ing over on the inner side of the foot. This, of course, tends to produce pronation and breaking down of the arch." (Lovett, "Transactions American Orthopedic Association," Vol. VIII). The elevated heel, especially when combined with a narrow toe, leads to breaking down of the anterior or transverse arch of the foot by throwing additional body-weight upon the metatarsal heads. The painful affection, called metatarsalgia, first described by Morton, of Philadelphia, is now known to be due to depression of this arch. The spring, or turning up of the front of the sole of the conventional boot, Fig. 28, by hyperextending the toes at the metatarso-phalangeal joints, helps to depress this arch. I need hardly mention the common though painful condition, sometimes dignified by the name clavus, but ordinarily called corns, caused by friction of an ill-fitting boot. Most of us are, no doubt, quite familiar with this affection. It is a trivial affair but, nevertheless, the cause of much misery. Tight shoes, by splinting the feet, interfere with the normal function of the muscles. This, as pointed out by Lane, deprives the limb of an important influence in forcing the blood upward through the deep veins and places a disproportionate strain upon the superficial ones. It is probably one of the causes of varicose veins, which frequently result in chronic ulcers so common in our clinics. The tight shoe, also, by compressing the toes and interfering with their circulation, may predispose to chilblain and frost-bite. It is plain that the wearing of improper shoes may have more than a local pernicious influence. The many deformities and the weakness they give rise to, lead to a lack of exercise, and, in consequence, the general health suffers. Predominant styles of foot-wear are illustrated in Fig. 28. A and B are two with copyrighted names, extensively advertised as reform and hygienic shoes. Observe that the toes are quite pointed and the heels comparatively high. The shank is weak and narrow and placed near the middle of the sole. These are at present very popular styles. Style C, has a large circle of admirers. It is the typical French shoe; short, narrow, very high heel placed well forward, and extremely pointed toe. It is much used as a dress shoe, though not uncommon for street wear. D, represents a type of child's shoe responsible for serious injury to many feet. Happily, children's shoes as pointed as this are not worn as much to-day as they were a few years ago. Most people consider the style pictured in E, as a very sensible one. It is, indeed, far less pernicious than D, though an outline of a child's normal foot for comparison must convince that this shoe exerts considerable compression on the toes. F and G are popular among men. Though not as bad as some shoes worn by women, they do not allow sufficient room for spreading the toes. One common fault is to be observed in all-the front of the sole turns upward in such a way as to hyperextend the toes and cause undue pressure upon the ball of the foot. This leads to depression of the transverse arch, which is normally present under the heads of the metatarsal bones. One can, to-day, find in some shops fairly good foot-wear for men and children, but the demand for it in St. Louis is not very great. Very few shoe dealers, however, carry a stock of proper foot-wear for women. I have often been told that it is difficult to sell and, therefore, not profitable. Nevertheless, such can be bought and its purchase should be encouraged. Casual observation will show how common is the habit of wearing short, narrow-toed and high-heeled shoes. In an afternoon's walk the writer counted 168 children, of whom 142, or 851/2 per cent, were wearing shoes with more or less pointed toes; 96 women who were all wearing pointed foot-wear, and 66 men, of whom 45, or 68 per eent, were wearing shoes tending to the toothpick variety. Of the children only about 26 wore the extremely pointed, and spring heels were the rule. The women, however, very generally wore the decidedly pointed type, and the typical French heel was much in evidence. Among men the extreme point was rarely seen and is apparently out of fashion. Many wore the style shown in F, while that shown in G, was quite common. Though foreign to the title of this paper, a few words about the proper shape of shoes will not, perhaps, be out of order. The front of the inner sole should correspond in shape to and be a little wider than the front of the foot. It should allow for adduction of the fore part of the foot at the mid-tarsal joint and for separation of the toes, especially for inward motion of the great toe. To fit a normal foot, the inner edge should be straight. The shank should be wider than the weight-bearing portion of the foot-sole at this point and should be placed well to the outer side and not in the middle, as is so frequently done. The posterior part should follow the outline of the heel. The length should be a little greater than that of the foot when bearing the body-weight. The correct shape for the inner sole of a shoe to fit an undeformed foot is shown in Fig. 29. Its shape may differ according to the character and degree of existing deformity, but care should be taken that the front of the inner sole is always somewhat wider than the corresponding part of the foot, and it should be changed whenever necessary to meet any improvement that may occur in the form of the foot. The front of the sole should not have the upward turn or spring, which is universal in conventional shoes and which tends to obliterate the transverse arch; but it should be flat both from before backward and from side to side. The upper leather should be sufficiently full to allow for the thickness of the toes and for their individual movement within the shoe. It should, though, fit so closely over the instep as to prevent the shoe from slipping back and forth. For this reason a lace shoe is preferable, as its tightness can be regulated. Children should wear spring heels, a custom which it would be well to continue throughout life. Adults who are accustomed to the use of heels would find it awkward to walk without them. They should, when worn, always be very low, broad and flat. The foot, especially in the young, is very plastic, continued pressure can give it almost any shape. A familiar example is the foot of the high caste Chinese lady. By a system of bandaging, begun at the fifth or sixth year, the toes are made to approach the heel. The foot is, in fact, forced into a position of exaggerated calcaneo-cavus, so that the toes and heel may fit into a dainty little shoe no larger than a teacup. What matters it if the lady can not stand still, but must constantly step backward and forward to retain her balance, or that she can barely walk at all without support if, only, she possesses a pair of "golden lilies," as such feet are fancifully called. Fig. 30 is a photograph of a pair of such horribly deformed feet, and Fig. 31 a photograph of shoes worn on these feet. Fig. 32, copied from an illustrated magazine of the war with China, shows natives leaving Tien Tsin. In front are seen some high caste women, wearing such shoes, holding on to each other evidently for the purpose of facilitating locomotion which, under less exciting conditions, they probably rarely indulged in. Behind them is seen a Chinese woman of the Fig. 28. Predominant styles of modern foot-wear. great toes. |