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ASHLEY: SHOES. (New Vo«k Medical Jouknal. (iiiderslaiiding and approval. Ihc therapeutic shoe will be a source of greater dilTereiice of opinion; amon.ij orthopedists, in regard to the form and functions of the fool brace, there are advocates of the rigid shanihysiological shoe that may Generic Cialis 20mg Uk be pos- sible in treating the individual foot, and in any case there is no reason for constricting the toes. I^el nn concept: logical The heel is too far behind. II illustrates a well furnied upper spoiled by a bad heel which makes the shank too long. The breast Generic Cialis 20mg Uk of the heel should be as far forward as a line dropped perpendicularly from the an- terior border of the internal malleolus. This would bring the breast forward to the dotted line. By making the heel full Generic Cialis 20mg Uk pitch behind, as in Fig. 2, the face of the heel would be no larger than at present. With a flexible shank this shoe would soon become broken and the heel tipped up behind. Fig. 4. — The long drag heel. The heel is too long, wide, high. flat, and hard. This style of heel is peculiar to numerous makes of trade shoes. Noting the position of this individual's heel in this shoe, it will Generic Cialis 20mg Uk not take much discernment tp realize that the foot is working at a great dis.idv.intage. The exceeding width of Generic Cialis 20mg Uk the heel counter cannot be depicted in the x ray. Heel seat is very insecure and the toes are wedged. With .ill this length of heel, the bre.ist is not far enough forward, according to the rule. If the counter and heel seat were built in conformity with the contour of the wearer's heel, much of the weight of the licel would be relieved. normal function of the foot be restricted to the further weakening or damaging of the machine, though in many instances a departure may be necessary in several respects, changing the shoe materially. Seldom will these modifications from the physiological make the shoe unsightly or even particularly noticeable or heavy. It should be borne in mind that a shoe may have excellent lines physi- ologically and yet be ruined by a heel or a sole, or both, which tend to pronate or unbalance the foot. This is generally done by the heel being built higher Ki':. 5. — rhc writer's conception 01 the physiological heel sear. I'he heel could have been made a quarter of an inch shorter. on the outer side, or the welt extended further on the outer side and cut away in the region of the ball. "The same mechanical etifect is produced Generic Cialis 20mg Uk by loo long a heel or shank, the breast not set far enough under the arch (Fig. 3). The breast of the heel should be as far forward as a line dropped perpendicularly from the anterior border of the internal malleolus (Fig. 2, 5, 8, and 9). As re- marked before in this series, other therapeutic measures are not to be excluded. Causative factors otljer than the shoe are to be kept in mind and diligently sought out. It is of primary importance to instruct the patient to walk so as to protect tlu foot, to direct the weight and body thrust away from the naturally weak or weakened part. Of no less importance is the building up of a strong muscular tone by sy.stematic Generic Cialis 20mg Uk exercises especially designed to strengthen the foot structures. The foot must recover in a meas-