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War Surgery and Medicine
Different Types of Feet
Different Types of Feet
Flat Foot with Free Mobility: This was associated with undue pronation and with some eversion at the ankles, and there was a tendency to a weakening of the transverse arch with widening at the metatarsal heads and a condition of hallux valgus. It was essentially a position of rest or inactivity. With strong musculature the position of activity could be readily attained and the foot function normally. With weak muscles and liability to fatigue, the foot could be the focus of discomfort.
Flat Foot with Rigidity due to the arthritic changes in the tarsal joints and general lack of flexibility in the foot. The position page 395 occupied was similar to the above, but the position of activity could not be resumed. If the condition had become stabilised and painless, satisfactory functional activity was possible. If not stabilised there might be definite disability.
Dropped Anterior Arch: This was really only a part of the relaxation of the foot, but often reconstitution of the arch was impossible and callosities formed under the tread and the foot would not stand the normal strain. Remedial exercises to strengthen the musculature were of special value.
Pes Cavus: The high-arched rigid foot with hammer-shaped toes and some restriction in ankle movement denoted a foot which could not stand undue strain, and in the severer forms was not accepted in the army for any branch necessitating marching. No treatment was of any use in the army.
Hammer Toes: These were often a part of pes cavus but, in minor forms, were of little importance, except for the discomfort from corns which formed on the prominent joints. A simple operative procedure brought about relief in the mild cases.
Hallux Valgus: In the milder forms this was of no importance except as an indication of a weaker foot. When there was a pronounced exostosis of the head of the first metatarsal with a bunion over it treatment to remove both bunion and exostosis was useful. In the severer forms where this simple operation was unavailing no treatment was of use and the men were down-graded. (Lieutenant-Colonel J. K. Elliott reported in 1949 that the removal of the exostoses had in many cases resulted in increased lateral deviation due to the weakening of the capsular ligament.)
Hallux Rigidus: This was a genuine disability because of the inability to spring off the big toe. Treatment was of no use in the army and grading down was necessary.
Overlapping Little Toes: This was a congenital deformity often giving rise to symptoms. The removal of the toe was done if there was real disability. A plastic operation with dorsal division of the capsule of the metatarso-phalangeal joint was preferable to amputation and protected the fourth toe.
Exostosis of the fifth metatarsal, generally associated with a broad foot with spreading transverse arch. If a wide-fitting boot was available, no treatment was necessary. The exostosis was removed, with relief in some cases.
Ingrowing Toenails: This was a very frequent condition, being associated with infection, especially in feet prone to sweating. Simple attention cleared up the milder infection, but in the severer forms the removal of the side of the nail with the nail bed was required. A form of operation popular amongst some orthopaedic page 396 surgeons of removal of the terminal part of the last phalanx of the big toe with all the nail bed was unnecessarily drastic, and constituted a permanent pensionable disability in many cases. (Like other radical measures it is not suitable for army conditions, though indications for its use may arise in civil surgery in cases of engrained and long-standing infection.)
A similar outlook on operative procedures in the army was shown by an Australian Army Instruction.