(Flat-foot) In discussing a subject more or less well known to the public conservation should be practiced if undue emphasis and incorrect impressions are to be avoided. It cannot truly be said that this subject does not deserve emphasis and impression—it does. However, on the other hand, one should not be led to believe by the flamboyant statements of those interested for financial reasons that this condition is common to the degree that one-half of our manhood is thus affected. Such statements and insidious advertising are made for a purpose. The impression I wish to make here is that every little ache and pain in the arch of the foot or leg is not a forerunner of this condition. Such symptoms may mean nothing but a tired foot; a condition of foot strain or bruised foot. A diagnosis of this condition cannot be made by the symptoms presented. An accurate diagnosis requires more than symptoms and a casual inspection of the foot. It has been found by extensive use at this camp (Quantico, Va.) that the method described by Dr. Edward A. Rich of Washington, D. C. has been most efficient in the diagnosis and altering shoes to fit abnormal feet. He has rightly said, "The diagnosis of the static foot defects has always been made largely by guess. Diagnostic aids have not been commonly sought or encouraged. .illauv surgeons, uninterested in foot subjects, have jumped at con-elusions from mere inspection, with the usual result that treatments applied have been misfits. To diagnose and classify the foot defects without graphic aids is exactly on a par with the attempt at diagnosis and classification of the chest derangements without a stethoscope." (See the subject of Pedography).

The principal causes are:

1. Inherently weak and ill-developed muscles of the lower leg and sole of the foot. These muscles being subjected to the sudden bearing of excessive weight and work, or weight and

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work excessive for that particular individual, fail to support the horny arch and allow the latter to fall.

2. Ill-fitting, ill-constructed shoes causing incorrect foot posture-toes turned out. The first cause has been discussed in Chapter 2. The second cause may be explained as follows: Where the feet are parallel in standing or locomotion the line of weight bearing runs through the center of the knee

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cap, middle of the leg, and to the center or the longitudinal arch. When the toes are turned out this line of weight bearing is shifted inward on the inner portion of the longitudinal arch which may or may not be able Lo bear the burden. If not

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the inevitable happens—the muscles fail to buttress the bona' arch and the latter fails with stretching of the ligamentous attachments.

Objectively. in cases of Pes Planus inversion (turning in)

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of the ankles may be noticed. However, this may be absent or even occur in the opposite condition Pes Cavus or hollow foot. This inversion lift the ankles should not be taken as a criterion in diagnosing tin' condition of Plat-foot, The arches' appearance as the bare feet with the full weight upon them are placed in a plane surface offer no means of discovering the true height of the bony arch. The symptoms of flat-foot are varied and numerous.

The symptoms of flat-foot are varied and numerous. However, the predominant one is pain in the feet. This may be located indefinitely in the arches of the feet, heels or secondarily in the calves of the legs, knees or hips. The pain is usually absent during rest and is experienced only when use of the feet is attempted.


1. Complete rest for a few days.

2. Alternately immersing 'the feet in hot and cold water.

3. Correct walking posture; the feet parallel in standing and walking.

4. Feet measured and shoes fitted.

5. Foot exercises.

6. Strapping of the feet which should be done or supervised by the Medical Officer.

7. Shoe alterations to shift the misplaced weight where it naturally belongs.

8. Arch supports should not be worn for this condition as they tend to decrease the muscular power of the soles of the feet.