The soldier's foot and the military shoe; a handbook for officers and noncommissioned officers of the line

Front matter

Ill Mill HI

•Idler's Foot

Military Shoe t^IUNSON

Preface

In the investigation of the Army Shoe Board, which extended over four years and included the critical study of the feet of some two thousand soldiers, the fitting of many thousands of pairs of shoes, and many months of direct inquiry into the causes affecting the shoeing of the United States soldier, it became evident that in very many instances the faulty conditions found were due to lack of information on this important subject on the part of the officers and noncommissioned officers of the line concerned.

The purpose of this book is to supply the practical information on this subject which has not heretofore been available, and without which it cannot be expected that the several factors which must correlate in order to produce the best foot conditions and marching capacity among American troops will be suitably recognized and satisfactorily coordinated.

To Captain William J. Glasgow, General Staff, and First Lieutenant Benjamin F. Miller, 27th Infantry, who, with the author, composed the Shoe Board, and to Captain John R. R. Hannay, 226. Infantry, later added as an additional member, very many of the new points here brought out on the subject of the military foot and footwear must be attributed.

The Army Service Schools, E. L. M.

Contents

Foot Injuries and Marching Capacity .... i

The Anatomy and Use of the Foot 7

The Military Shoe 34

Chapter I. Foot Injuries And Marching Capacity

It will not be disputed that the marching powers of foot troops are a most important factor in the conduction and success of battles and campaigns, and that the army which marches best, other things being equal, is the successful army. Mobility is the key of military success, and troops which cannot march will not be given, by a more vigorous enemy, opportunity to fight except under what may prove to be decisive military disadvantage. History is full of instances where military success has been won more by marching than by fighting, and as time goes on rapidity of movement will probably be an even greater element in military strategy in wars of the future than it has been in the past. The advantage of position, by which both the disadvantage of inferior force may be minimized and the power of superior strength still further enhanced, is the object of every commander.

Furse, in his "Art of Marching" says : "Marching is the foundation of all operation in war. An army below the standard in marching power is at the mercy of a more mobile force. Actual battle consumes but a fraction of the time spent in marching. The most brilliant plans fail if the troops do not march the distances calculated upon. Mobility is the first requisite of the soldier".

Napoleon is reported to have said that he made war not so much with the arms as the legs of his soldiers, while Forrest defined the art of war as "getting there first with the most men". Many examples could be given where battles have been lost and won by marching capacity. Waterloo was lost and history changed because of delay in the arrival of the expected French reinforcements — while the march of Jackson's socalled "foot cavalry" in the Manassas campaign of 1863 turned Pope's anticipated victory into the defeat of the

Second Bull Run. War has become a business in which each unit has its part to play ; and the soldier whose badly shod feet are unable to carry him into battle fails at the critical moment of the purpose for which he was trained, and instead of being an added strength he becomes an incumbrance.

The effect of badly fitting shoes upon the psychology of war is very great. Even where the soldier is able to continue the march, the discomfort produced at every step soon reduces buoyancy of spirit, causes mental irritability and materially diminishes fighting capacity. As the attention and interest of the soldier is focussed upon his own personal condition and withdrawn from matters relating to the success of the military enterprise as a whole, the mental force which inspires the command to military achievement is dissipated and lost.

Some foot defects are in the nature of deformity in the anatomical relations of the foot structures. These mechanically weaken the foot and prevent it from exerting its powers to best advantage in the propulsion of the body in marching. Pain, also, may accompany these foot deformities and seriously interfere with marching power. Blisters and other injuries of the feet, which in themselves may be of no importance, require rest for their recovery. For this reason, they possess a very great practical interest from the military point of view, since they rapidly render a large number of men unfit for service and so diminish in large proportion the effective force relied upon at the beginning of a campaign.

The amount of disability from foot injury in modern armies is enormous. Brandt calculated that seven per cent of conscripts annually drafted for the German army are found unfit for military service by reason of foot defects due to bad shoeing. Lindau found that of ten thousand men discharged annually from the German army for physical disability in time of peace, four hundred were for affections of the feet — a proportion which he states would be tremendously increased in time of hostilities. In the early part of the Franco- Prussian War, in the Tenth Army Corps, the constant ineffectiveness from injury to the feet as a result of marching ranged from eight to ten per cent; and it is said that at one time not less than thirty thousand German soldiers were, from this cause alone, incapacitated for field service.

