That this is an age of foot-consciousness is emphasised by the number of shoe shops which specialise in "correct" footwear. People generally seem to be waking up to the fact that foot troubles can produce many ailments in other parts of the body even far removed from the cause and which were formerly not suspected of having their origin in the feet.

Perhaps in no other region of the body can such accentuated pressure be found as in the feet, encased as they are in "coffins" during practically the whole of the waking life. The word "coffin" at once conjures up the idea of death, and most human feet are but half alive so far as their full function is concerned, as two out of every three people suffer from some form of foot defect with consequences so far-reaching that sufferers would indeed take more heed did they but know. They would surely see to it that their precious feet were put right, not merely by having the symptoms treated by the removal of corns and callouses, not by the wearing of arch supports, but by having subluxated bones adjusted and the feet rebuilt as a whole and then adopting proper shoewear and avoiding excessive standing and other strains on the feet.

To arrive at an understanding of osteopathic methods of foot correction let us first take a superficial glance at that marvellous structure, the human foot.

It is made up of twenty-six little bones, each most ingeniously shaped and articulated to serve the purpose of the whole. They are held firmly together by bands called ligaments, whilst the muscles and tendons, which give movements to the foot, add to its support and afford elasticity to the arches, so as to mitigate against the jarring of the spinal column. There are twenty-eight articu­lations or joints, and the foot has the ability to perform no less than one hundred and twenty-six movements. It has been stated that, according to engineering standards of measurement, the feet have to bear a stress of two hundred and fifty tons to every walking mile.

Some misunderstanding about the arches must now be cleared up. The foot has three arches: the inner longitudinal or spring arch, the outer longitudinal or weight-bearing arch and the trans­verse tarsal or instep arch. But what about that so-called arch that comes in for more attention than the other three put together, namely the much talked of "metatarsal" arch! Is it not true that a goodly number of assistants in the modern shoe shop will assure their customers that they have "dropped" metatarsal arches and will promptly advise the purchase of supports? (The question of arch supports will come up later). Here let us deal with that erroneous but prevalent idea of the existence of the metatarsal arch. One surely has no need to be thoroughly acquainted with the complicated anatomy of the human foot in order to recognise with very little observation that with all the heads of the five metatarsal or long bones of the foot in direct contact with the ground when the weight of the body is upon them, there can be found no arch, and to quote Dr. Hiss the well-known American Osteopathic Foot Specialist and Orthopaedic Surgeon, to ascribe an arch to the metatarsals is a misnomer.

Whilst granting that a support beneath and just behind the heads of the metatarsals certainly affords relief from pain and discomfort in certain cases of metatarsalgia, it cannot be corrective, as previously stated. The hollow or groove observed on the front of the upper part of the foot—especially in high-arched feet— certainly gives the appearance of the bones having "dropped," but that groove is really caused by the extensor tendons of the toes having become contracted, thus pulling them upwards in a hyper-extended position, with the end of the toes flexed so that they look like hammer toes without, however their fixity.

We now come to what constitutes the main cause of the majority of foot troubles, namely, shoes that do not conform to the natural shape or stress of the human foot. The whole economy of the foot is thus destroyed, and with complete lack of normal function or of very limited function malformation takes place in the course of time. True, there are shoes now on the market which conform to the natural shape of the foot, more or less, but what consideration has been given to the stress that each foot is subjected to?

Now a timely word about the wearing of arch supports, whether they be built in or inserted into the shoes.

Let us revert to the natural arches of the actual foot. We have already mentioned that the inner longitudinal arch is the "spring" arch, but if it be "dropped" it obviously has lost its spring, hence it follows that by placing a firm arch support—especially of the steel variety—beneath the arch, it certainly has the mechanical effect of forcing the arch upwards through the resistance caused by the weight of the whole body upon the foot. But, and this is the important point to note, the actual cause of the "fallen" arch has thereby not been touched. The spring or recoil of the foot is still absent and whatever slight recoil there may have been before, that "little" has now been taken completely away by the steel contrivance. The foot is now held in a far more rigid state creating further tension not only in the foot but all over the body as the sufferer goes stumping along, jarring the nerves of the whole of his spine at each step right up to his head, quite irrespective of whether the wearer experiences relief from the support or not. Hence, you see these "crutches" maintain and tend to worsen the very condition they set out to relieve, and this in spite of the fact that some foot sufferers are obviously relieved at first, whilst others suffer more acutely and discard them. Here is another point, the continuous wearing of arch supports must eventually weaken the muscles of the foot since the action of the muscles is restricted, and natural law has it that "what you do not use you lose." Further, the spring arch is so designed by Nature that it does not come closely into contact with the ground at each step and still less so when standing, depending upon the height of the arch natural to the individual. Thus, when pain is felt in the sole of the foot, it is due to the delicate nerves and blood-vessels being impinged upon; hence it can now be easily recognised how hard supports increase the pressure upon them and how "fallen" and particularly artificially supported arches enhance the disability, and interfere with circulation.

