Moreover, it must be stated that in children whose feet arc pressed into shoes at an early date the development of the feet is much slower than in barefooted children.
If the commencement of locomotion in a normally built bone spelt danger to the further development of the foot, how much more danger ous must it be when the osseous and ligamentous structures yield, and when a disproportion exists between the weight to be transferred and the strength of the lower limbs to support such weight? In overfed, heavy children who are immediately taught to stand on their legs, rachitic tendencies are not even necessary to produce deformi ties of the feet. Flat-foot, the deformity brought on by overweight, is soon noticeable (in an increased measure if complicated by rachitis).
(a) Flat-foot (Pes valgus) The pathological anatomy of the bones and joints is just opposite to that of club-foot. The foot appears to be turned outward below the ankle and the axis of the lower leg presents an outward deviation in the plane of the ankle. The internal ankle projects considerably; the arch of the foot is not alone lowered, but in severe cases even appears to be convex, the bulging resulting from constant lowering and outward turning of the head of the astragalus and scaphoid bones. The inner border of the foot is apparently much longer than the outer.
Symptoms. —The most important symptom is undoubtedly the deviation of the axis of the lower leg (pronation and abduction of the foot). The evidence derived from an impression of the sole on blackened paper which is commonly employed in adults fails in children, on account of the above-mentioned reasons (fatty tissue). (Sec Pathology of the commencement of locomotion.) The gait of such children is heavy. While in normal children the trotting gait soon gives way to the ordinary swing of the feet, children afflicted with prorating deformities continue to walk upon the entire sole. The toes are markedly turned outward, the soles of the shoes are worn away on the inner border, and the children are quickly tired out, complaining of pains and discomfort and want to be carried continually.
The condition may become permanent in case the deformity remains untreated and the deforming factor active. The children grow up with
their flat feet and complain less of pain as they become stronger, while the parents lament shout their ungraceful gait and the rapid wearing out of shoes around the internal ankles.
However, such weak feet in early ehildhood are often the beginning of severe deformities later on, such as flat feet, which become quite pain ful when subjected to an increased strain during adolescence or deficiency of vitality after the fortieth year.
But even in a child "weak-foot" may develop into an actual flat-foot which may become a very painful affection.
Prophylaxis and Treatment.— The important question of prophy laxis may be settled by insisting upon the following demands: 1. The feet of small children must never be forced or pressed into shoes.
2. Creeping must be encouraged as much as possible. Infants should be placed on the stomach. Inquisi tiveness and the desire of locomotion will soon induce the child to get ac customed to creeping.
3. Abnormal locomotion, such as sliding over the floor on the buttocks, develops when children arc forced to assume a sitting posture at too early a date, the creeping period being suppressed.
4. The period of creeping must be changed spontaneously by the child into one of walking. Only when a child of its own accord attempts to stand up and walk ahead, holding to some surrounding object, should it be permitted to do so.
5. To force children to walk, either with the aid of a nurse or go-carts or walking apparatus, is absolutely objectionable. All such appliances and devices of any construction whatever are impracticable and unnatu ral. Hastening the commencement of locomotion increases the danger.
6. Children must not be taken on long walking trips where there is little or no opportunity for them to rest when overcome with fatigue.
7. Regarding the choice of shoes, sandals with free soles to allow of an unrestricted action of the toes arc the best. The muscles of the toes are at the same time supporting muscles of the foot. The shoes must be made to order with broad soles for each foot separately.