will find all needed files here.
See http://kmeleon.sourceforge.net/resources/translations.php for old translations still not added to the KMeleonWiki.