und.

[Illustration: FIG. 154.--Imprint of Normal and of Flat Foot.]

_Skiagrams_ are useful for showing displacement of bones and
differences between sitting and standing, and for recording the
results of treatment.

_Prophylaxis of Flat-foot._--Stress is to be laid on a supervised
training of the whole muscular system, and especially of that of the
legs. In walking and standing, the feet should be kept parallel and
not pointed outwards, as was formally taught in schools of gymnastics
and insisted upon by drill instructors. Children should be taught to
walk properly, rising on the balls of the toes with each foot in
succession. Attention should also be directed to the boots, which
should be so fashioned that the medial side of the boot is kept
straight and the end of the boot is opposite the big toe.

_Treatment._--This is directed towards restoring and maintaining the
arch of the foot. As the measures adopted necessarily vary with the
extent to which the condition has progressed, it is convenient for
purposes of treatment to recognise the following four degrees. A first
degree, in which the arch reappears when the weight is taken off the
foot or the patient rises on the balls of the toes; a second, in which
the normal attitude can be restored by manipulation; a third, in which
this is only possible under anaesthesia; a fourth, in which the bones
are so displaced and altered in shape that correction is impossible
without operation.

_Cases of the First Degree._--If there is marked pain and tenderness,
the patient must lie up. The general health is improved by a
nourishing diet and by cod-liver oil and tonics; and the legs and feet
are douched and massaged thrice daily. When pain and tenderness have
disappeared, the patient is instructed how to walk and exercise the
feet. In walking, the medial edges of the feet should be parallel with
one another, first the heel should touch the ground and then the balls
of the toes. He should neither stand nor walk long enough to cause
fatigue, and in standing he should alter the attitude of the feet from
time to time, and occasionally rise on the balls of the toes. The
following exercises, devised by Ellis of Gloucester, should be
practised: (1) Rising on the balls of the toes, the toes being
directed straight forwards; (2) rising on the balls of the toes, with
the points of the great toes touching each other, and the heels
directed out, so that the medial borders of the feet m