“In the 15 years I have worked with families of children with clubfoot,” study leader Zosia Miedzybrodzka wrote, “I have become aware that the condition is more of an issue for families than healthcare professionals believe it to be. The generally held view is that because the condition is treatable it does not affect families too much. However our study shows that this is not the case. The treatment for clubfoot puts a huge burden on families who have to deal with months and years of treatment with plaster casts and then boots with bars on their child’s legs, as well as frequent visits to the hospital.”
The children, it seems, may see things differently. When Edwin van Teijlingen of Bournemouth University interviewed young patients for the Aberdeen study, he discovered that they did not necessarily share their parents’ concerns, at least not to the same extent. True, the children knew they had a problem, but did not see themselves as being unlike others their own age.
This optimism is likely conditioned by the availability of treatment, but there is another possibility as well. Nothing so strengthens trust in your society as a law that says, “You are one of us.” For these children, as for others with far more disabling conditions, the world is larger than it once was and their access to it is guaranteed by twenty-five years of legislation to ensure protection against discrimination: The Americans with Disabilities Act of 1990 (amended and updated in 2004), the British Disability Discrimination Act 1995 (updated and replaced by the Equality Act 2010), the Canadian Employment Equity Act 1995, and similar though sometimes less-expansive legislation in Europe and the Middle East. Our view of disability and the disabled has been irreversibly altered by these laws spurred not only by the number of infants born with birth defects, but also by growing numbers of those disabled by war and disease who, thanks to dramatic advances in medicine, survive to cope with the results of disabling injury and loss.
As noted earlier, in the ancient world, infants born with a clubfoot were spared the fate of other children with birth defects. Tut’s disability was royal and thus seemingly acceptable. The Greeks and Romans raised acceptance to a higher level. Hephestus (Vulcan to the Romans), was the son of Zeus and in his own right the god of fire and the smith who crafted Hermes’ winged helmet and sandals. More to the point, Hephestus was born lame, with one or possibly two clubfeet, thus making the deformity not only royal but certifiably divine. In Europe, as late as the Middle Ages, a clubfoot was regarded by some as a sign of the Devil, but by the eighteenth century, even moderate treatment allowed clubfooted Byron and Talleyrand to function well in societies that prized their intellectual talents above their physical deformities. Today, when treatment begins soon after birth, those born with a clubfoot are likely to walk, skate, or run past their disability to a thoroughly normal life with impressive regularity.4
In the United States alone, the list of well-known people born with clubfoot includes Thaddeus Stevens (1792–1868) and DeWitt Clinton Fort (1830–1868). Neither Stevens, an abolitionist radical Republican who defended runaway slaves and helped draft the Fourteenth Amendment to the U.S. Constitution, nor Fort, a member of the 2nd Missouri Cavalry most famous for escaping from a Northern prison, carrying with him the oversize extra-long, heavy double-barreled shotgun he hauled along with him from Texas on his way to join the Confederate forces, was ever slowed by his disabled foot.
In the Arts, there’s Gary Burghoff, “Radar” O’Reilly in the M*A*S*H television series who was also born with shorter-than-normal fingers on one hand, a deformity he often camouflaged by carrying a clipboard on screen; filmmaker David Lynch, best known for the movie Blue Velvet and what may be the first intentionally weird television series, Twin Peaks; and the late more-or-less honorary Yank, British actor-comedian-musician Dudley Moore (1935–2002) who wore one shoe with a built-up sole to compensate for his clubfoot.
Among American male athletes, count Hall of Famer Troy Aikman, former quarterback for the Dallas Cowboys; Red Sox and Pirates infielder Freddy Sanchez; New England Patriots offensive lineman Brian Simmons; pitchers Larry Sherry (named most valuable player in the 1959 World Series when the Dodgers took their first championship after moving from Brooklyn); and Jim Mier, retired from the Marlins in 2003.
Finally, 2,500 years or so after the Greek poet philosopher Hermodorus walked out of the shadow of Mt. Olympus to Rome—unfortunately to assist in demonizing those whom Plato called “the other sort who are born defective,”—Kristi Yamaguchi, the 1992 Olympic singles women’s figure skating champion, and Mia Hamm, a member of the American women’s champion soccer team at the 1996 Olympics both had the birth defect.
It is pleasant to imagine these women speeding to the gold on winged sneakers or skates forged, at least in spirit, by a true Olympian, Hephestus, the clubfooted son of Zeus.
Notes
(1)The name Scarpa is still linked to the word “shoe,” though not the way Scarpa intended. Today, SCARPA is an acronym for Società Calzaturiera Asolana Riunita Pedemontana Anonima (Associated Shoe Manufacturing Company of the Asolo Mountain Area), now owned by the Parisotto family of Asolo in northern Italy. The first Parisotto, Luigi, went to work for SCARPA at thirteen in 1942; fourteen years later he and his brothers bought the company that today is best known for its innovations in outdoor gear. This includes the first high-altitude plastic boot, the first Gore-Tex boot, and the first plastic TelemarkSki skiing boot, designed, of course, to keep the foot safe and steady. To which Pare might well have said, “Plus Ça change, plus c’est la meme chose” (“The more things change, the more they stay the same.”)
(2)The first English edition of Madame Bovary appeared in 1886, thirty years after its debut in France and three years after Flaubert’s death. It was translated by Eleanor “Tussy” Marx Aveling (1855–1898), one of six children of Karl Marx, only three of whom survived into adulthood. Like Emma Bovary, who unsuccessfully rebelled against the Bourgeois society, Eleanor died a suicide, of poison. In one of those “we all know each other” moments, the doctor who pronounced her dead was Henry Shakleton, father of the future polar explorer, Henry Ernest Shakleton.
