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War Surgery and Medicine

Remedial Treatment in 2 NZEF

Remedial Treatment in 2 NZEF

A considerable number of men were down-graded in the 2 NZEF for foot disabilities, most of them for flat feet. The disability was present generally in debilitated individuals prone to fatigue, and was often just part of a general lack of vitality and also part of a psychoneurosis. The man robust physically and mentally could carry on with a very flat foot without complaint, but the weakling not only felt the results of fatigue more often but used the mild page 397 disability as a refuge. Efforts were made by special remedial training units to make the men Grade I, but because of the psychological condition of so many it was difficult to improve their condition.

A report written by the DMS 2 NZEF in August 1941 gives a clear idea of the difficulties experienced at that time:

The problem of men who become unfit through flat feet and other foot disabilities is becoming an acute one. A number of men are sent to the bone and joint specialists at the general hospitals and are ordered foot exercises, graduated training, and various matters of attention to boots and socks. In very few cases are the results successful.

It is felt, therefore, that some arrangement must be made to get these men together under supervision so that all these necessary measures may be carried out and decision made as to whether men are fit to resume training for the field, or must be re-graded. The most suitable arrangement would seem to be to form a special group at the Base Reception Depot under the control of a junior officer or senior NCO.

A good surgical bootmaker is desirable, though a certain amount of alterations to boots is carried out by the splint-maker attached to 2 NZ General Hospital. A chiropodist attached at present to 1 Camp Hospital could be transferred and a medical officer could be detailed to check all cases twice a week.

This statement was supported by a report by the Consultant Surgeon 2 NZEF on the problem:

In cases appearing before medical boards for reclassification during the last few months, there has been an increased incidence of cases designated as flat feet, metatarsalgia, or other afflictions of the anterior arch, and a small number of cases of pes cavus. The following observations are made after carefully eliciting the history and symptoms of the cases, and after examination of them, by both general and orthopaedic surgeons:

In only a very small proportion of the cases has there been any real anatomical abnormality that can be readily ascertained on physical examination. In almost all the cases the symptoms complained of are not those pathognomonic of flat feet or metatarsalgia.

Treatment by raising the inner aspect of the sole and heel of the boot has not only been of no benefit in most cases but has aggravated the condition, the men being more comfortable in tennis shoes. In a definite proportion the boots have been found to be illfitting and they are always stiff and rigid. In many cases the first onset of the symptoms has followed very prolonged route marches. It is an almost constant statement that no route marching had been done in New Zealand and often little or none done in Egypt previously.

As a result of these observations it is clear that the symptoms complained of are not those due to flat feet but rather to muscular fatigue, especially and naturally shown as foot fatigue in men undergoing training by route marches or constantly on their feet. This is shown by the symptoms being aggravated rather than relieved by wedging of the boot, and by the relative comfort of sand shoes. These symptoms naturally arise in those soldiers who are unable temperamentally to put up with discomfort of any kind—the feebler type of soldier.

The problem is naturally difficult to solve, but, if looked upon as one of fatigue and lack of energy generally, perhaps something can be done page 398 to solve it by arranging a special platoon at the Base for men suffering from foot fatigue and other somewhat similar conditions, such as convalescence from knee and leg injuries. This platoon could be given special graduated training by physical instructors capable of dealing with the position sympathetically yet firmly. Special attention could be paid in the platoon to the fitting of boots, the wearing of satisfactory and clean socks as well as to any alterations in the boots advised by the medical officer. Chiropody could be made available from the camp hospital. An orthopaedic surgeon could carry out regular visits to the platoon to advise on problems connected with the training, and also to examine any special cases.

Finally I consider that observation of these cases shows that massage and physiotherapy is not only useless and a waste of time, but actually aggravates the condition by fixing the disability in the mind of the patient and giving him a sense of invalidism.

Special clinics were set up in Maadi Camp for a short time, but were not successful as was at first hoped.

For the remainder of the war there was no special incidence of foot trouble in the 2 NZEF and no fresh problems encountered. In Italy there were no long marches and no abnormal conditions such as heat and sand likely to aggravate foot disabilities. It was noticeable that there were no fatigue fractures seen. The foot disability had been evaluated in its relation to the army, and all that was necessary was a regular grading of personnel who were unable to stand the stress of front-line service.