Podiatrist

“ The foot must be restored and held in its normal position and measures must be adopted to quiet local irritability or inflammation, and to strengthen the muscles. The best treatment does not consist in the permanent wearing of a flat-foot support; the support should be regarded in the same light as one uses a crutch in a fracture of the leg.
As a preliminary to all treatment, the use of proper shoes must be insisted upon. A shoe should be as wide in front, as the unshod foot, when bearing the weight of the body. ”

“ Those drugs which partake more of the nature of food may be useful. Cod-liver oil, maltine, thick cream, or possibly bone marrow, might be worth a trial.
Jessie.—Probably you are suffering from flat-foot, and your doctor wished to take an impression of your foot to decide what form of boot you should wear. For the treatment of flat-foot is chiefly a question of well-made boots which bear some resemblance to the human foot. You will find an account of flat-foot in an article on "clothing" which appeared in last year's Girl's Own Paper. Puffiness of the ankle is very common in kidney disease ”

“ Symptoms. The feet burn and tire easily and feel stiff and lame. They may swell, and the size of the shoe worn must be then increased. Later, a painful period generally begins in which walking is avoided and a dragging pain in the arch and behind the inner malleolus is noticed. This is increased by walking and standing and tender points may be found under the scaphoid and on the upper surface of the heel. The foot feels strained and irritated and is a constant source of discomfort. The inner malleolus is generally more prominent and the foot is displaced outward in relation to the leg. ”

“ The law that any limb or organ of the body will adapt itself to a change of position is one that cannot be questioned; the only doubt is as to the extent of the change which may be thus effected. When the foot has been years in growing into a bad shape, it cannot be expected to right itself immediately, though much may depend upon the thoroughness with which the remedy is applied.
[Pg 58]
Prevention, however, is said to be far better than cure. It certainly is in this matter, and, being so easy and simple, there can hardly be any good reason for its neglect. ”

“ There is little or no tendency to heal, even under exacting treatment, and if recovery should take place, a speedy relapse is the rule, even with the patient remaining in bed. The indolent and foul ulcer tends to eat deeply into the adjacent tissues, progressively involving bursae, tendons, muscles, joints, and bones. A deep round hole results, which may even perforate the foot. The most striking symptoms are chronicity, stubborn resistance to treatment, and the absence of pain and tenderness. ”

“ Wearing a shoe, or walking, becomes impossible. The condition may last for months, or even years, if not rightly treated.
Treatment.—Properly fitting footgear must be worn—broad at the toes with low heels and of sufficient length. If pus ("matter") forms, the cut edge should be raised up by pushing in a little absorbent cotton under the nail every day. Hot poultices of flaxseed meal, or other material will relieve any special pain and inflammation. Soaking the foot frequently in hot water, and observing especial cleanliness, will aid recovery. ”

“ The procedure, when using liquid acids is as follows: render the growth and the surrounding parts aseptic; by means of a tapering glass rod or a wooden toothpick, apply a drop of the acid so that it will spread over the growth only, making certain that every part of the outer surface has been treated. If pain becomes excessive, apply a neutralizing agent. Dress the part with a shield that is holed-out, so that when the foot-covering is in place there will be no pressure over the tissues treated. ”

“ The feet ought after each washing to be well dried, taking care to dry with the towel between each toe. The above process must be repeated at least once every day, every morning, and, if the annoyance be great, every night as well. A clean pair of stockings ought in these cases to be put on daily, as perfect cleanliness is absolutely necessary both to afford relief and to effect a cure.
If the feet be tender, or if there be either bunions or corns, the shoes and the boots made according to the German method (which are fashioned according to the actual shape of the foot) should alone be worn. ”

“ The term “radical cure” does not necessarily indicate the performance of the so-called radical operation, but may result from proper treatment of a down-curved nail edge, or of a diseased nail fold, together with such prophylaxis in foot-gear as is indicated. With sufficient room in the shoe and the removal of offending granulations or cutting nail edge, a radical cure can frequently be effected.
Any inflammatory condition, either of the nail or its matrix, or the tissues contiguous to the nail, may result in the train of symptoms which are indicative of ingrown nail. ”

“ In these instances the pus shows a marked tendency to spread, strips the periosteum from the bone, perforates the outer layer of the membrane, and finally infiltrates the surrounding tissues.
This forms a near approach to what is known in human surgery as an infective periostitis, and in our subjects is nearly always met with in cases of severe prick. Its rapidly spreading character makes it always a dangerous condition, and a punctured foot exuding a discharge of this nature should always be regarded as serious. ”

“ If flat foot exists, a support should be supplied for its aid in restoring the position of the great toe. In severe cases, nothing short of an operation is likely to be of value. A toe-post may be worn for a time in mild cases. ”

“ A sore on the left foot, probably of specific origin. A slight sprain has brought about a swelling of the foot accompanied by acute pains. Different treatments have only had a negative effect, and in a little while a suppurating sore appears which seems to indicate caries of the bone. Walking becomes more and more painful and difficult in spite of the treatment. On the advice of a former patient who had been cured, she comes to me, and there is noticeable relief after the first visits. ”

“ You must wash your feet at least once a day, and oftener if they feel the need of it. The great preventive of foot-soreness is to have the feet, toes, and ankles covered with oil, or, better still, salve or mutton-tallow; these seem to act as lubricators. Soap is better than nothing. You ask if these do not soil the stockings. Most certainly they do. Hence wash your stockings often, or the insides of the shoes will become foul. Whenever you discover the slightest tendency of the feet to grow sore or to heat, put on oil, salve, or soap, immediately. ”

