War Surgery and Medicine
Second World War
In the code of instructions for medical boards in New Zealand at the beginning of the war it was directed that the grading of persons suffering from deformities of feet and toes should be determined by the degree of disablement occasioned and not by the nature of the deformity.
Conditions causing disability were noted as club foot, hammer toes, hallux valgus and rigidus, and flat feet. Severe cases of club foot were classed as totally unfit for service. Hammer toe was considered only to be a disability if painful corns or bursae were present, and the same applied to hallux valgus, though a man with severe hallux rigidus was considered to be only fit for base service in New Zealand. As regards flat feet, rigidity was held to be of special importance.
In 1942 the Regional Deputies were asked their opinions regarding the desirability of making changes in the code of instructions. There had been criticism from the army of the physical standard of many of the recruits graded I who had subsequently had to be down-graded or discharged either in New Zealand or overseas. Auckland was the only centre in which an orthopaedic board was available, and elsewhere the difficulty in getting an orthopaedic page 392 opinion without delay meant that the borderline case was generally rejected. As a result of the opinions received, the National Medical Committee altered the code of instructions.
It pointed out that it was important to investigate any degree of disablement experienced by the man in civilian life and his type of occupation. Consideration had to be given to the possibility of aggravation of the disability by the conditions of military service.
Callosities on the soles of the feet, if not curable, rendered a man unfit for overseas service, as did club foot in the majority of cases. Cases of flat feet were to be graded according to the degree of disablement or anatomical deformity. Cases of hallux rigidus were to be graded as unfit for overseas service. Men with hallux valgus could, in the absence of symptoms, be graded I. No operation was to be recommended for this condition, and no case previously operated on was to be graded I. Hammer toes, on the other hand, could be operated on to improve the grading. No case of pes cavus was to be made Grade I, and severe cases were not to be accepted except for base duties in New Zealand.
This advice was sound in that the grading was to be determined by the degree of disablement occasioned and not by the nature of the deformity. Stress was laid, however, on the anatomy of the foot, and any abnormality of anatomy was held suspect. The boarding was carried out all over New Zealand by very many practitioners, many without army experience, and most without any special orthopaedic or other experience of foot conditions. The functional standard of the feet was difficult to evaluate in a short examination. Without a functional test, it was natural that the anatomical aspect of the problem would be particularly considered.