FLAT FOOT, or PES PLANUS, a very common deformity of the foot due to a loss of the natural arch. A strong ligament holds the os-calcis and astragalus in such a position that an arch is formed by the bones of the foot and the weight of the body is transmitted through that arch. There is a congenital variety that is said to be due to lack of the normal fatty pad in the hollow of the new born infant's foot. During the first five years of life this fatty pad takes the place of the bony arch and if the pad be lacking the arch does not develop. The acquired variety affects those suddenly called upon to stand for long hours upon the feet. - A very large number of nurses, soldiers, waiters and policemen suffer more or less with this de formity in their early months of training. Rickets, knock-knees, sprains and badly set fractures of the leg may give rise to flattening of the arch. Flat-foot is a physical disability which, in most countries having universal mili tary service, is considered to unfit the person affected for military service.
The bones are not changed from their nor mal shape except in the very young, but their relation to each other is altered. There is also a stretching of the extensor tendons of the foot and the muscles and fascia of the sole. Besides the flattening of the foot there is a more or less marked turning out of the toes and a tendency to walk on the inner side of the foot. This gait becomes quite characteristic.
In the acute cases particularly there is apt to be severe pain in the spring ligament, the inner malleolus or the ball of the great toe. Because of this, the affection is very commonly thought to be rheumatism, gout or disease of the bone.
The normal marking of the sole of the foot is an impression of the heel, a narrow margin of the outside of the foot and a broad line made by the ball of the foot. When the arch becomes weakened there is a gradual increase of the outer margin until almost the whole foot makes its impression. This simple test is of great value.
Congenital flat foot may be greatly improved if discovered in time by manipulative massage, bandaging and the use of supports until the bony arch is formed. Acute cases of flat foot in adults sometimes require rest for a time. Prop erly made shoes without braces frequently suffice to prevent a return of the trouble. Others require the constant use of felt or well-adjusted steel springs in the shoes. Exercises of the extensors of the foot, massage and electricity are of value.
The bad cases of deformity that cannot be corrected require operation under an anesthetic, the joints being forcibly freed and kept in nor mal position by plaster cast for a period and then kept up by a support. Consult Kahler, C. 0.,