It is important that this condition, heretofore conspicuously', absent from Foot Manuals in general, be discussed and brought to the attention of officers because of its extreme disabling character when made manifest. In the past, the subject of Pes planes (Flat-foot) has, in my opinion, been stressed entirely too much both by manufacturers of foot supports for pecuniary reasons and by military men because of carelessness or inadequate means of examination. By this, I do not mean to say; that Pes Planus (Flat-foot) is not common, it is common

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but still other conditions exist and we should watch for them with an unbiased frame of mind. Pes Cavus (Hollow-foot), is just the opposite and is a condition where the longitudinal arch is higher than normal. It has been noted so frequently in foot examinations were a previous diagnosis of flat-foot by inspection had been made, that it is hereby brought to the attention of officers as an entity. This condition of Pes Cavus, more common than has been

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formerly thought is characterized by a longitudinal arch higher than normal, poor muscular development of the soles of the feet and an inherent tendency on the part of the individual to shift the greater part of the weight to the outer borders and balls of the feet. Where the arch has assumed a great height and the muscular development is poor the weight is not borne by the outer borders of the feet but is, in turn, shifted entirely to the balls of the feet (anterior arches). This latter, being unable to support the weight, fall. Associated with extreme degrees of Pes Cavus and fallen anterior arches is the condition of inversion (prominence of an inner side of the ankle). For facility of description and measurement for treatment, Pes Cavus has been divided into three degrees of height.; one, two and three. (See foot imprints.) The causes of Pes Cavus are usually ill-fitting shoes which, cramping and binding, restrict functional activity. The assumption of the great burden and excessive hiking also play a part in making a condition worse the tendency of which has existed since birth due to inherent organic and functional muscular deficiencies. Again, incorrect foot posture with the toes turned in has a part in the causation of the condition.

The most common causes from ill-fitting shoes are

1. Shoes too short.

2. Shoes too narrow across the instep and ball of the foot.

3. Heels of shoes too high with (1) and (2).

4. Pointed-toe shoes (English) where the inner side of the sole curves outward.

5. Poor muscular development since birth with incorrect foot posture. The symptoms are very fugacious and inconstant. Many complain of pain, which at times becomes intense when weight is borne, situated in the toes, the ball of the foot and longitudinal arch. The pain does not tend to remain at toe point but skips from place to place.

Treatment: Where the soldier is disabled and incapacitated and this condition is suspected, temporary relief may be obtained by placing a gauze or felt pad 1/4 inch in thickness under the longitudinal arch and strapping it in place with adhesive tape. The thickness of the pad may be increased or decreased until relief is experienced. Alternately immersing the feet in hot and cold water contrast baths—gives comfort. Where circumstances permit, however, all cases should be sent to the Medical Officer for diagnosis and treatment.