\N SCHOOL- OF PRACTIPEDICS
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PRACTIPEDICS
The Science of Giving Foot Comfort
and Correcting the Cause of
Foot and Shoe Troubles
Based on the Experience, Inventions
and Methods of
Dr. William M. Scholl
OF.
This extension course is official only when the name of the student to whom it is issued, and the seal of the school, appears on this page.
Issued to and for the personal use
student no
AMERICAN SCHOOL OF PRACTIPEDICS
Chicago, U. S. A.
(COPYRIGHT 1917)
COPYRIGHT 1 91 7
BY
AMERICAN SCHOOL OF PRACTIPEDICS
V
LESSON No. 1
PRACTIPEDICS ( Prak-ti-pediks)
THE SCIENCE OF GIVING FOOT COMFORT
AND CORRECTING THE CAUSE OF
FOOT TROUBLES
This study is based on a broad principle and idea of a definite, studied-out means of relieving foot ills without encroaching upon or interfering with the rights or practice of the physician, surgeon or chi- ropodist.
The designation of Practipedic and the science it covers is based principally on mechanics and mechan- ical therapeutics as applied to the feet, although alle- viation and prophylactic measures take an important part. The time is not far distant when the Practiped- ist will have every recognition and enjoy the prom- inence, and scientific as well as social recognition of his profession.
The numerous conditions of the feet to be found needing the assistance as provided in practipedics will at once secure the co-operation of physicians, sur- geons and chiropodists, who will be only too glad to send their patients to a man educated and qualified by the study of this course.
It is essentially prepared for instructing shoe deal- ers and their salesmen in the art of handling the feet, giving them a practical knowledge of anatomy, phys- iology and the normal use of the feet, with a complete and practical outline on foot troubles and their cor- rection by the methods used in the wide and success- ful practice of Dr. William M. Scholl, foremost authority on the mechanical treatment of deformities of the foot.
The course, when mastered, will mean added power to anyone who has to do with the feet. The principal opening for the qualified Practipedist is in the shoe store. Every foot-fitter — every shoe man can qualify by carefully studying this course.
American School of Practipedics, Chicago
In beginning with the study of Lesson No. 1, please bear in mind that the author has endeavored to handle the subject in an elementary and understandable man- ner, and, if the outline and suggestions are carefully followed, there will be no difficulty in completing the course with high honors.
This course of study is intended to qualify one to scientifically fit shoes, appliances and other devices that are designed and recommended for specific pur- poses and nothing more. It gives no one the right to give treatments, of any kind whatsoever and the in- structors wish to make it clear that its graduates should not deviate from the instruction given herein.
Nearly every State in the Union has laws govern- ing the practice of Chiropody, and the giving of treat- ments or the cutting of corns or callosities would be, in most instances, a violation of the Chiropody Act.
Each and every student enrolled is duty bound to do his best, to concentrate his efforts and to hon- estly pursue his studies of the course until they are completed.
The simplest way to proceed with the study is by commencing with Lesson No. 1, thoroughly master- ing it, and be able to answer the review questions be- fore proceeding with Lesson No. 2. Then complete Lesson No. 2 before studying Lesson No. 3. Then when the entire five lessons have been studied by you and you are ready to answer the examination ques- tions notify this school and a set of examination ques- tions and blanks for replies will be sent you. This examination paper will then be corrected and graded and you will be notified whether your grade is high enough to entitle you to be graduated. Should it not be, you can study further and then take a new exam- ination. Do not send in answers to review questions.
Students are invited to write to the instructor of the school on any point not clear.
AMERICAN SCHOOL OF PRACTIPEDICS Chicago, U. S. A.
American School of Practipedics, Chicago
TO THE STUDENT:
The purpose of this course is to teach the funda- mental basis of foot comfort, i. e., Anatomy, so as to understand thoroughly the functioning of the normal foot, to understand the positions and locations and bones of the foot, the different types of feet, weak- nesses and foot troubles and how they develop and how they may be relieved and permanently corrected by properly fitted shoes and scientifically constructed and adjusted appliances.
