The “Thomas” sole may be used in mild cases. This is made by building up the inner part of the sole of the shoe one-eighth to one-quarter of an inch higher than the outer side, thus securing a slight inversion of the foot.
Exercise and massage of the deficient muscles should form a part of the routine treatment in all cases of flexible flat foot.
To diminish local inflammation and irritability, the foot should be soaked in hot water; hot and cold alternate douches should be applied, and hot-air treatment and massage should be employed.
Rigid Flat Foot. Rigid flat foot cannot be successfully treated until the position of the foot is corrected. The patient should be anesthetized, and, by the use of a wedge as a fulcrum, the bones should be forced into position. A pressure of about two hundred pounds is generally necessary to effect this reduction. After this, the foot is placed in a plaster cast, in extreme adduction and is allowed to remain thus encased for three weeks. After this, a properly fitted plate should be worn. The results are usually satisfactory.
Operative Treatment. Cases that have resisted all other forms of treatment, may be cured by the removal of a wedge-shaped piece of bone, with the base downward and inward at the point of greatest inward convexity, that is, in the neighborhood of the head of the astragalus. Osteotomy of the front of the os calcis and neck of the astragalus will at times be necessary for a radical cure.
Many other operative procedures have been advised for flat foot and they have been employed with varying successes.
Hallux Flexus or Hammertoe. The upward prominence of a toe (usually the second or third) in a rigid position, is known as hallux flexus or hammertoe. In this condition the toe is flexed in its second joint so that the end bears on the ground, while the junction between the phalanges makes a prominence upward. Helomata and callosities may develop on the end of the toe, but the chief discomfort is in the disturbances which arise on the prominence which presses against the side of the foot-gear.
Treatment. A knowledge of the forces at work will show how futile must be any effort to correct this deformity by strapping or bandaging. There is a shortening of the plantar fibres of the lateral ligament of the joint. The trouble does not lie in the flexor tendons, as it seems, and operations directed to this point fail. Even with incision of the lateral ligaments, followed by the application of a splint, recurrences are common and amputation must be the procedure.
The condition described as hammertoe may exist in several or in all of the toes, the great toe being least often involved. This occurs most often as a result of wearing improper shoes, but is sometimes the consequence of paralysis.
Flexed or Clawed Toes. Extreme flexion of all but the great toes causes the weight to be borne by their dorsal aspect. In this condition the toes, and especially the small ones, develop painful helomata on the prominent joints, and the small toe may become the source of great discomfort.