MEDICAL NOTES.

Auckland Star, Volume LXVI, Issue 76, 30 March 1935, Page 7 (Supplement)

MEDICAL NOTES.

FLAT FOOT. THE UNNATURAL BOOT, NUTRITION PROBLEMS.

(By PERITUS.)

It is strange how easily people are misled by oft-repeated statements obviously inaccurate; statements they are well able to examine and test for themselves. In common with others, I have long mistaken an acquired foot deformity as a normal and natural shaping. For many years the deformity known as "flat foot" has been considered as an acquired defect, and treated as a disease. Many appliances have been invented to "restore the arch" of the foot, and medical men have designed exercises and treatment to "correct faulty posture" of flat feet. If the footprint of a child learning to walk is examined you will find that the imprint bears the outline of the whole solo of the infant's foot. The footprint of "Man Friday" was similar, and any normal "native" foot, uiulistorted by the wearing of boots or shoes, gives the same training. In short "flat foot" is natural, and the arched sole is abnormal and acquired only as a deformity duo to the cramping action of foot clothing, for, when the muscles of the foot are at rest and relaxed the sole of the foot is flat, but when the muscles aro in | action and contracted the arch of the sole appears. You can understand how the cramping action of boots or shoes prevents the return of the relaxed position, and in the course of years foot constriction makes the arch permanent. Permanent flat foot is as unnatural as a permanent arch. The change from one to the other is no more than the difference between action and rest. The cure of painful contracted foot is forcible manipulation and extension of the muscles of the sole. The Constricted Foot. When we are allowed by fashion to wear a soft elastic foot covering, per- | mitting the foot to take any natural position freely, hammer toe, bunion, corns, and "flat foot" will be unknown. An English surgeon says that as long as the human foot is confined, constricted and contorted, "foot strain" will be general, and most acquired deformities be curable only by operation. Sir Herbert Barker was the first to detect the foot strain known wrongly as "flat foot," and to treat it correctly and successfully, proving all artificial supports unnecessary and faulty. Powerful foot I muscles cause the formation of a high arch in action, as walking and running, but in standing or quite relaxed the whole of the sole of the foot should touch the ground. The "Arab" arch is so called because the barefoot man of the desert has a long, slender and powerful foot, arching like a spring in action. - The children of this country have the opportunity of adopting something like a moccasion for wear throughout life, and preserving the natural shape and usefulness of the feet. Fifty years ago an attempt was made to introduce socks with separate compart-j ments for each toe, as gloves arc made for the lingers, but the wide "Natureform" boot or shoo required to accommodate feet so covered alarmed all but a few old people, who wore woollen shoos and were generally derided. Fashion almost always moves contrary to health and comfort. A window full of human feet, as they are to-day, would be highly unattractive, but the admiration all women display for the feet of a baby is evidence that a sense of what is right and beautiful is not quite dead. 1 Malnutrition. This word is loosely used. A child of one family may be "strong" and well fed to that family, but show up badly when compared with children of the same age of other families. A standard of feeding of health and strength is only approximate. In medical circles just now there is much discussion connected with the 8.8.C.'s advice that all young persons require a meat diet. The vegetarians (medical and lay) are up in arms. One large private school (England) exclusively vegetarian, produces records of success of pupils as against other schools, in mental ability, physical measurement, absence of illness, in sports and games. In place of meat the whole school feeds on eggs, cheese and milk (minimum quantity for each boy, two pints daily), and disregards the finicking fussy cooking commonly believed to be necessary, and makes vegetables and fruit general, but nuts a luxury. It seems evident that meat is quite unnecessary. In order to test schoolchildren and form a reasonable standard of fitness, doctors have devised such simple things as "standing at ease," without evidence of fatigue; holding both arms extended with fists closed; and pulling a dynamometer.

The Human Organism. Good nutrition means that the nutritional processes are proceeding in a healthy manner and that the diet is such as to make this possible. In its true s?euse malnutrition is the state of disordered function brought about by faulty diets. The human organism possesses a remarkably wide range of adaptability (aptly called by Cannon "the wisdom of tlie body"); only when the limits of safety are overstepped do pathological defects become manifest. Apart from this "primary" malnutrition, disordered nutrition arises indirectly from organic change caused by pre-exist-inar disease of the circulatory, nervous, respiratory, or endocrine systems, or by former disease of the organs of nutrition. The correct treatment of primary malnutrition is a well-balanced diet, but additional measures are needed for malnutrition of "secondary" origin.

Both the art and the science of medicine are available, says one doctor, for assessing the nutritional state. As to the art, only experienced physicians can give even a fairly accurate estimate of the state of a child's nutrition or make valid comparisons. Individual physicians have not the same conception of what a well-nourished child is. Recourse to the science of medicine implies the employment of physiological measurements, but it must be noted that the physique of the body at a givm moment is a measure of the balance between income and expenditure of food during the whole previous'life, and ;s not an index of normality at the time. It is, for example, no more correct to call a child mal-nourished who hat been stunted by previous protein deficiency, but whose body functions-well in proportion to its bulk, than a bandy-legged youth who is playing a strenuous game of football. Primary malnutrition is most likely to produce effects on body physique at the ueriods of most rapid growth.

Another doctor, a diet expert, says that there was no subject 011 which more muddled thinking has taken place than on nutrition and dietecics; he is afraid that discussion has shown that it is not entirely confined to the lay Press. Ho emphasises the idea that malnutrition is entirely a cli'iieal concept and that qualitative as well as quantitative factors must be considered, as in the thin but healthy child; mere height, he says, like mere bulk, is also not in itself meritorious. He also mentions the comparative unimportance of vitamins.

In testing strength and staying power normal children can stand steadily without discomfort or evidence of gross instability for 20 minutes or more; unfit children break down inside ten minutes. By this method muscle tone and circulation are tested. Finally, suitable tests for the efficiency of the involuntary functions offer wide field for research. To obtain scientific evidence of functional derangement before organic change sets in would make prevention possible in the true sense. In short, standard physique is as impossible to fix as standard diet, and malnutrition is a relative term we may use freely in relation to the children of other peoples.