Flat foot or weak foot is one of the common disorders that the
osteopath is constantly called upon to treat. In the first place
the patient should be taught to walk correctly. The feet should be
parallel in walking so that the weakened muscles may be developed and
strengthened. This will be difficult at first, but recovery depends
upon this important point. In addition to this, special exercises, like
turning the toes under and tip toe exercises, should be persisted in
for a few minutes two or three times daily. Upon the other hand, do
not overdo the exercises but always carry them to a point of fatigue.
These two features, walking correctly and exercising, are essential
complementary measures to the adjusting treatment. In conjunction
with the above, the Scotch douche at the end of the day will prove of
considerable benefit.
In the technique work, first make certain that there are no innominate
or spinal lesions that bear upon the circulation and innervation of the
feet. Then frequently faulty walking is due to these lesions.
In recent cases, simply remolding the arches of the foot will be all
that is necessary, providing correct walking and foot exercising is
maintained. But in the more chronic cases considerable adjusting and
remolding of the tissues, bones, ligaments, muscles and fascia, are
demanded. Perfect apposition between the astragalus and navicular
bones, the highest point of the longitudinal arch, should be first
secured. Attention should also be given the other articulating
structures down to the metatarsal bones. This reestablishes the arch
and overcomes the everted tendency. Considerable repeated force is
often demanded to release the fibrotic tissues, but it is the important
part of this technique.
With the patient on the table, supine, place your thumb firmly at the
articulation of the navicular and astragalus. Then with the other hand
around the metatarsals to be used as a lever in extending, rotating
and inverting the foot with the fulcrum at the thumb of the first
hand, spring, thrust and adjust the arch. This requires considerable
strength and exactness of application. The tissues must give freely
before the result can be secured. This is often painful to the patient
but should be continued and repeated to the furthest point of motion
until recovery is complete. Treat as often as the condition permits.
Substituting the crotch of the thumb and forefinger or the knee for the
thumb will give added advantage. Follow this with thorough springing of
the plantar tissues by thumb and fingers.
If this is kept up with suitable exercises and correct walking, and
proper shoes (Munson last), excellent results will be obtained in the
great majority of cases. Same pair of shoes should not be worn two days
in succession.
Many times the anterior arch is involved, jointly or separately.
Persistent adjusting and remolding of the arch tissues will secure
satisfactory results unless the bones are markedly deformed and the
weight of the body is relatively too great. In this disorder, aside
from paying special attention to the metatarsal articulations, the
great toe requires a particular technique. For this grasp the toe
firmly, exert traction until the tissue gives slightly and rotate it
inward, toward the median line of the body, on its longitudinal axis.
Have the patient frequently turn the toes under, or attempt to do it
until the exercise can be easily accomplished.
Do not employ arch supporters except in hopeless cases. They simply
splint the foot and thus further weaken the foot muscles. If the above
methods are persistently followed to the point of actual adjustment,
accompanied by releasing of fibrous tissue and actual strengthening
of muscles through exercise, a very large percentage of cases will
recover. In a few cases adhesive strips will be of benefit.
=The Shoulder.=—Exclusive of muscular and other strains there may be a
partial dislocation. In these cases the acromial end of the clavicle is
frequently dislocated, and owing to a general lack of muscular tone may
be very hard to keep in place. The lower and inner part of the capsule
is often affected, so that freedom of function is lacking and there is
considerable pain. This is due to the thinness of the capsule and the
large amount of soft tissue, so that when the arm hangs at the side the
tissue is thrown into folds; and being very vascular is easily injured,
so that the vascular lymph readily organizes and the part becomes stiff
and unyielding. It requires patient, laborious treatment to break up
and absorb this fibrous tissue. Then the long tendon of the biceps in
some shoulder sprains is dislocated, but rarely. In shoulder injuries,
examine also, the upper ribs.
=The Elbow.=—The elbow is another complicated joint. One should be
careful that there is no fracture, and in children that there is not
=epiphysial separation=. Extending, flexing, pronating and supinating
the arm will aid much in the diagnosis. Examine well the rotation of
the radius at the elbow joint, and be positive that the olecranon
process drops normally into its fossa at the end of the humerus.
=The Wrist and Hand.=—The wrist is another joint commonly sprained.
Here, also, care should be taken that a fracture does not exist.
Colle’s fracture is frequent. The bursal and tendon sheaths are usually
markedly involved. The scaphoid and semilunar are apt to be displaced;
also, the os magnum and the unciform.
Sprains of the =fingers= are often met with. Outside of strains to the
muscles, ligaments, and other tissues the joint is apt to be somewhat
impacted. Traction will correct the latter. Care should be taken that a
fracture is not present. =Dupuytren’s contraction= occurs from sprains
or injuries, as the result of contraction of the fascia. The ring and
index fingers are members usually affected. In some cases the affection
will be found in both hands (symmetrical), and a spinal lesion will
be the predisposing factor. Treatment every day, by straightening the
fingers and stretching the tissue will at least retard the deformity,
but in a number of cases surgery will have to be resorted to.
A =ganglion= or “weeping sinew” is a swelling in connection with the
tendon sheath. It presents a round, firm outline, usually upon the back
of the wrist. There is generally found a displacement of one or more
of the wrist bones. If treatment of the joint and tendon sheath does
not remove the ganglion, surgery may be utilized. =Trigger-finger= is
a rare disorder. There is usually a history of local strain, which
probably resulted in some thickening of the tendon. Manipulation and
passive motion if continued will generally give relief.