Weak Ankle and Flat-foot
In spite, however, of the thick elastic ligament and the strong tendon just mentioned, the joint between the astragalus or key-bone and the scaphoid bone still remains a weak point. The head of the key-bone, from being insufficiently supported or from being overweighted, is very apt to descend a little below its proper level; the consequence of which is that the plantar arch is lowered and the foot is flattened; and the more the foot is flattened the weaker it necessarily is, because the position of the bones then becomes less and less favourable for bearing weight, and an increasing strain is thus incurred by the ligaments and muscles. Hence the foot and ankle feel weak; and the weakness is especially felt when the person endeavours to raise the heel, so as to mount upon the balls of the toes, in walking. For the performance of that movement with ease and steadiness a well-formed plantar arch is essential; and the person, whose feet are defective in the manner we are considering, can never walk with a bold, firm step. The movement in him may be better described as a shuffling from one foot on to the other, than as a walk. To this I will recur again when I come to speak more of walking. The defect, when slight in degree, is commonly called “weak-ankle;” when more decided it is called “flat-foot,” because the sole is then nearly, or quite, flat. The head of the key-bone, under such circumstances, may even bulge downwards and inwards, and form a prominence on the inner side of the sole, so as to give more or less convexity to the line on the inner side of the foot, which should be concave.
The representation of “flat-foot” here shown was drawn from the foot of a labouring man in this county. He said he believed the deformity was due to his having worn thick tight shoes when he was a growing boy. He is most likely right in his opinion; for tight or ill-fitting shoes, cramping the feet and preventing the proper growth of the bones and the free play of the muscles, are a common cause of this evil. This is so especially among the agricultural class, whose feet are, from an early period, enclosed in stiff unyielding leather cases that are enough to mar nature’s best efforts to construct a plantar arch.
The same drawing shows that flat-foot is not the only deformity for which “high-lows” are answerable. Besides the almost total want of calf, which is due to the wearer being obliged to hobble along, whole-footed, with short feeble steps, it will be seen that the great toe has not been allowed to assume its natural straight line, but has been squeezed athwart the other toes, so as to be almost at a right angle with the foot. No room at all is thus given for the second toe; it has been driven quite out of the field, and has been obliged to hide itself by bending down under the other toes. This is no uncommon state of things. Frequently it is attended with the formation of a painful bunion upon the prominent inner side of the ball of the great toe; and, in addition, there is sometimes a corn upon the first joint of the second toe, which is a source of so much inconvenience that I have known many sufferers glad to get relief by parting with the toe.
I wish I could hope that the days of high-lows are numbered, and could believe that in the next generation they will be ranged with the things of the past, and that our children may know these enemies to the form of the rustic foot, only as objects to be gazed upon with feelings of astonishment and pity, just as we regard the perukes and the stays of our ancestors. There are, however, some practical difficulties in the way of the fulfilment of this charitable wish.
There are two periods of life at which Flat-foot is most likely to be engendered. First, in infancy, if the child be put upon its feet too early, before the bones and ligaments are strong enough to bear the weight of the body. Therefore mothers should not indulge their anxiety to see their infants walk very early; the pride attendant on premature success is liable to be followed by regret at finding that the children never walk well. Parents and nurses should be content to let the children crawl and roll about upon the floor, and should not encourage them to stand upright, especially if they be rather heavy or weak children. Children are quite sure to acquire the faculty of walking as soon as they are well fit to exercise it.
The second period is at about fourteen. The body attains a considerable increase of weight at this time, in consequence of the quick growth that takes place. We often remark that lads and girls of this age shoot up apace; and their greater weight is not always attended with a proportionate acquisition of strength. They are apt to be rather weak and ungainly in their movements; and the weakness often shows itself in the foot, by a yielding of the plantar arch. Moreover, many boys and girls are, at this age, turned out into the world to earn a livelihood, and are obliged to be a good deal upon their feet, and perhaps, in addition, have to carry weights. Thus errand-boys, butchers’ and bakers’ boys, and young nursery-maids, are frequent sufferers in this way. The constrained positions in dancing, also, if enforced too much, or continued too long, so as to tire the feet, sometimes lead to the same result. On the other hand, moderate exercise of this kind is calculated to strengthen the foot and also the whole frame, and contributes much to improve the carriage.
This is not the place to enter into particulars of treatment. I will, therefore, merely remark that the common notion of supporting and strengthening the ankles by tight-laced boots is altogether a mistake, and must be ranked among the most influential of the causes which combine to spoil so many feet. It has its parallel in the idea of strengthening the waist by stays. The notion is, in both instances, fortified by the fact that those persons who have been accustomed to the pressure, either upon the ankle or the waist, feel a want of it when it is removed, and are uncomfortable without it. They forget, or are unconscious, that the feeling of the want has been engendered by the appliance, and that had they never resorted to the latter they would never have experienced the former; just as dram-drinking induces a recurrence to the stimulus by causing a sense of sinking when it is discontinued; and, for the same reason, the opium-eater can hardly exist without his drug.