In a review of 157 anteroposterior (AP) foot radiographs in 117 adult and pediatric patients, we observed a medial excrescence on the plantar aspect of the terminal phalanx of the hallux in 88.5% of the feet. Histologic analysis documented the presence of reactive bone. The bony outgrowth appears after closure of the adjacent physeal plate and is rarely symptomatic. Its high prevalence indirectly implies that it is not specific to any particular type of foot. Although certain types of foot may contribute to its development, we believe that repetitive forces occurring during ambulation induce this reactive bone formation.

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Maureen Lee reflects on the first 18 months of the Early Years Pupil Premium being available to the sector and assesses how it is being used to make a difference to children in early years settings.

Maureen Lee looks at some of the literacy learning approaches being developed by reception professionals across the sector, with case studies from two settings illustrating good practice.

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