This Home Study Course naturally requires study and close attention, but as you progress you will find many important points that you can make use of every day. This is especially true of the shoe fitter.
The instructor advises every student to have a skel- eton of the foot to refer to, if it can be obtained for study purposes.
Study this lesson carefully and when you have com- pleted your study, go over the review questions be- fore proceeding with the study of Lesson No. 2.
American School of Practipedics
211 W. Schiller Street
Chicago, III.
American School of Practipedics, Chicago
ANATOMY
To the Student: Anatomy is a very important branch of the study of Practipedics. It is very essen- tial that you thoroughly understand the human foot and the various parts that go to make it such an im- portant and useful member. Please read carefully, and refer to the easily understood illustrations as you go along. If there are words you do not understand the significance of, you should obtain a copy of the ^Dictionary of the Foot" so as to be able to properly pronounce the words and understand their meaning.
LESSON No. 1
ANATOMY OF THE FOOT
The foot is composed of bones, muscles, ligaments, tendons, nerves, arteries, veins, fat tissue substance, skin and nails.
BONES
The skeleton or framework of the human foot con- sists of twenty-six bones arranged so as to permit considerable movement at the various joints.
The bones act as a framework or support to the fleshy part. The study of the bones is very important, particularly for the Practipedist, in that most all foot troubles, such as treated by the Practipedist, result from some abnormal positioning or displacement of the various bones.
Another reason why the bones or framework should be carefully studied is that they serve the purpose of easily recognizing the cause of the ailment, because in Practipedics, after relief is given the cause is cor- rected.
The bones of the foot are irregular in shape and vary in size from the largest bone, which is the Os
American School of Practipedics, Chicago
N2 Nff OlSTAl PHALANX
2ND MEDIAL PHALANX
18T DISTAL PHALANX-
1ST PROXIMAL phalanx!
2nd PROXIMAL PHALANX 3bd OISTAL PHALANX 3RO MEDIAL PHALANX
rd PROXIMAL PHALANX 4th DISTAL PHALANX
4th MEDIAL PHALANX
4th PROXIMAL PHALANX
5th DISTAL PHALAN
5th MEDIAL PHALANX
5th proximal phalanx, 1st metatarsal
2nd METATARSAL , 3RD METATARSAL
, 4th METATARSAL . 5th METATARSAL
, INTERNAL CUNEIFORM
MIDDLE CUNEIFORM EXTERNAL CUNEIFORM
SCAPHOID
CUBOID
ASTRAGALUS
OS CALSIS
No. 1. Bones of the foot — a top view.
American School of Practipedics, Chicago
Calsis, measuring two and one-half inches long, to the smallest, the Distal Phalanges, which are three- eighths of an inch long.
The bones of the foot may be divided into three sections known as the Tarsus, Metatarsus and Pha- langes.
The Tarsus group of bones consists of the Os Cal- sis, Astragalus, Scaphoid, internal Cuneiform, middle Cuneiform, external Cuneiform and Cuboid, or a total of seven bones.
METATARSUS
No. 2. Bones of the foot divided into three groups — Tarsus, Metatarsus and Phalanges.
The Metatarsus consists of the five metatarsal bones, Nos. 1, 2, 3, 4 and 5. No. 1 begins at the inside or great toe side of the foot. These bones form the in- step and forward or anterior end together with the bones of the toes form the ball of foot.
INTERNAL CUNEIFORM METATARSALS SESAMOID
SCAPHOID m ,
S IOS CALS
No. 3. Bones of the foot — inside view.
(Student will please refer to illustration No. 1 showing skeleton of
foot with the respective names of each bone, showing the top view.
Also illustration showing division of the bones of the foot,)
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The Phalanges, or the bones of the toes, consist of fourteen bones. There are three bones in each toe except the great toe, which has but two.
The largest bone in the foot is the Os Calsis or Heel Bone. It is to this bone that the big, heavy Ten- don Achilles is attached. This tendon is a continua- tion of the muscles of the calf of the leg which act as a lift or leverage in raising the foot in the process of walking.
No. 4. Showing bones of the thigh. Femur, and bones of the leg, Tibia, Fibula and Patella, or knee cap. This also shows how the weight is carried down into the foot.