“ For Navicular Disease, when that malady is diagnosed, the earlier neurectomy is performed the better. The greater work given to the diseased bursa and bone, and the return of the contracted heels to the normal, brought about by the greater freedom with which the foot is used, are claimed by many to effect a cure. ”

“ Even a maker of proverbs can tell at a glance that "the legs of the lame are not equal." From the limp, coupled with the direction in which the toe or foot is turned, the tilt of the hips, the part of the foot that strikes first, the presence or absence of pain-lines on the face, a snap diagnosis can often be made as to whether the trouble is paralysis, hip-joint disease, knee or ankle mischief, or flatfoot, as your patient limps across the room. ”

“ As a prophylatic against infection, it cleanses the wound, produces a local immunization and reaction before the infection has a chance to work; the earlier the bandage is applied the more remarkable is the effect.
For incised wounds of the foot with division of the muscles and tendons, if the tissues are not too seriously injured, the muscles and tendons should be united and the skin closed with interrupted sutures sufficiently far apart to allow free excretion. No drainage is employed and a slight compressing dressing is applied. ”

“ Free incision, if possible, otherwise incision, cauterizing with pure carbolic acid, and packing with iodoform gauze. Internally, large doses of iodide of potassium should be given, as this drug alone has cured many cases.
Trench Foot. This results from exposure to wet and cold in the trenches, and soldiers who were compelled to have their feet immersed in water for any length of time and were then exposed to cold, are afflicted with this condition. The symptoms are similar to frost bite and the prevention of frigorism (Trench Foot) is as follows: adequate feeding; perfect circulation ”

“ The patient is to be kept upon a spare diet beforehand; and when the operation is about to be performed, he is to be directed to walk, so as to bring down the stone to the neck of the bladder, which is to be ascertained by introducing a finger into the anus. Then a strong and experienced person, sitting on a high seat, is to take the patient and hold him secure, his buttocks being placed upon the assistant’s knee, and his legs being drawn in and his hands placed on them and held there. ”

“ This variety of ulcer is seen more frequently in males than in females, and it is almost exclusively confined to adults, especially between the ages of forty and sixty. Occupations requiring standing or walking are strong predisposing causes, provided a tendency to the disease exists. A poor fitting shoe and deformities of the foot giving rise to excessive pressure or irritation, are of much importance in determining the appearance and location of the ulcer. ”

“ These custom shoes lasted a long time, and, after they were once molded to the foot, the wearer was not {419} disturbed for many months by the process of having to become accustomed to another shoe. The many advertisements in quite recent times of foot powders and other artificial relief for the foot show that people are suffering much more than before, or, at least, are less able to bear the discomfort. These powders, however, are not likely to do good in the long run, since they tempt the wearers to stand the discomfort against which they do furnish a certain amount of soothing. ”

“ When the stone falls into the neck of the bladder a sudden retention of urine takes place. Of those cut for the stone, children to the age of fourteen are the best subjects for the operation, on account of the softness of their bodies: old men are difficult to cure because ulcers of their bodies do not readily heal; and the intermediate ages have an intermediate chance of recovery. And again, those who have larger stones recover best because they have become habituated to the inflammation, whereas those who have smaller recover with difficulty for the opposite cause. ”

“ The œdema may go on to suppuration, and involve the articulations, and ankylosis of the smaller joints may follow. This, too, is to be traced to the neuritis. The skin of the foot becomes pigmented, and may be dry or covered with offensive sweat. As the patient cannot walk while the ulcer remains, the condition demands treatment. Rest, moist warm applications, antiseptic lotions, scraping out the sinus, and other surgical means appropriate to the treatment of ulcers and sinuses do not often prove of benefit, and in obstinate cases recourse has been had to amputation of the foot. ”

“ As a general rule, it may be taken that most diseases of the foot are comparatively easy of diagnosis. When, however, the condition is one which commences simply with an initial lameness, the greatest care will have to be exercised by the practitioner. ”

“ All cross presentations are said to be difficult to rectify, but the child is to be brought by the head or the feet according to circumstances. When delivery is retarded by rigidity of the parts, he strongly recommends the warm bath. When fulness of the bladder occasions obstruction, he properly directs the urine to be drawn off by a catheter. When a foot or hand presents, he directs us not to pull down the part, lest it become more firmly impacted, or lest it should be fractured or dislocated ”

“ But the disadvantages attending the loss of sensation in the foot have been brought forward on many occasions as an argument against neurectomy, and no one can deny that the foot with sensation is better than one without that faculty. ”

“ Contusions of tissues that cannot be given physiologic rest, such as the thoracic wall, and the respiratory muscles, respond less promptly to treatment.
The general condition of the patient is an important factor in the prognosis, the most favorable being vigorous adult life without organic disease. Among the unfavorable general states are, the extremities of life, the very anemic and the plethoric, the tuberculous, the syphilitic, the diabetic, and like diatheses, while in the rheumatic and the gouty, the slightest injury may be most persistent. ”

“ Onyxis.—This distressing affliction consists in an incurvation of the toe-nail from a bruise or the pressure of a tight shoe, producing inflammation and ulceration, and followed eventually by fungous growths, or proud flesh, which is exceedingly tender and painful. The cure is slow but certain. The foot must be frequently soaked in warm water, until the soreness is so far abated that it can be handled without pain ”