War Surgery and Medicine
The problem of foot disability in the army is quite distinct from that in civil life. It has been found that, provided the foot is mobile, minor deformities of any kind are of no significance in function. The grosser deformities and the rigid feet are generally not suitable for full military service, except that fixed bony deformity does not seem to give rise to any marked disability. There are three danger points: on enlistment, at physical training, and on long route marches.
There is profound alteration of the foot habit of the individual when he enters camp. From a sedentary worker wearing light shoes and thin socks, he is transformed into a soldier with heavy boots, thick socks, and then subjected to strenuous physical exercises and long route marches. An ill-fitting boot can play havoc with his feet, and his muscles will need gradual training to enable him to carry out his military duties without foot strain.
The recruit may then come under the control of an over-zealous and exacting physical training instructor who may not realise that the feeble leg musculature cannot at once do all that is asked of it, and as a consequence acute foot strain may develop.
Finally, long route marches may overtax the relatively untrained man, who may feel in honour bound to keep up with his fellows and so subject his feet to severe strain from which he may take a long time to recover.
The provision of well-fitting boots is essential and must be given every attention by combatant officers. The repair of boots, and return to the man of his own boots, is also of great importance. The care of both boots and socks and cleanliness of the feet will guard against most troubles.
Difficulty arose because of the mistaken idea of foot physiology, page 405 and the overstress laid on anatomical variations, which were often mere temporary postural attitudes.
With regard to the treatment of foot deformities, it has been amply proved that no major surgical procedures are advisable under army conditions, and only minor procedures to alleviate a few of the lesser marked deformities are of any real value.
Skin diseases demand attention, and of all diseases hyperidrosis is the most common and most disabling. Eczema, pyogenic infections, especially with reference to ingrowing toenails, and tinea are also of importance. Tinea necessitated constant vigilance in preventing the spread of the infection at bath houses, but did not cause much disability.
The association of psychoneurosis with the disabilities of the foot was the most important, and the most difficult, aspect of the whole problem. It was found that the feebler type of soldier complained, often with perfectly shaped feet, whereas the keen, alert men would carry on under the most rigorous conditions with badly deformed feet.
The realisation that the foot is a highly mobile structure depending for its strength on muscular action is necessary to appreciate its function.
These disabilities were commonly associated with other conditions affecting the general health of the soldier, especially if he was in the older age group.
The total number of cases diagnosed as flat feet reviewed by the War Pensions Department up to March 1952 was 1009 with overseas service and 444 with service only in New Zealand, but the number of those actually receiving pensions was not available.