There is a reason for there being so many bones in the foot. It is to give numerous joints or articu- lations which permit various movements and in that way supply flexibility in walking, running or jumping.
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These numerous joints also have a tendency to break the jar of sudden impact, which, if the foot was one or two solid bones, might cause a fracture. Because of these twenty-six bones and numerous joints, it is, however, very easy for bone displacements to take place.
■'■'A
VI
No. 5. To the student: This illustration will show how the entire weight of the body is carried into the foot and is suspended by the high point of the arch.
MUSCLES
Muscles supply the motive power for moving and giving various motions to the foot and leg. Muscles consist of fibrous tissue intermixed with nerves, blood
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vessels, arteries, etc., and are subject to nerve stimula, which allows shortening and thickening, contracting and extending, in order to provide the various move- ments of the bones or framework.
OS CALSIS
*W
No. 6. This shows first layer of muscles on sole of the foot. These muscles are attached to the Os Calsis and branch out to their tendons toward the toes, where they are inserted. There are four layers of muscles on the sole.
LIGAMENTS
All of the bones of the foot are held together at their joints, or articulations, by numerous ligaments of great strength and, while permitting only slight movement of each joint, they do, however, provide for considerable motion of the foot in its entirety.
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Ligaments consist of bands of flexible, inextensible, fibrous tissue which connect the various bones and limit the movements of the joints. The arch of the foot is principally maintained in the passive state by this fibrous structure.
When the ligaments become strained or stretched and lose their tone, they allow the bones of the foot to drop from their natural position, or articulation, which is one of the causes of broken arch and flat foot.
Short plantar tig-; Long plantar^/*
No. 7. Showing the long and short plantar ligaments and how they connect and give support to the arch.
When this takes place the natural action of the muscles, as explained above, is interfered with, and in order to restore the strength and tone to the liga- ments, it is necessary to relieve the strain and abnor- mal pressure.
TENDONS
Tendons consist of fibrous cords (slightly flattened) which are the continuation of the muscles. The func- tion of a tendon is to attach the muscle to the bone or bones to be moved.
(It is well for the student to observe the different structures; bones that make up the skeleton frame- work— muscles that supply the motive power for giv- ing various motions — ligaments that hold together the
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various joints or articulations and tendons that attach the muscles to the bone or part to be moved.)
The Achilles Tendon is attached to the Os Calsis or Heel Bone and is the largest and strongest tendon in the foot or in the whole body.
US THIS
vtmitii'
fJJMT
No. 7A. Showing Achilles Tendon (Tendo Achilles) attached to heel sev- ered to show relative size comparing with the other structures of the leg.
This illustration also shows other muscles, arteries, veins, etc., of the leg.
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American School of Practipedics, Chicago REVIEW QUESTIONS FOR LESSON No. 1
To the Student:
After you have read this lesson it is well for you to answer the following quiz or review questions. If you are not able to fully answer any of the questions, then please refer to the text until it is quite clear in your mind. These review questions are not the ex- amination but one or more of these questions may be covered in the final examination, therefore it is well to learn thoroughly the subjects as you go along.
(1) How many bones in the foot?
(2) What bones form the tarsus?
(3) What is the largest bone in the foot?
(4) How many bones in the toes?
(5) In what way do the bones in the little toe differ from those in the great toe?
(6) What is the function of a muscle?
(7) What is the function of a ligament?
(8) What is a tendon?
Write the answers as you remember them, then refer to text to prove you are correct.
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LESSON No. 2
American School of Practipedics, Chicago
TO THE STUDENT:
Now that you have completed Lesson No. 1 which furnishes you with a basis of Anatomy, you are ready to take up the one very important branch of Practi- pedic work and that is the poise and balance of the bodys weight through the different arches of the foot.
In studying these lessons we suggest that you have a member of your family remove their shoes so that you may point out from the descriptions given in this course the exact locations of the different arches and in that way, it will be much easier for you to memo- rize the names and their respective locations.
This is a short lesson and, when you have com- pleted it, you may proceed with the study of Lesson No. 3. By this method of study you will quickly ac- quire a very complete knowledge of this important subject.