Leques found that excoriations of the feet figured as one-third of all the causes of exemption from active service among young French soldiers in campaign. In our Civil War, whole brigades were said to have been temporarily disabled and prevented from marching from this cause. Germaine has estimated that, after several days marching, about one-fourth of an infantry command would present excoriations of the feet and not less than ten per cent of the command would be in the hands of the surgeon; while military statistics in general show that from one-fourth to one-third of a command sustains foot injury in the first few days' marching. It has been estimated that for European armies an average loss of ten per cent must be expected from this cause among unseasoned troops on taking the field.

Examples of such incapacity and losses in our own army in more recent times are not wanting. Probably not an individual of any extended military experience but can recall instances in which the capacity of his command for marching was greatly diminished, and its effectiveness as a fighting force materially impaired, as a result of foot injuries. Many examples might here be cited, but the following instance which occurred in the experience of the Shoe Board is sufficiently typical.

In 1908, a battalion of United States infantry took a practice march in shoes which the men had themselves selected. It marched eight miles, went into camp for twenty-four hours, and then returned by the same route to the post. The members of the board examined the feet of all the men of the battalion at the end of the first day and again on their return. On the first day, 30 per cent, and on the last day 38 per cent, of the command were found to have severe foot injuries, some requiring hospital treatment. The feet of many others were reddened and sore from this short march, and a few more miles of marching would have converted these painful areas into blisters, and small blisters into large ones. This march is illuminative of what may be expected in our service if the matter of shoes and shoe fitting is turned over to the men and the matter of shoe supply is not given the attention its importance deserves.

But because foot injuries have usually been so common among soldiers of all armies is no reason for our accepting them with patient resignation as one of the inevitable concomitants of field service. The opposite is in fact the case. It is of grave military concern that the mere act of mobilizing a large military force by marching may require the immediate temporary discount of some ten per cent, of those previously effective, from foot injury. A cause which operates — without any possible compensating results — in practically every command at the beginning of a campaign to bring about the absence on the firing line of as many men as would be lost to that command as the result of a pitched battle is worthy of far more careful and thorough investigation than it has heretofore received. Inquiry shows that the armies of different countries are not alike — and within the same army its various component organizations may be quite dissimilar — in this respect. Moreover, it has happened that troops have been put into proper shoes and marched under field service conditions over long distances without the slightest loss from a cause which usually operates so severely. These exceptions, few and isolated though they may be, are proof positive that the general rule is the result of conditions which are unnecessary or removable. It thus becomes evident that proper care relative to the feet and shoes of infantry soldiers will be well recompensed by the increased efficiency of the latter. Since it appears that disability from foot injury can be prevented, it becomes a military duty to apply at all times the measures which it can be demonstrated will accomplish prevention.

In this connection, a brief summary regarding a recent march by regular infantry will be instructive. In this test march, which was conducted by the Shoe Board to try out the several military shoes, three types of the latter were employed, viz: the garrison tan shoe, the marching shoe of 191 2 contracts, and the military shoe devised by the board. Enlisted men were fitted with a pair of one of these types — in regular sequence and irrespective of their preferences or desires, as the purpose was to determine and compare the respective effects of these different shoes upon the foot of the soldier class as a whole. But within each class, fittings were made as accurate and comfortable as possible. A full supply of all sizes and widths of each of these varieties of shoes was available for fitting. Eight companies participated in the march, and in each company about one-third the men had the same kind of shoe. The latter were worn by the men from twelve days to two weeks before the march, so as to get the feet reasonably habituated to the shape of the shoe supplied. Light wool socks were used for fitting and marching. The march included nine marching days ; while the distance covered scaled 117^2 miles but was probably at least 120 miles from bends and inequalities of the terrain. The shortest march was 8 miles; the longest 21 miles. A total of 379 officers and men, of whom 44 per cent were recruits of less than six months service, started on the march and 352 completed it. The full equipment, with ammunition, was carried.

