Burying Our Heads in the Sand

People will believe most readily what they want to believe. If certain facts lead to conclusions which are unacceptable to the average individual, he is quite capable of ignoring those facts, or rationalizing them in such a way that they no longer pose a threat to his peace of mind. Nowhere can this human shortcoming be better illustrated than in the attitude most of us take toward the kind of shoes we wear.

With the exception of the "Munson Last" type of workman's shoe, practically all shoes worn daily by men and women in our Western civilization have little relation to the shape of the human foot. The reason is that the well dressed man and woman of today like a symmetrically shaped shoe - one which tapers nearly to a point to the middle toe. Our feet however, are far from symmetrically proportioned, being quite broad at the toes and considerably longer and thicker on the big-toe side than on the outer side of the foot.

People are generally unwilling, it seems, to face up to these facts. Perhaps they realize unconsciously that logic would then compel them to wear a shoe shaped like the human foot-and this would be thoroughly unacceptable to the average clothes-conscious man or woman in the United States.

What Do We Know About Foot Health Today?

Strangely enough, it is as unusual to find a doctor wearing a pair of properly shaped shoes as it is to find a businessman or any type of white collar worker in shoes conducive to foot health. What then can doctors advise their patients concerning the proper kind of footwear for their health and comfort? The answer is very little, for the medical profession, as a whole, knows very little about foot weakness, its causes, its cure, or its close relationship to the kind of shoes we wear. Why?

In most medical schools, and in the practice of medicine generally, foot disorders fall into the domain of the orthopedic surgeon. But the average orthopedic surgeon spends very little of his time with nonoperative foot disorders. Unless a foot is so distorted (by a bunion for instance, a hammer toe, an injury, or a congenital anomaly) that operative intervention is clearly indicated, the orthopedist is usually not too concerned with treating and following the case. His time is taken up with the other aspects of orthopedic surgery and he has little interest in running a foot clinic for curing weak and disabled feet.

In the field of foot weaknesses and disabilities, the only classes that most medical schools provide for their students are given by the department of orthopedics. The limited time devoted to this department in the curriculum is almost always utilized in teaching about the handling of fractures and the other more dramatic aspects of orthopedics. The editor of Clinical Orthopedics, Dr. Anthony S. DePalma, himself a professor of orthopedics in a medical school, stated that "Medical Schools fail almost completely in giving the student a sound grounding and a sane therapeutic concept of foot conditions."

By common consent of patients and the medical profession, non-operative foot problems are referred to chiropodists. Yet it seems that most chiropodists do not know a great deal more about the cause and prevention of "foot trouble" than do the members of the medical profession. Dr. William A. Rossi, a leading chiropodist and an editor of the Boot and Shoe Recorder, stated in the October 1958 issue of the Journal of the American Podiatry Association: "Absence of scientific standards are the missing links in fields of foot health and footwear. Physicians, orthopedists, chiropodists, shoe fitters, shoe manufacturers, all have individualized approaches to foot health, with the result that no one knows what is a 'normal foot,' a 'good shoe,' or how to evaluate a foot."

A Crusade for Healthier American Feet

From time to time voices have been raised protesting that the shape of the shoe is almost invariably the causative factor in producing weak and disabled feet. As early as 1905, Dr. Peter Hoffman, an orthopedic surgeon, contended that most foot trouble was caused by compressing the feet into poorly shaped shoes which did not conform to the shape of the foot. Major Edward Lyman Munson, Jr., in 1912, in his book The Soldier's Foot and The Military Shoe, succeeded in convincing the Army that shoes should be built on a last which would conform to the natural shape of the foot. Presently Dr. Alfred Rives Shaiids, Jr., author of the Handbook of Orthopedics, states that the overwhelming causes of foot disability in children are the shoes they wear. Many people who have agreed with these theories in principle however, have never put them into practice because of the psychological block resulting from aesthetic considerations of shoe styles.

Dr. Wikler is convinced, as am I, that foot trouble among children is almost always caused by shoes, and that most adults' foot trouble would either not exist or would be much less bothersome if properly-shaped shoes had been worn during childhood or, better yet, if those people had gone barefoot (or the equivalent). In this book, Dr. Wikler states his case with great cogency, and in a manner so simple and direct as to be convincing to the unprejudiced and the lay reader. If his book could be widely read, and the concepts outlined herein were accepted and followed by pediatricians, general practitioners and orthopedic surgeons, the next generation of children in this country would have an excellent chance of growing up with little or no foot trouble, and consequently far healthier than any generation that has preceded it for many, many years.

Thomas Hale, Jr., M.D. Director, Albany Hospital Albany, N.Y.

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