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LESSON No. 2
ARCHES OF THE FOOT
To promote the elasticity of the foot, and to provide strength and motion in walking, so that this collection of twenty-six bones will be able to properly support the weight of the body, they are arranged in the form of arches. These arches are four in number:
The Inner Longitudinal Arch, No. 1 The Outer Longitudinal Arch, No. 2 The Anterior Metatarsal Arch, No. 3 The Transverse Arch, No. 4
INNER LONGITUDINAL ARCH
The Inner Longitudinal Arch is the one most rec- ognized by the general public as being the arch of
No. 8. Showing the inner longitudinal arch commencing at the Os Calsis forward to the first metatarso-phalangeal joint. This is the long arch of the foot.
the foot, and while this arch has a very important bearing on foot troubles, the other three are very im- portant and must be very carefully considered by the student.
The Inner Longitudinal Arch commences at the
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inner border of the Os Calsis from behind and ex- tends forward to the first metatarsal. It is composed of the Os Calsis, Astragalus, Scaphoid, Internal Cu- neiform, and first metatarsal.
This arch is supported by ligaments and plantar fascia which stretches across the concavity like a
No. 9. Showing the outer longitudinal arch from the Os Calsis to the fifth metatarso-phalangeal joint. (Student will please note that the ele- vation of the outer longitudinal arch is very slight.)
bow string across a bow, which gives it elasticity and allows it to return to its original length each time weight is thrown upon it.
OUTER LONGITUDINAL ARCH
The Outer Longitudinal Arch follows the line of the inner longitudinal arch except that it is on the outside of the foot. It extends from the Os Calsis or heel bone to the head of the fifth metatarsal and is formed by the Os Calsis, Cuboid, and fifth Metatarsal. It is well to remember, in this arch, that the elevation is only very slight and that the high point of the inner longitudinal arch at the Astragalus diminishes to the
No. 10. Showing the Anterior Metatarsal Arch. This arch extends trans- versely between the first and fifth metatarsal head.
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ANTERIOR METATARSAL ARCH
TRANSVERSE ARCH
No. 11. Showing the bones of the foot, top view. First pointer shows the position of the Transverse Arch and second pointer shows the loca- tion of the Anterior Metatarsal Arch.
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outer longitudinal arch where there is just a slight space when the person stands barefooted on the floor.
The Anterior Metatarsal Arch is also very impor- tant. It extends between the first and fifth metatar- sal bones. It is formed by the heads of the 1st, 2nd, 3rd, 4th and 5th metatarsals. When this arch is nor- mal there is a perfect dome-like shaping between the great toe joint and the little toe joint.
The Transverse Arch extends across the foot, be- tween the Cuboid and Internal Cuneiform bone. This arch is frequently affected when there is a breaking down of the longitudinal arch posteriorly. (Posterior means the backward part and Anterior meaning the forward part.)
Student: Observe that the purpose of these arches is to increase strength and elasticity to the foot at the same time to provide a hollow space for protecting the muscles, nerves, arteries and veins from pressure. For if these arches are depressed they at once inter- fere with other natural functions.
USE OF THE FOOT
The author's definition of a normal foot is one that performs its functions and attends to the work im- posed upon it without discomfort or pain; one that has generally natural lines, in that the bones are not displaced and that the four arches are perfectly formed, and the external surfaces of the foot free from excrescences and abnormal growths, such as corns, bunions, callouses, protruding or prominent joints, etc.
The foot is intended to carry the body's weight and it should do so, gracefully, comfortably and naturally, if it is normal.
Why should people's feet tire any more than their
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hands? The foot is constructed for the purpose of taking the weight of the body, carrying it and doing so comfortably. If there are pains, discomforts, and fatigue, the foot is not normal and therefore requires a scientific application of Practipedic treatment.
No. 12. The black dots show the three bearing points of the normal foot which are the Os Calsis, the first metatarso-phlangeal joint and the fifth metatarso-phalangeal joint. This gives the foot the tri- pod bearing points.