Not a single man failed to complete each day's march as a result of foot injury; losses from the command being due to a few cases of illness and accident and detachment for other duty on orders from higher authority. The feet of each man were inspected by the board after each day's march, and even the slightest pinhead blister was noted on the man's record card. Many of the injuries so reported were so trivial that at inspection on the following day they were not apparent and even their former location could scarcely be determined. This demonstration of the fact that it is quite possible to march American troops long distances without appreciable loss from foot injury is in marked contrast with the heavy loss which has habitually occurred under similar conditions in our own and other armies. The result justified the belief long held by the board that any of the shoes as furnished by the Quartermaster's Department were fairly satisfactory, and that shoe difficulties and foot injuries heretofore obtaining in our army were chiefly due to shortage in the supply of sizes and widths of shoes available to troops through post quartermasters, and to ignorance, indifference and neglect on the part of company commanders in respect to the fitting to the feet of their men with such shoes as were available. Only such personal attention was given by the board to fitting as might reasonably be required of organization commanders and only such simple measures of foot cleanliness and care were carried out as could be enforced by the latter. Such trifling injuries as occurred, chiefly developed during the first few days when the men's feet were tender; and after the long 21 mile march, which was quite a severe test of the feet and endurance of the command. The percentage of recruits who developed foot injury was slightly less than that of the old soldiers, showing that length of service is not necessarily the important factor that it has heretofore been generally regarded, and that the higher proportion of recruits who in the past have probably had foot injuries was probably due to the difficulty in fitting themselves, with shoes of a new shape, in the sizes and widths to which they had been previously accustomed. In the entire march, 190 men, or 56.5%, never at any time suffered the most trifling injury of the feet; while 43.5% at one time or another suffered an appreciable lesion ranging from a pinhead blister undiscernable the next day to those of slightly larger size. Practically not a single injury of those which occurred was either large or severe. It thus appears that a very large proportion of the foot injuries common to marching troops, in number, extent and gravity, are unnecessary, are preventable by simple measures, and should be so prevented.

Chapter II. The Anatomy And Use Of The Foot

The human foot is. not to be regarded, as seems almost to be the idea with many, as an incoordinating mass of flesh, bone and gristle which may with impunity be crowded into almost any sort of protective covering to form a fleshy peg, more or less similar to a horse's hoof, on which to walk. It is, on the contrary, one of the most intricate anatomical structures of the human body. Every one of its parts has a definite function, and interference with its normal anatomical relations and development produces a corresponding structural defect or weakness which will always to some extent diminish — and not rarely is completely destructive of — the capacity to accomplish military marching.

Officers of the mounted branches are carefully instructed in the anatomy of the horse, with special attention to the hoof, foot and their related structures. For the cavalryman, it is appreciated that a competent knowledge of the inter-relations and coordinate functions of bone, muscle and sinew form an essential to the proper care and shoeing of the feet of his mount. This truth applies with even greater force to the soldier's foot; which in its structural anatomy is far more complex and delicate than that of a horse or mule, and in addition is compelled to wear a protection which, if poorly fitted, is much more liable to produce marching disability in the man than it is in the animal. It is impossible to effectively select and adapt a proper military shoe without a sufficiently comprehensive and intelligent knowledge of the integral and coordinating structures of the soldier's foot which is proposed to cover ; yet study of the elementary regional anatomy of the human foot by all officers — including those specially concerned with dismounted troops — seems to have been practically disregarded in our service. It is of course not necessary that

Skeleton of right foot, seen from above. (From Gray's Anatomy.)

Fig. 2

Skeleton of right foot, seen from below. (From Gray's Anatomy.)

line officers should go into minor details in this respect, or learn confusing medical terms ; but it is not too much to expect that they should at least gain and carry in their minds a general idea of the nature of the more important structures of the foot and ankle, with the individual and collective purpose and use of these parts. Indifference is probably not so much the cause of the lack of proper knowledge in this respect, as is the fact that appropriate attention has not been directed to the matter and the necessary information has not been readily available in suitable form. The foot has two functions : That of passive support of the body in standing, and use as a lever to raise and propel the body in walking.

The human foot has as its general basis a framework or skeleton, composed of twenty-six bones (See Figures i and 2). Of these, nineteen are the so-called long bones, composed chiefly of hard, firm bony tissues, of smooth surfaces and

Fig. 3

Section through foot on line of great toe. (From Volsz.)

various sizes, and joining with other bones at their ends only. The remaining seven bones, of various sizes, are composed of bone which is loose and spongy in texture; these bones have the appearance of irregular pebbles, and have

TI

Fig. 4 many smooth facets forming surfaces for joining with adjacent bones, by which each bone is in contact with from four to six others. Fourteen of the long bones above mentioned are small and belong to the toes, while the other five are much longer and form the metatarsus or ball of the foot. The seven irregular and spongy bones form the basis of the foot arch and heel (See Figs. 3 and 4). One of these — the astragalus — articulates with the leg bones to form the ankle joint (See Figs. 3 and 4).

