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the effect of the introduction of elementary education was not fully felt for a generation,
until an educated parentage took the place of an illiterate one, so the full effect
of the first twenty years of school medical work will be seen later when those of the
children who have experienced its benefits become, in turn, the parents of a new
generation.
The Incidence of Flat Feet in School Children.
Special attention to the condition of the feet of the children was given by
several school doctors as the result of a letter from the orthopaedic surgeon of one of
the great general hospitals, who pointed out that a number of boys comes for
treatment for painful flat foot about 6 months to one year after leaving school and
going to work.
During school life flat foot attracts little attention, as complaint is scarcely
ever made, but if a number of children is examined specially, there is always
found a certain proportion who present various degrees of flattening of the arch of
the foot, varying from 3 to 12 per cent., according to the idiosyncrasy of the doctor
inspecting, and the age and sex distribution of the children.
It is by no means certain, however, that the children thus singled out as having
flat arches are those who later fail in industry owing to the development of acute
flat foot causing pain and disability. It is noteworthy that children who present
themselves for licensing as stage dancers and have the most perfect mobility of the
feet are found in repose to have feet which can only be described as flat, although
they have finely developed calf muscles and are able immediately upon springing
into activity to produce well.arched feet. Osgood at the American Congress at
Buffalo in 1913, stated that many of the weakest feet are those in which the arch
is high but under strain, whereas the feet of savage men are quite efficient, although
they often show complete depression of the arches when the muscles are relaxed.
Bankart, in 1923 (Lancet, p. 799), stated that the worst symptoms of flat feet occur
in feet which are not flat. A high arched, thick.set or sturdy foot offers resistance,
and distortion of its joints is very painful.
The shape of the feet of young infants is flat and remains flat in races that do
not resort to boots, but retain the mobility and partially prehensile character of the
feet. Some eminent surgeons have expressed the view that wearing of plimsolls or
sandals leads to the development of flat feet, while others point out that what happens
is that the arch fails to develop.
General
conclusions.
It seems as though it were not possible to predicate during school life that a
particular child will suffer from flat foot after entering industry, but there are certain
types which, whatever the condition of the arch, are more likely than others to develop
painful trouble, and these are to be looked for amongst those with least mobility
of the feet and poorest developed muscles, and not necessarily amongst those with
feet which are flat in repose.
Whilst doubt exists as to the course of the natural development of the human
foot, there can, however, be no doubt as to what the schools must do to anticipate
and prevent the development of flat foot in adolescence. Physical exercises must be
directed towards increasing foot mobility and muscular development, and should be
carried out in flexible shoes or, what is indeed better, without foot gear of any sort.
Dr. Verner Wiley inspected the feet of 592 boys at two secondary schools;
the number found with flat feet was 49, or 8.4 per cent. Of the 49 boys, 38 were
classed as slight, 8 as moderate and 3 as severe. From general observation of the
physique of the sufferers it appears that flat foot is found in two types—(i.) the
weedy boy of poor physique; (ii.) the very heavy louty boy. Only 4 of the boys
complained of symptoms (tiredness or pain).
Statistical
information
Dr. Verner
Wiley.
Dr. Danvers.Atkinson examined the feet of 504 children of the leaver age groups
in elementary schools. Amongst 251 boys flat foot was found in 8 or 3.18 per cent.
Amongst 253 girls flat foot was found in 11 or 4.34 per cent. In none of the feet
showing as " flat " was the typical picture of talipes valgus manifested. There was
Dr. Danvers
Atkinson.