Now consider the disturbing influences which cause foot troubles. How a person may overwork, may stand on their feet excessively, long hours, may wear too tight shoes, short shoes, pointed toe and ill-fitting hosiery or take on weight suddenly, all of which go to distort the feet and cause abnormal conditions.
(The student now having an understandable knowl- edge of the structure of the foot should refer to the illustrations in the preceding lessons or obtain a human skeleton of the human foot in order to more closely study this framework and its action.)
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American School of Practipedics, Chicago REVIEW QUESTIONS FOR LESSON No. 2
To the Student:
In this lesson you have covered a very important section in the study of Practipedics, and so that you will have no difficulty in thoroughly understanding all of the different points contained in this lesson, the instructor asks you to be particular to be able to answer all of the following review questions. It will be very useful to you as you go along. It is further suggested as a help that you remove your shoes and note the location of these arches on your own feet.
(1) How many arches in the foot?
(2) Name them.
(3) Where is the inner longitudinal arch located?
(4) What bones form the transverse arch?
(5) What bones form the anterior metatarsal arch?
(6) Why is it so important to thoroughly under- stand the arches of the foot?
(7) How many bearing points in a normal foot?
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LESSON No. 3
American School of Practipedics, Chicago
TO THE STUDENT:
This lesson will be given up to the study of abnor- malities— the underlying causes of foot troubles. You will notice that in each instance there is an involve- ment of the bones or framework of the foot. This is very important for you to understand. Every man who fits feet, sells shoes or has to do with footwear should possess the knowledge that you have now gained and put it to practical application.
Without a question of a doubt the information and knowledge that you will gather from this lesson is of the most importance that you have to understand. There are so many persons suffering from conditions which are described in this lesson that you will be amazed at the amount of work that you will have to do under this particular subject.
After you have thoroughly studied this lesson and correctly answered the review questions, you may proceed with Lesson No. 4. Please do not "skip" through the course, but study it methodically as out' lined by the instructor.
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LESSON No. 3
WEAK OR FALLEN ARCH— WEAK FOOT
When the ligaments, which hold the bones form- ing the arch in their natural arched positions, become strained or lose their tone, a condition of weak or fallen arch results. This is strictly a weakened foot condition. You will find this condition among men and women, probably more among the latter.
The weak foot condition is the first stage of a con- dition later developing into broken down arch or flat- foot. This early stage is more prevalent and is less understood and recognized by the public. It is, never- theless, a condition that the Practipedist should be careful to recognize and apply the proper corrective appliances so as to prevent the more serious and ad- vanced stage of foot weakness.
It is well for the student to understand, while on this subject, that the weak foot and flat foot condi- tions can be divided into several stages of develop- ment:
No. 1 — Weak foot, the early stage of.
No. 2 — Weak foot where there is a structural change in the contour present.
No. 3 — Weak foot where the arch is somewhat flat- tened when the patient stands.
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No. A — Advanced flat-foot where the foot has lost its natural arching and assumes a flattened condition.
No. 13. This sketch shows a typical case of weak foot where the arch is somewhat flattened.
By classifying these stages you will be able to more quickly recognize the different defects and know that
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in many cases there is need for a scientifically ad- justed appliance, even though the outward appearance of the foot is nearly normal, such as you will find in Condition No. 1.
Fig. A
No. 14. Sketches show approximate position of foot in shoe. Please note A and B.
(A) Showing approximate position of bones in a normally arched foot and how by being properly arched the foot is held up and toe is kept away from end of shoe.
Fig. B
CB) Showing relative position of bones in a weak arch and how it permits the foot to elongate and be pushed into the toe of the shoe.
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WEAK FOOT
When the shoes are removed, the feet may appear perfectly normal; in fact, in many cases, the arches are high and appear well developed while there is, however, a flabbiness and loss of tone to the tissues.
SYMPTOMS
The person will complain of tiring and tenderness in the heels, a tendency to sudden turning of the ankle, and occasionally the ankles become swollen and pain- ful. Constant standing or walking causes general discomfort in the feet. Tiredness saps vitality and is
No. 15. Showing a weak foot with very normal shape of inner longitudinal arch.
due to the weakness and strain on the foot structures. The foot usually slides forward into the toe of the shoe, causing discomfort to the toes. The customer will also complain that the shoes do not fit and feel comfortable. There is a tendency for the ankles to rotate. The feet sometimes burn on the soles and are extremely tender, while in other cases the feet appear cold and uncomfortable in that way. Another symp- tom is callouses along the great toe on the ball of the foot.