The heel is obviously intended by nature, through both position and structure, to receive the shock of impact of the foot against the ground and support the greater part of the weight of the body and burden in standing and at the beginning of a new step. (See especially Figs. 3 and 4). The os calcis, or heel bone, lies almost in prolongation of the line of the center of gravity of the body as represented by the leg

bones. It is the largest bone of the foot, is broad and strong, and articulates closely with the astragalus — which lies above and in front of it and forms the keystone of the foot arch. The rear prominence of this heel bone is the point of attachment of the tendon of powerful muscles of the calf of the leg, which by their action lift the heel and rear of the foot off the ground and thus accomplish the first movement of the foot in walking. (See Fig. 3). This heel bone is guarded against injury by an especially thick layer of skin, fatty and fibrous tissue and muscle (well shown in Figs. 3 and 4), which serve as an efficient cushion between it and the ground. It is held firmly in position and attached to the bone it articulates with (the astragalus), and with other bones anterior

Transverse vertical section through ankle joint. (From Volsz.)

to it, by numerous strong ligaments and fibrous tissue (See Figs. 6 and 7). These attachments and the nature of the articulations of this bone permit of a certain degree of elasticity without true joint motion. The foot articulates with the bones of the lower leg, forming the ankle joint, through the astragalus. The latter also forms the keystone of the foot arch (See especially Figs. 2 and 7), as it is wedged between the heel bone and the scaphoid bone. It is a large, strong bone, with broad articulating surfaces, in contact with those of the leg bones, which embrace it on each side and support the entire weight with every step. From its position in the foot, its direct ligamentous attachments to other bones are relatively weak, but it receives additional support from the strong ligaments attached to other bones at the ends of the foot arch by which the latter are held together and prevented from spreading — and the astragalus from being thereby forced down — under the body weight. (See Figs. 6 and 7).

The front of the foot arch is formed by the five small bones, viz : the scaphoid, the cuboid, and the three cuneiform bones, together with the five metatarsals. The first five small foot bones are so closely articulated with each other by irregular surfaces, and are so firmly bound together by numerous small ligaments, as to form a compact bony mass, which is, however, capable of a certain limited amount of yielding under pressure which materially assists in lessening the shock to the foot and body which accompanies each step in marching. (See Figs. 6 and

Fig. 5

dorsalis pedis artery middle cuneiform bone external cuneiform bone extensor brevis digitorum '

cuboid bone

\ internal cunei » form bone j Internal muscu- \ lar group external muscular group

plantar fascia tendons of flexors middle muscular group

The Transverse Arch of the Foot. Section through the anterior row of tarsal bones. The line A B represents the surface upon which the foot rests when the individual stands erect. (From Gray's Anatomy.)

7). It will also be seen (Fig. 5) that the bones of this region not only form part of an arch extending from front to rear but also are so disposed among themselves as to form a secondary foot arch from side to side, thereby materially adding to the strength of the whole. Support to this lateral arch is given by ligaments and the tendon of one of the leg muscles.

From the very slight amount of elasticity and extremely limited relaxation anatomically possible as a result of the relations of the seven round bones of the foot, it is evident that a foot covering can logically be a close fit back of the tarso — metatarsal joint without in any way interfering with the purpose and functions of the foot.

The five long metatarsal bones form the extreme front of the foot arch. (See Figs. 1, 2 and 3, and all radiographs). They are firmly held at their posterior ends by ligaments binding them to the round bones of the foot (See Figs. 6 and 7), but the joints so produced are more flexible than those further back in the foot and permit of considerable motion downward (See Fig. 3). But between the shafts of these metatarsals there is no ligamentous union whatever, thus permitting marked spreading of these bones with broadening of the foot under pressure in the interests of greater flexibility, the production of broader surfaces and resulting increased stability in standing and marching. (See Fig. 6 and all radiographs). The frontal ends of these metatarsal bones, especially the ends of the first and fifth metatarsals, form the front of the foot arch (See Figs. 2 and 3). It will be noted (See Fig. 2) that the line of junction of the five metatarsals with the round bones of the foot, which forms the ball, is not square across but extends obliquely from without inward. The result of this oblique articulation, when the foot is pointed to the front, is to naturally tend to throw the weight of the body on the outer part of the foot, where the structures are strongest. The ball measurement in fitting shoes is taken just in front of this line of articulations, over the bony prominences at the base of the little and of the greater metatarsal bones.

This marked physiological capacity for spreading of the

Fig. 6 metatarsal bones, especially at their anterior ends, together with that obviously possible in the unconnected toes, results in a requirement that any shoe suitable for military purposes

shall be of such form and width in its anterior part as to allow proper broadening of the foot in its metatarsal and toe regions to the extent naturally assumed by the bare foot in standing and walking. If this be not done, the foot is narrowed, contact with the ground is decreased, and body equilibrium is impaired. In the natural effort to preserve the latter in too narrow shoes, the man tends to turn his toes out, thereby largely shifting weight from the strong outer margin of the foot so as to fall over the relatively weak inner arch.

