Flat-foot / by A.G. Miller.

  • Miller, Alexander Gordon.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Flat-foot / by A.G. Miller. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    distinction between those cases in which the loss of the plantar arch (or rather arches) is the only deformity and the only disease, and those in which other conditions are present—such as (a'.) genu valgum; (b.) talipes valgus; (c.) hallux rigidus; (d.) gout in the tarsal joints; (e.) varicose veins; (/.) strumous disease; (y.) rheumatism; (k.) the effects of some injury, such as sprain or fracture, etc. Such a distinction is of importance, especially as regards treat- ment. (a.) For instance, genu valgum and flat-foot are said to be always associated. This I have not found. In a case of genu valgum, seeing that the leg is abducted from the knee downwards,—in other words, slopes obliquely outwards,—the inner side of the foot comes in contact with the ground principally in walking, or ought to, at any rate. As, however, this deformity (genu valgum) occurs gradually and not suddenly, the foot is educated into adopting a position of inversion that brings the whole sole, and not merely the inner side, in contact with the ground. The proof of this is easily seen after the limb has been straightened, say by Macewen’s operation, when the sole of the foot is seen to turn inwards, and it is some time, in aggravated cases, before the patient learns to turn the foot out again, for at first he walks on the outside of the foot. The foot, indeed, is in a condition resembling somewhat talipes varus, and not valgus, as is also sometimes erroneously stated. The primary condition in genu valgum is not flat-foot properly speaking, far less talipes valgus, but certainly resembles flat-foot. I admit, however, that flat-foot and genu valgum may occur together. But it is a mere coincidence, as of any other two affections, which may occur on the same side or opposite sides of the body. If flat- foot is only simulated, the diagnosis is easy, for on careful examina- tion of the foot the existence of a tarsal arch that cannot be opened out is made out at once. (b.) Talipes valgus is sometimes confounded with flat-foot. Even eminent writers do not hesitate to say that the two are virtually or practically the same. The two may exist together, and thus prove their separate identity. Talipes valgus, I take it, consists essentially in a turning outwards of the whole foot, including the astragalus as well as every other bone of the tarsus, and is associated with paralysis. Except when very aggravated, Pes Planus does not affect the astragalus, or even the os calcis, materially in the way of eversion, and is not due to paralysis, but is essentially a giving way of the arch of the foot, and is associated with stretching of the ligaments. (c.) Hallux rigidus is sometimes a complication of flat-foot. That it is a result of flat-foot I doubt very much. I cannot enter into an argument on that subject here. I would only say this from a clinical point of view. I have found the rigidity of the great toe disappear to a great extent under ansesthesia. It was due, there-