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CAUSES
The cause of weak foot is practically the same as flat-foot. Flat-foot is the advanced stage of weak foot which develops into the flattened condition. There are many causes. Those who do much standing in one position or do much walking are subject to this condition. Improper shoes and improperly fitted shoes weaken the foot structures. Occupational causes seem to be very prevalent. Those who are compelled to stand long hours on their feet, such as waiters, barbers, mail carriers, clerks in stores, cooks, machinists, bar-tenders, and policemen are all sub- ject to foot strain, which later develops into a condi- tion of flat-foot. Overwork, strain, constant wrench- ing, causing injury, illness, etc., which weakens the tissues, are all causes. Adults who take on increased weight suddenly, or those who carry heavy weights, all of which causes undue strain on the ligaments and muscles of the arch, are apt to find that these bring about weak foot conditions.
Favoring a certain portion of the foot, to escape the pain of a corn, callous or bunion, or throwing the weight on to one foot because of an injury or painful condition of the other foot, changing from one style of shoe to another, wearing short and pointed toe hosiery, changing from a high heel to a low heel causes abnormal strain and weakness.
Among children, it is caused by rapid growth and acquiring abnormal weight before the structures have accommodated themselves to additional strain. This condition is frequently present among children between the ages of five and fourteen.
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DIAGNOSIS
Cases of weak foot can be diagnosed, first, from the symptoms as outlined above. Second, by asking questions. Third, by manual examination, as palpa- tion and twisting of the foot. Fourth, examining the shoes. It is very easy to notice whether the shoe is spread out of shape, whether the heels are run down, and if the shanks have lost their natural arched shape.
It should be borne in mind that in stage No. 1, when the shoe is removed the foot will look practically nor- mal, and therefore the early stage of weak foot should be diagnosed from the symptoms and queries put to the customer such as:
Do your feet tire? Do the soles of your feet burn? Are they tender? Do your toes feel cramped? Have you weak ankles? Do you tire easily after much standing or walking? Do your feet perspire?
Then examine the foot. By putting pressure on the head of the first metatarsal while you grasp the
No. 16. Testing the foot for weak arch. With one hand take hold of the heel and with the other hand bring pressure against the ball and also manipulate to see how much resistance there is to the structures.
heel, you can see whether there is much weakness present and whether it is in the first or second stage of development. Always look at the customer's old shoes very carefully. They often give you an idea.
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PRACTIPEDIC CORRECTION
The first thought is to give comfort to the wearer and to prevent further development of the weakened foot condition. This is done by fitting the light, springy appliance — Dr. ScholTs Foot-Eazer.
No. 17. Showing application of Foot-Eazer to a weakened arch. It should be arched high enough to fit snugly into the cavity of the arch.
The correct size should be first selected and it should then be fitted to meet the contour of the foot arched quite highly so as to support the bone struc- ture and prevent further strain and tension on the already weakened or deficient foot structures.
The Foot-Eazer is of double spring construction so that the top plate slides easily on the under spring, giving firm support, yet permitting a certain amount of flexibility and motion so as to stimulate muscular activity. The foot should be carefully measured to ascertain if the patient is wearing the proper size shoe, so that the ball of the foot will set at the broad part of the tread or at the inner shank curve.
In addition, look to the stocking. If the customer has been wearing short or pointed toe stockings they should be told to wear a kind that will overcome any
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restriction and permit free use of the foot and toes. See Lesson No. 5 for use of arch fitting machine to do adjusting of appliances to the individual foot.
WEAK FOOT WHERE THERE IS A STRUC- TURAL CHANGE IN THE CONTOUR PRESENT
In this stage, when the customer stands, there is a slight tipping in at the inner border of the arch or ankle joint. The foot also elongates quite consider- ably when weight is placed upon the feet. There is a slight spreading. The outer longitudinal arch is flattened so that the Cuboid bone, the heel and the fifth metatarsal practically touch the floor. (This outer longitudinal arch, remember, should be slightly arched without touching the floor when standing.)
