Treatment.
—Mild cases will be benefited, often practically cured, by simply raising the inner border of the sole and heel of the shoe. This causes more weight to be borne on the outer border than in the natural attitude of the foot. It will be sufficient usually to make from ³⁄₈ inch to ⁵⁄₈ inch difference in the level between the inner and the outer borders of the sole and heel. Shoes may be so constructed that this difference is made invisible, or suitably bevelled narrow strips of leather may be sewed beneath the sole along the inner side, or laid in between its upper and lower layers.
While this suffices for the milder cases it is not sufficient for the more severe cases, which require forcible correction, and often under an anesthetic. The best way to accomplish this, after having patients thoroughly relaxed with chloroform, is to make a thorough manipulation of the foot, trying especially to so loosen its outer ligaments that it may be more easily put in proper position and finally overcorrected. The foot is then put up in plaster of Paris in this much overcorrected position. Such splints are worn for five or six weeks, after which suitable shoes should be provided, either with their inner borders elevated or with metal flat-foot plates inserted, or both. These plates are now in general use, and may be procured from instrument dealers and in shoe stores. In particular cases it is advisable to make a mold of the lower aspect of each foot, to have this cast in iron, and then over the iron model to have a suitable metal plate hammered so that it shall exactly fit the individual for whom it is intended.
Only in extreme cases, rebellious to other treatment, has it been shown necessary to resort to such treatment as division, by osteotomy, of the neck of the calcis or of the astragalus.
Most of these cases may be benefited subsequently by gymnastics and massage, i. e., by stretching the contracted gastrocnemius, if necessary, with some mechanical device, and improving the general condition of the leg muscles by suitable massage.
Metatarsalgia; Morton’s Disease.
—Under this name has been described a peculiar painful affection of the third and fourth or the fourth and fifth toes, which gives rise to constant sensitiveness and sometimes attacks of acute pain, especially when the foot is shod, and which is often only relieved by immediately removing the boot or shoe. These affection’s are more common in the upper walks of society, especially among women who are disposed to cramp their feet in shoes which are too small for them. Aside from the location of the pain there will often be found a tender spot at the point of greatest complaint. As these cases become worse pain radiates farther and farther up the leg, and may even assume the type of a sciatica.
Fig. 265
Talipes equinus.