This document summarizes an article from 1937 on treating flat feet through exercise. The article discusses how modern footwear and hard surfaces have weakened foot muscles. It argues that exercise is as or more important than orthotics for treatment. The article describes simple foot exercises that can be done at home or played as games to strengthen the foot muscles, including walking barefoot on uneven surfaces, jumping rope, and throwing objects like medicine balls or pinecones to work the entire leg.

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THE TREATMENT OF FLAT-FOOT BY MEANS OF EXERCISE
ERNST BETTMANN
J Bone Joint Surg Am. 1937;19:821-825.
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2. THE TREATMENT OF FLAT-FOOT BY MEANS OF EXERCISE
BY ERNST BETTMANN, M.D., LEIPZIG, GERMANY
The human foot was originally an organ for gripping. Our fore-
fathers had a capacity for walking and climbing which most of us no longer
possess. Nowadays, due to the wearing of shoes which cramp the feet
and walking on hard pavements, the foot often becomes painful and in-
adequate to perform its function. In the treatment of flat-foot, exercise
is of equal importance with, if not of more importance than, the mechanical
supports which are too generally sold to cure individual cases. The pur-
pose of medical exercises is the systematic strengthening of the lifting
muscles on the inner border and transverse portion of the arch,-tibialis
anterior, tibialis posterior, flexor hallucis longus, flexor digitorum longus,
interossei, and peroneus longus. If the foot muscles functioned properly,
they would prevent the painful lowering of the arch, and mechanical
support would often be unnecessary.
There are two types of gymnastics which may be employed to correct
flat-foot:
1. A series of foot exercises which can be supervised by the wise
mother, the nurse, or the family doctor.
2. Exercises by means of special apparatus, which permit the amount
of the exercise to be increased as much as is necessary for the gradual
strengthening of the weak muscles.
EXERCISES
Concerning the first type, the author suggests the following simple
foot exercises which may already be known:
FIG. 1-A
Exercise with the medicine ball.
VOLE XIX NO. 3. JULY 1937 821

3. 822 ERNST BETTMANN
1. Walking with bare feet on
coarse and uneven ground (grass,
stubbles, and pebbles).
:“
2. Jumping rope; this improves
posture and breathing, strengthens
the calf muscles, and raises the arch of
the foot.
3. Use of the so-called “Spitzy
ball “ (a wooden ball sewed on a straw
sole and worn as a sandal).
4. “ Towel exercises”, which im-
prove both flexion and adduction.
FIG. 1-B In order to make the treatments
Exercise with a pine cone. attractive for children, the exercises
may be employed in games,-foot
gymnastics with the medicine ball and the gripping and throwing of pine
cones or chestnuts. (See Figures 1-A and 1-B.) Both games strengthen
the musculature of the entire leg. With the help of imagination and
experience, it is possible to develop innumerable combinations of exercises.
APPARATUS
The following types of apparatus, which can be made by a good
carpenter and mechanic, have as their bases these corrective principles:
1. Fixation of the heel in supination;
2. Pressure of a stable correction cushion against the weakest point.
in the foot arch,-the talonavicular joint;
3. Regulated adduction and pointed-toe position.
All exercises must be carried out with the knee bent at right angles
and the lower leg perpendicular.
The Potter’s Disk
It consists of a slanting disk, forty centimeters in diameter, covered
with rough rubber. (See Figure 2.) The disk revolves on four wheels
and its height is adjustable by means of a screw plate. On the fixed hub
there is an adjustable plate for the right and the left foot in supination.
A heel clamp, which can be tightened and loosened by means of a screw,
helps to fix the heel in position. Both wings of the clamp have adjustable
cushions for the redressment of the talonavicular joint. The fixation is
maintained by two straps. The amount of flexion can be varied by raising
and lowering the disk. Movement of the disk is made difficult by means
of a braking weight.
The Fool-Correction Ball
A wooden ball, about twenty centimeters in diameter, is mounted on
a round joint, which makes possible its adjustment in every direction.
The heel rests on a support. (See Figure 3.) By means ofa, screw
the
height can he regulated ; by screw the
b, degree of supination is controlled;
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4. TREATMENT OF FLAT-FOOT 823
FIG. 2 FIG. 3
The potter’s disk. Grasping exercise with the
foot-correction ball.
by screw C, fixation of the heel is guaranteed ; and by d, the
screw correction
cushion is adjusted. If the axis of the ball is horizontal and parallel to the
foot, a “grasping exercise” is afforded, which can be regulated by moving
the ball or by elevation of the heel support. If the axis of the ball is
vertical and at a right angle with the foot, the foot is obliged to adduct
in order to move the ball. The amount of adduction can be regulated
in the manner just described.
Apparatus for Limbering Stiffened
Flat Feet in Adults
This apparatus is shown in
Figure 4. The foot rests on d.. a
fixed cushioned stirrup, a. A
strap cuff, which is laid around the
ankle and passed over the heel of
the foot, is attached to the lever at
b. Another strap is laid around
the front of the foot and led
over
a pulley to the other end of the
lever at c. The attachment of the
straps must be made when the
front of the foot is in extreme
plantar flexion. The axis of the
lever is connected with a bar,
d,
which permits the manipulation
of the lever so that a corrective
FIG. 4
pull on the heel and front of the
Apparatus for limbering stiffened flat feet
foot is possible. The toes rest on
in adults.
VOL. XIX, NO. 3. JULY 1937

5. 824 ERNST BETTMANN
FIG. 5
The turbine wheel:
a: grasping exercises
b: adduction exercises.
an adjustable plate, which fixes and mobilizes them, so that the patient
can apply the treatment himself.
The results obtained by the use of this apparatus are : (1) stretching
of the Achilles tendon and pointing of the calcaneum ; (2) raising of the
arch in the talonavicular joint; (3) conversion of the position of the
metatarsal part of the foot into pronation ; and (4) shortening of the front
from toe to heel together with mobilization of the toes. With the help
of this apparatus, which can be used from two to three times daily for a
period of from twenty to thirty minutes, the author has succeeded in
preparing many stiffened and painful feet for the wearing of arches.
The Turbine Wheel
To make foot calisthenics attractive for children, the so-called “tur-
bine wheel” has been constructed. (See Figure 5.) By means of dif-
ferent adjustments it permits the corrective exercise of practically all foot
muscles, and it can be used for both the right and the left foot. Two
parallel wooden disks, covered with rubber, about twenty centimeters in
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6. TREATMENT OF FLAT-FOOT 825
diameter, and about thirty centimeters apart, are connected by means of
wooden spokes. The resulting turbine wheel is mounted on an axle and
supplied with an adjustable brake to guarantee movement in one direction
only. On the same plate which carries the turbine wheel there is a metal
bar to support the adjustable heel rest. The heel of the foot remains
fixed in the rest by a bandage strap and a rubber correction cushion at the
talonavicular joint. At the upper end of the bar there is a hand grip, so
that the child can support himself. In this form (Fig. the5, apparatus
a),
permits a flexion exercise,-the child continues to grasp the connecting
spokes with the toes and propels the turbine. When the wheel is placed
horizontal to the plate and the foot rest is lowered (Fig.
b), the5, child
can practise adduction. In order to encourage the child, a small animal
on wheels is attached to the turbine and, by turning the turbine, the child
also moves the animal which can be weighted so as to increase the work
done.
VOL. XIX. NO. 3, JULY 1937