SYMPTOMS Symptoms in this stage are practically the same as those already described except that they become slightly more acute, because as soon as the structural change takes place the natural balance of the foot is interfered with and strain is thrown onto the various parts of the foot.
No. 18. Showing a weakened arch with enlargement at the great toe joint and bunion formation.
In this stage greater weight is thrown upon the first metatarso-phalangeal joint which often produces a redness, tenderness and even swelling. The toes are
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cramped, shoes are thrown out of shape and the pa- tient complains of extreme discomfort, rotating of the ankle outward or inward is noticeable. There are pains through the heel and ankle, often swelling. Pressure on the arch will cause it to slightly flatten. The heels of the shoes are worn crooked. The per-
No. 18A. Showing bones of weakened arch foot; how it looks with weight on foot.
son will complain that walking over rough pavements or cobblestones or on rough, uneven surfaces will cause wrenching and pain on the sole. There is also tenderness and sometimes pain or a callosity along the edge of the fifth metatarsal extending out to the ends of the toes. Callouses also appear around the heel and on the ball of the foot.
CAUSES
The causes are practically the same as weak foot in the early stage, as previously explained. Of course, after the foot has become even slightly weakened the condition advances more rapidly because the same feeling of support which the shoe counter gives is lost and with the disturbance of the balance or poise of the foot the strain becomes more severe.
Then again, where there is a weakened longitu- dinal arch, it naturally causes a spreading trans- versely, forcing down the outer longitudinal arch, causing that much more strain to the ligaments.
DIAGNOSIS
In addition to putting the queries to the patient, examine the foot carefully. You will find tender and
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painful areas. These can be located by pressing with your thumb or index fingers over the different areas of the foot, such as the tuberosity of the heel, where the plantar ligament and fascia is attached. There is usually slight pain or tenderness there, then causing pressure at the different metatarsal heads commencing at the first metatarso-phalangeal joint by manipulating the great toe. See if there is ten- derness in the outer longitudinal arch. Have the pa- tient stand and notice if the weight causes the ankles to turn in or out and if the arches are lower.
No. 19. Showing a weak foot where structural change has taken place. In these cases the Astragalus rotates inward and in examinations you can notice the prominence of these bones.
Again examine the shoe. Note if there is any swell- ing through the ankle or through the foot. Ask your customer questions that will lead up to this. It is very easy to diagnose this condition because there is in- variably callous formation, burning or tenderness on the soles, and the patient usually complains of the shoes being the cause. It is a fact that persons hav- ing this trouble will blame their shoes.
Run your hands inside the shoe and notice if there are any depressions or wrinkles caused by uneven distribution of the weight and a tendency for the foot to stretch out because in this stage the arch weakens and allows the foot to elongate and stretch more than in the normal.
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In this stage will be found also many complaints of short shoes. The patient will be fitted to a shoe sufficiently long, and in a few days' time complain that they are too short. Therefore, it is well for the Practipedist to set a rule where there are complaints of short shoes to make examination for the secondary stage of weak foot.
PRACTIPEDIC CORRECTION
Treatment is practically the same as given in con- dition No. 1. The Foot-Eazer or Tri-Spring arch should be applied. If the person is quite heavy and the weakness quite pronounced the Tri-Spring Arch Support should be applied. It gives a wider base for
No. 20. Showing the Foot-Eazer fitted with weight on the foot.
support. In these cases the appliances should be fitted up into the contour of the arch so as to at once sup- port the bone structures and remove the strain on the ligaments and fascia. In this stage the appliances should be fitted to hold the foot into a nearly nor- mal shape. If the arch is fitted up quite closely to the arch proper there will be less uncomfortable feel- ing than if it is lowered so that the weak foot is forced down to meet the elevation of the appliances. The operator should take care when selecting the Foot- Eazer or Tri-Spring Arch Support as is best indicated.