It is of interest to note that the osteopath finds the source of most foot troubles in the posterior transverse or instep arch, and this quite irrespective of whether the arch comes under the category of "high," "medium" or "low." The actual height of the arch has little to do with the pain experienced, except that, ironical as it may seem, the very high arch can cause the greatest discomfort if the alignment of the bones constituting the instep arch is affected by even the slightest displacement of the bones, although to all appearances the foot presents a perfectly normal shape. What can rigid arch supports do here where there is no prolapsed arch to lift!

If there be no pain or tenderness felt in ordinary daily life, and none elicited when the foot is under examination by palpation, then be the height of the arch what it may the foot of that particular individual is normal to him, so far as its function is concerned. "Comfort varies with function," says Dr. Hiss. It must be stated, however, that whilst a patient can be quite unconscious of any pain or discomfort in his ordinary daily activities, yet it can be elicited on palpation of the bones.

The instep arch is composed of four small bones named from within outwards, the three cuneiform (wedge-shaped) and the cuboid (cube-shaped). In a case of so-called "fallen" arch it is one or more of these little bones that have become displaced. Very frequently the scaphoid or navicular (boat-shaped) bone is involved too. The scaphoid is situated behind and is articulated to the three cuneiform bones in front, and if the normal alignment of these bones is disturbed, the arch is really more "broken" than "dropped," such "dropping" not being so much in evidence in high-arched feet. Thus the correction lies not in the wearing of arch supports, but in the adjustment of displacements by manipulative technique.

It is indeed very remarkable how quickly most foot ailments will yield to skilled manipulative treatment; and not only do suc­cessful adjustments cause the pain to vanish but afterwards the whole body feels a wonderful sense of well-being.

While bad shoes are undoubtedly the major cause of many foot disorders, which must be corrected locally by manipulation of the feet, the osteopath finds that bad feet are also caused in many instances by structural faults elsewhere in the body. Such defects are largely traced to a lack of symmetry and balance in the bones comprising the pelvis and lumbar area of the spine.

The distortions found here are numerous and complicated and would require much space to describe. Briefly, the effect of these is to disturb the normal line of gravity falling through the body and to place an unequal weight-bearing stress through parts not intended to take such a stress. This weight stress can be deflected so that it falls too far forward, backward or to one side, thus straining the feet with every movement, and no matter how perfect the shoes are in time the normal relationships of the foot bones are disturbed. It is futile in these cases to attempt foot relief without prior spinal correction, because the foot distortion here is a compensatory effect. As in all other disorders, the osteopath primarily considers the body from the standpoint of the "whole," and while relieving distress locally he invariably seeks its cause throughout the entire structural mechanism.

A certain type of headache has often disappeared through foot adjustment. That awful dull and irritating ache in the upper back between the shoulder-blades as well as pain and tightness in the neck and the small of the back have likewise vanished. Patients report that organs that were prolapsed seem to have regained their normal position. This happy condition would automatically be brought about by the altered and improved posture causing the spinal column to straighten, and with this, lengthening of the spine and the uplifting of the abdominal viscera would take place.

This article would not be complete without a word of solace to the ladies lest they may think that by wearing "sensible** shoes they are doomed to deny themselves the adornment of what is styled a fashionable shoe with its smart high heel, which gives them not only physical but also mental uplift. Provided that your feet spend the major part of the day in low-heeled shoes, the wearing of high heels in the evening will do but little harm. After all you are then sitting down most of the time and, if you are at a dance, you dance on your toes anyway, though admittedly the high-heeled shoes do affect the normal alignment of the whole spine, so that to maintain a good posture an abnormal and great strain is thrown upon the respective muscles responsible for the erect state.

A good plan for you ladies to adopt is this, wear shoes in the mornings with little or no heels, a sensible walking shoe in the afternoons, and then indulge if you like in your high-heeled shoes in the evenings.

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