The bones of the phalanges or toes (See Figs. I and 2) articulate with their respective metatarsals, and with each other, in the production of joints intended to have a large degree of upward and downward mobility.

This mobility of the toes is naturally greater than that of the fingers of the hand, with all the delicacy of use required of the latter, yet it is completely lost sight of by the average shoe manufacturer. Under pressure and confinement from ill fitting shoes, these highly mobile joints may largely or completely lose their function and the toes their use. Nearly all the muscles of the foot have their anterior attachments to the phalangeal bones or metatarsals, and contraction of these muscles causes the toe to press against the ground while lifting the body, near the end of the step, by pulling the ends of the foot

Ligaments of sole of foot Gray's Anatomy.)

(From

Fig. 7 arch nearer together and thereby increasing its concavity downward.

The resting position of the weight bearing foot is maintained by the ligaments, which are not elastic and are not

overstretched in the normal foot. These ligaments bind the bones of the foot together. They hold up the foot arch only in the sense that they interfere at a certain point to prevent fur- ^(^ ks - 3 ' ther spreading and flatten-

Anteroposterior arch: 1, Short plantar . r ,, r «

ligament; 2, long plantar ligament; 3, plan- ing OI the lOOt arch as a re-

tar fascia - suit of downward pressure.

The manner in which the bones of the foot are bound together by these ligaments, which are the strongest of those in the body, is well shown in Figs. 6 and 7. These ligaments are tough, fibrous and inelastic, and are not intended to give much play to the parts they hold together. It will be observed that while these ligaments are numerous and run in all directions, by far the strongest ones — and those which naturally have to stand the greatest strain — are those which extend from front to rear of the foot arch. It will also be observed that while the sole of the foot is strongly bound together by ligaments, the latter are practically absent (See Figs. 3 and 6) on the upper part of the foot. The practical result of this location and arrangement of ligaments is that the natural tendency of the arch to flatten under pressure is checked at a certain point ; while the absence of ligaments from the upper part of the foot permits of its flexion downward, with raising of the foot arch and a shortening of the distance between the heel bone and the metatarsals as the result of muscular contraction in walking. The relaxation or giving way of these ligaments is necessary in order that flat foot may occur.

But the passive resistance to pressure offered by the ligaments of the sole of the foot is not of itself sufficient to prevent flattening of the arch. Inelastic structures will ultii6

Fig. 8 mately tend to yield to excessive pressure which is sufficiently long continued. To provide against this, nature has reinforced

these ligaments with an array of foot muscles, whose elastic contractions in producing locomotion also serve to take up a large part of the tension due to body weight which would otherwise fall directly on the ligaments. The intricate relations of these muscles to bones, ligaments and each other is clearly brought out in Figs. 8, 9, 10, 11 and 12. It will be observed from Fig. 3 that the muscles of the upper part of the foot, which are chiefly concerned in the slight labor of lifting the toes and fore foot, are few in number and of very slight development. However, one muscle of the leg — the tibialis anticus — has its attachment (See Fig. 2) on the under part of the foot arch, and by its contraction operates to heighten and hold up the latter. The muscles of the sole of the foot, on the contrary, are numerous and should be well developed and strong. Not I : :: _ j| ^ only do they exert necessary ten-

sion, but they cushion the more delicate part of the foot and serve to protect it against injury. It will be observed from Figs. 8 to 12 inclusive, that there are no less than five distinct layers of muscles of the foot, practically all of which — except the transversalis muscles (See Fig. 10) — extend from the rear of the foot to its front. The outer or first layer of sole muscles (See Fig. 8) practically runs from the heel to the tips of the toes, their contraction resulting in flex-

Muscles of the Sole of the Foot, first layer. (From Gray's Anatomy.)

*7 ion of the foot and toes between these two points. The second layer of muscles (See Fig. 9) runs from the heel to the base of the toes, reinforced by the Fig 9

tendons of certain muscles of the calf of the leg. The third layer of muscles (See Fig. 10) strengthens the metatarsal region and adds additional force to the thrust of the ball of the foot against the ground in walking. The fourth and fifth layers of muscles, (See Figs. 11 and 12) with one group of the third, simply serve to prevent too great expansion outward of the smaller metatarsal bones in marching and assist in maintaining the balance of the body. The contraction of all these muscles flexes the sole, adducts the foot and forces the arch to rise. A buffer is thus formed which breaks the shock of impact of the ball of the foot against the ground.