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Again, hosiery and footwear should be given care- ful consideration, and in this condition where the weakness is more pronounced it is well to advise the use of Dr. Scholl's Granulated Foot Soap, Dr. SchoH's Foot Balm and Antiseptic Foot Powder. These three articles should constitute the home treatment for the patient to use and are essential in obtaining the best results from the use of the appliances.
No. 21. Showing the Foot-Eazer inside the shoe and how it spans the weight from heel to ball. This corrective appliance must not rely upon the strength or the shank of the shoe in making corrections.
This treatment first thoroughly cleanses and opens the pores of the skin, stimulates the circulation and tones up the muscles and prevents an accumulation of unhealthy skin secretions, keeping the feet soft and pliable. The Foot Balm is a most excellent massage cream and relieves painful conditions of the muscles and joints.
WEAK FOOT, WHEN THE ARCH IS SOME-
WHAT FLATTENED WHILE THE
PATIENT STANDS
In this stage, the sufferer usually resorts to some home treatment or purchases shoes, has rubber heels applied and often resorts to liniments and external applications. In this stage, one surely recognizes that there is something wrong with the feet, while in the other two conditions just described persons very fre- quently are of the opinion that the discomfort and pain is from a natural cause and is produced by the
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No. 22. Showing flat-foot and rotated ankle.
shoe or should be present as a result of over-exertion (or more than usual use of the feet).
SYMPTOMS
There is considerable pain present in all parts of the foot. There is invariably a tenderness or painful condition at the tuberosity of the Os Calsis or heel. There is likewise a painful condition at the great toe joint. There is pain present upon motion of the foot, swelling about the ankles, pains extending into the calves of the legs, knee and often into the thigh. The feet are hot and feverish and are often so swollen that it is impossible for the person to wear his shoes.
In other cases there is a clumsy, stiff feeling in the feet upon arising in the morning; in fact, it is frequently practically impossible for the patient to stand barefooted until slight and careful motions have gradually been made. It is not until after the person has done a little walking that the stiffness disappears. Then the pain is less severe until the middle of the
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afternoon, when it becomes quite pronounced, and the first thought of the sufferer is to get home and be able to remove the shoes.
By elevating the feet they are made more com- fortable. In this stage, callouses are present, as in Condition No. 2. The feet perspire profusely, espe- cially around the heels.
No. 23. Showing tender spots and callous formation caused by weakened arch and flat-foot condition. These callouses are caused by uneven distribution of the body's weight and these tender spots and callouses are one of the symptoms of a weakened arch condition.
It is not unusual to notice the lining of the shoe destroyed from this excessive perspiration. The per- son walks with a slouchy, dragging gait. The toes are turned outward. The heels are worn down at the inner border. The soles are worn through at the base of the first metatarsal, and often the toe end of the sole is stubbed off. Shanks are broken down and frequently the Anterior Metatarsal Arch is involved. There is a cramping of the toes.
In nearly every instance the third, fourth and fifth
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toes are slightly contracted and corns form on the top of the joints. Persons in this stage complain of pains simulating rheumatism. They frequently attend bathing resorts and take rheumatic cures.
CAUSES
Again the causes are practically as outlined in the beginning of this lesson. The student will soon ac- quire sufficient knowledge so that he will add to the list of cases from his actual experience. It is well to obtain as much information from the patient as is possible but to keep on the lookout for improperly fitted shoes, pointed toe stockings, constant standing or walking, standing in one position, favoring the
No. 24. Testing the foot to see if there is any rigidity or adhesions in the region of the arch.
feet to escape pressure on a corn or callous, heavy weight bearing, such as heavy people, wearing of ordinary rubber heels, debilitated physical condition, etc. These are the principal causes.
In some cases the patient may have had rheumatic neuritis which caused a weakness of the feet. Again venereal disease will cause erosion at the articulating joints, producing weakness and pain. Again pus ab- sorption from ulcerated teeth, infected tonsils, etc.,
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which is deposited into the weakened structures, may cause erosion and pain.
PRACTIPEDIC CORRECTION
In this stage, treatment is practically the same as Nos. 1 and 2 except that where structural changes have taken place more support must be given. The object is t