VOCATIONAL FOOT DISORDERS
Among the numerous diseases of the foot, there is a class of lesions
produced by strain and misuse, in consequence of the occupation of the
individual. Many occupations cause those who are engaged in them to
stand or walk for long periods of time on hard and unelastic ground,
and others subject the foot or a part of it to such unusual work that
the entire foot, or a part of it, ceases to functionate normally.
=Weakfoot.= The general term “weakfoot” is used to indicate all types
of disability caused by improper functioning of the foot. It is
particularly applied to that condition of the foot in which the muscles
and ligaments on its inner side have become weakened by overuse or by
improper use, and it is, as a vocational foot disorder, common among
barbers, waiters, letter-carriers, policemen and servants. It manifests
itself by pain in the foot, particularly in the heel and on the inner
side, and sometimes by pain in the calves of the legs, in the knees and
lower part of the spine.
At rest, the foot has a normal appearance, but, under weightbearing, it
assumes an attitude of deformity varying in degree with the extent of
the overwork to which it has been subjected. The chief characteristics
of weakfoot are: abduction of the forefoot, an inward rotation of
the upper part of the heelbone and a flattening, or obliteration, of
the longitudinal arch under weightbearing, only. When seen in its
incipiency, an anatomically correct shoe, together with suitable
exercises, can be made to arrest the progress and effect a cure of
weakfoot; but when found in the advanced stages it takes from several
months to several years of conscientious work on the part of the
practitioner and the patient to get results. In such cases, massage,
adhesive plaster strapping, corrective braces and shoes, exercises
and sometimes immobilization in an overcorrected attitude by means of
plaster of Paris dressings, have to be employed in order again to get a
normally functionating foot.
=Flatfoot.= This is a condition in which the longitudinal arch is
depressed and does not regain its normal position when relieved from
pressure. The forefoot is abducted, the head of the astragalus rotates
downward and inward, and the os calcis rotates inward from above and
outward from below. It is the successor to the weakfoot and differs
from it only in that it exhibits also at rest, the abnormal attitude
that a weakfoot assumes under weightbearing only. In flat foot this
attitude is static, in weakfoot it is only temporary. The person
afflicted with it walks with a shuffling gait, due to the accommodative
changes that have taken place in the muscles and ligaments of the foot.
=The Subjective Symptoms= are similar to those in weakfoot and quite
often are not as pronounced as in weakfoot, due probably to the fact
that in this condition a further stretching and strain of the ligaments
is impossible as the limit has already been reached.
=The Treatment= is similar to weakfoot, but must be augmented by means
to overcome the accommodative changes in the foot and leg. The same
class of patients suffer from this condition as are sufferers from
vocational weakfoot.
=Chauffeur’s Foot.= As the term indicates, this condition is found in
people who professionally, or otherwise, drive an automobile for many
hours each day. It is an affection, usually of the right foot and leg,
due to the excessive use of those members while “feeding the car.”
The constant pressure of the “ball” of the foot on the accelerator
causes pain in that part of the foot, followed by a numbness of the
entire foot. The foot feels as if it were dead and when moved, later
on, feels as if a thousand needles were penetrating it. Cramps in the
calf muscles are usually associated with the symptoms in the foot.
=Treatment.= Massage of the foot and leg together with flexion
exercises of the foot and toes.
=Policeman’s Heel.= When a person is compelled to stand upon hard
pavements for a long period of time, great strain is put upon the
tissues over the os calcis or heel. The calcaneo bursa becomes inflamed
and gives rise to pains in that region. This inflammation may affect
the periosteum, causing periostitis and finally a spur may develop
on the under surface of the heel bone, which will become a source of
constant pain.
=The Treatment= consists of rest to the part, and of transferring the
weight to a place other than the painful area, by means of a felt pad
or a brace. If a spur has developed, surgical intervention will be
necessary.
=Dancer’s Foot.= This is a foot lesion first described by Miss Bryde
Campbell, of New York City, who termed it the “Modern Dancer’s Foot,”
because she found it to occur almost invariably in women who were in
the habit of dancing excessively in a modern high-heeled slipper. It
is a painful enlargement of the tissues under the head of the first
metatarsal bone and is found, as a rule, in the left foot only. The
under and inner side around the head of the first metatarsal bone
becomes painful to the touch, and under weightbearing. It is best
described as a periarthritis although it is often complicated by a
bursitis.
=Treatment.= Measures to relieve the painful part from weightbearing.
(Felt pads, braces, etc.) Rest and means to reduce the existing
inflammation.
=Golfer’s Foot.= The attitude assumed in playing golf, especially when
driving the ball from the tee, often gives rise to a painful condition
called “Golfer’s foot.” This pain is felt on the dorsum of the foot
over the course of the extensor brevis digitorum muscle. The extreme
extension of the foot, while striking at the ball, is the direct cause
of the pain. Massage and rest have proven of benefit in Golfer’s Foot.
(Full details of all orthopedic lesions have been but
superficially treated in these pages by reason of the fact
that “Podiatry Orthopedics,” a volume now in the course of
preparation and the next of this series (Otto F. Schuster and
Alvah H. Stafford, authors), will provide exhaustive material
bearing upon all phases of foot orthopedics).