Chapter XXII · 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).