lOO 



SCIENCR 



[Vol. XX. No. 



fought their battles iu "shin buskins," rarely wearing any 

 foot covering at all. 



The first criminal step taken was that of lacing the entire 

 shoe; this error led rapidly to the pinching of the foot, and 

 in order to retain the foot well forward in the shoe the high 

 heel became a necessity. This is not the histological reason 

 why the high heel was first put on the shoe, but it is evident 

 to the thinker that, with the narrow toe worn during the 

 reign of Queen Elizabeth, it would have been practically 

 impossible to have prevented excoriation and severe rubbing 

 of the heel had the shoe remained flat; hence to prevent 

 this the heel was elevated, and the foot shot forward to the 

 toe of the shoe, and its return toward the heel prevented by 

 the elevation of its posterior extremity. 



Fig. 1.— Infant's foot, never worn a shoe. Scale, three-eighths of an Inch to 

 one inch. 



This can be but a brief resume of the history of the im- 

 proper foot-wear; it is sufficient to say, that, as fact, the 

 wooden shoe or the cast shoe is more conducive to maintain- 

 ing the normal contour of the foot than the pinchy leather 

 shoe. 



To return to the consideration of our subject proper, aside 

 from the influence of evolution upon the human foot, we 

 are to remember that the foot of a child as nearly represents 

 the ideal of a perfect foot as anything of which we can con- 

 ceive; so, taking that for a basis of our observation, let us 

 glance for a inoment at the essential features in maintaining 

 the beauty of this small piece of God's handiwork. 



As briefly outlining the course which the deformity of the 

 foot pursues as the result of improper shoeing, the accompany- 

 ing diagrams are presented. They are in no sense pictures, 

 and are made by placing the foot upon paper and carefully 

 tracing a continuous line around it; the same is true of the 



FiP. 2.— Five year-old child's foot, shewing beginning deformitr. Scale, two- 

 eighths of an Inch to one inch. 



shoe except that it is drawn in broken lines. It will be ob 

 served that the broadest part of Fig. 1 is at the tip of the 

 toes, that the toes are separated, that the pencil line can be 

 readily made between the toes without displacing or pushing 

 them aside. The foot is almost triangular in shape; from the 

 tip of the little toe, a line projected backward will touch 

 almost the entire length of the foot, and the inner margin of 

 the big toe being continuous with the line at the side of 

 the foot. The toes are straight, and when turned up, 

 that is, fully extended, they will be separated from each 

 other and evince perfect freedom of motion, both flexion and 

 extention in all the phalanges. The instep is well arched, 

 both on the plantar and dorsal surfaces; the foot is pliable; 

 and, when extreme flexion is made, it will be manifest in the 

 arch as well as in the toe; the heel is not found extending 

 backward, it is round from above downward posteriorly and 

 from side to side; there is no sharp angle, and the thicken- 



ing of the plantar skin begins gradually. This foot has 

 never worn a shoe, and therefore does not show any of the 

 evidences of the slowly developing deformity. Next we will 

 consider the foot of a child five years old (Fig. 2). It will be 

 observed that the great toe is beginning to deflect towards its 

 fellows; the little toe deflects slightly towards the inner side 

 of the foot; the greatest width of the foot is no longer at the 

 tip of the toes but at the metatarsophalangeal articulation ; 

 the toes can be but slightly separated by voluntary effort on 

 the part of the individual. The toes are beginning to show 

 slight stumping, and the overriding of the little toe and of 

 its neighbor is beginning to manifest itself. The foot, 

 although fat and plump, has not the smoothness, softness, 

 and roundness which the infantile foot possesses. A line 

 drawn from the heel along the outer or inner margin of the 

 foot but slightly touches the great toe or the little toe at its 

 base, and neither of them at their first phalangeal articula- 

 tion. The tracing of the shoe shows exactly how the foot 

 must be compressed in order to adapt itself to the shoe; and 

 it is to be remembered that these drawings were made upon 

 the outside of the shoe, and the foot must go on the inside of 

 the covering of which this is an outside tracing. The nar- 

 rowing of the toes must inevitably follow this pinching. 



Passing on to the next degree, we have that of an adult 

 foot (Fig. 3). The deformity here is sufficiently well marked to 

 speak for itself; a step further it becomes more marked, and 

 reaches its climax in Figs. 4 and 5, where we have a later stage 

 thoroughly represented. Here the great toe is overriden by 



Pig, 3.— Adult's foot, showing increased deformity. Scale, one-eigth of an 

 inch to one Inch. 



the second toe, which lies parallel with the third toe; they 

 are stumped, with nails and sides flattened. The fourth toe 

 bends under the third toe. The bend at the first and second 

 phalangeal articulation is angular, and both angles are sur- 

 mounted by corns. The little toe bends far under the fourth 

 toe, and at the metatarsophalangeal junctions of the small 

 toe and of the great toe articular enlargements are well ad- 

 vanced. Lines drawn along the outer and inner margin of 

 the foot no longer touch either the great or little toe. The 

 heel now projects backward as a result of the lacing to which 

 the ankle has been subjected. The foot is flattened in the 

 sole, and in some cases enlargement will be observed in the 

 tarsometatarsal articulation of the great or, more com- 

 monly, the little toe. These changes, as represented by the 

 above succession of figures, are but the history of one foot, 

 if it could be followed from infancy <o adult life or later. 

 The skin of the sole ot the foot will be thick, and in no small 

 number of cases corns will be situated either upon the heel 

 or internal or external ball of the foot. During the develop- 

 ment of these deformities the gait of the patient — for by 

 this time the sufferer is a patient either of the doctor or 

 the chiropodist — will have materially changed. Instead of 

 the free, swinging gait of childhood and youth, easily and 

 comfortably maintained, we have now the mincing, narrow 

 gait with evident unsteadiness in the ankles, a tendency to 

 prevent pushing forward of the foot and a manifest effort 

 required in ascending or descending stairs or steps. There 

 is a poorly developed calf as a result of the heel being highly 

 elevated. The leg is narrow and flat; the calf is deficient 

 and the tendo-achilles prominent. Climbing stairs, or go- 