(3)In 1956, hypnotist Morey Bernstein published The Search for Bridey Murphy, the story of Virginia Tighe, a Colorado housewife who, under hypnosis, recounted her “past life” as Bridey Murphy of Cork, Ireland. Based on Tighe’s knowledge of Cork and its inhabitants, plus her lilting Irish brogue, Bernstein insisted that his heroine’s story was authentic. Life Magazine’s March 19, 1956, story “Bridey Murphy Puts Nation Into a Hypnotizzy” made Virginia/Bridey a national phenomenon, but as details of Tighe’s life emerged—one of her childhood neighbors was named Bridey Murphy Corkell; there was no birth certificate for Bridey in Cork and no death certifiate in Belfast where Tighe said she had died—the story becme less interesting and faded from the headlines. Tighe died on July 13, 1995.
(4)Today, every year around the world an estimated 135,000 to 150,000 infants are born with a clubfoot. The following table shows the estimated numbers for selected countries. The actual numbers may be higher because these figures, based on one case per 1,000 live births in the population, are drawn from the Global Clubfoot Initiative’s record of the number of persons in the selected country currently being treated with the Ponseti method.
Country Estimated number of people with clubfoot* Number being treated each year†
Bangladesh 141,340 1,351 (2010)
Democratic Republic of the Congo 61,315 554
Ethiopia 71,336 651
Ghana 20,757 282
Kenya 32,982 691
Laos 6,068 78
Niger 11,360 17
Paraguay 6,191 56
Tanzania 36,070 75
Zambia 11,025 548
* Adapted from Cure Research.com, http://www.cureresearch.com/c/clubfoot/statscountry_printer.htm
† Global Clubfoot Initiative, http://globalclubfoot.org/world-data. Except where noted, the figures are for 2009.
3
DIFFERENCE
“If a man be courteous
to a stranger, it shows he is a citizen of the world.”
Francis Bacon, Essays (1625)
WHETHER FIERCE AS A LION or meek as a mouse, all human beings and other domesticated animals are born with two instinctive fears: the fear of falling and the fear of loud noises.
Time adds two more terrors: the fear of separation and the fear of strangers.
Early on, Freud blamed separation anxiety on the trauma of birth, the primary separation, and then on the absence of warmth from the nursing mother. British psychiatrist John Bowlby (1907–1990) re-cast it as a mistake in attachment behavior, the socialization that begins with the newborn’s relationship to her mother and then, with that secure, spreads out to encompass other people and experiences.
Bowlby, who codified the stages of attachment behavior, was raised by parents who thought that too much attention and affection would spoil a child; as an adult he went full steam ahead in the opposite direction. After graduating from Trinity College, Cambridge, he served in the Royal Army Medical Corps during World War II; was then named director of London’s leading psychiatric facility, the Tavistock Clinic; and eventually became a mental health consultant to the World Health Organization, which in 1949 asked him to evaluate the mental health of displaced and homeless children in Europe. His report, Maternal Care and Mental Health (1951), proposed that a child’s attachment to a stable nurturing figure was in fact an evolutionary imperative built into the infant’s brain to benefit her mental health for the rest of her life. He was right. As anyone who has seen one of those heartbreaking National Geographic documentaries about an orphaned baby lion or elephant knows, throughout the animal kingdom infants who are protected from the day of their birth are more likely to survive and thrive.
Like Bowlby, Harry Harlow (1905–1981) was raised by a chilly mother. Born Harry Israel, he took his father’s middle name at the request of his mentor at Stanford University, Lewis Terman (1877–1956), the American psychologist best known for developing IQ tests. Despite his name, Harlow was not Jewish, and Terman thought he would do better with a name changed to avoid the anti-Semitism then rampant in the science research community.
Harlow challenged Freud’s theory that feeding was the essential component in the mother/child bond. To prove his point, he separated newborn Rhesus monkeys from their mothers, putting the infants in cages with two substitutes: One was covered with soft cloth, but provided no food; the other was a bare naked wire form equipped with a formula-filled baby bottle. Given the choice, the babies spent more time with the soft substitute than with the nursing one, proving that Freud had missed the more important point, Harlow’s conclusion that “contact comfort is a variable of overwhelming importance in the development of affectional response, whereas lactation is a variable of negligible importance.”
Freud eventually pinned his own phobias not on the moment of birth, but on the sudden disappearance of his beloved nanny when he was three; the woman was arrested for stealing from the Freud household, an event he called the “primary originator” of his own neurosis. As for Harlow’s baby monkeys, they were so traumatized by separation from their mothers that they never recovered. As adults, they found mating difficult and could not properly care for their own infants. Harlow’s work, still considered essential to an understanding of the foundation of human love, earned him a National Medal of Science (1967) and a Gold Medal from the American Psychological Foundation (1973). But the experiment, widely condemned as extraordinarily cruel, became a rallying cry for the Animal Rights Movement in the United States.
As for the second social anxiety, the fear of strangers, no one yet seems to have pinpointed the exact moment when (or whether) stranger anxiety happens to puppies and kittens and monkeys, but for human babies Bowlby put it at some time between eight and twelve months of age when infants begin to shy away from new and unfamiliar faces. Most of us eventually learn to make new friends, or at least to mask our unease at the presence of new people, but as a society our infantile fear is ingrained as xenophobia, a generalized dread of the Others, those people outside the clan from whom we must protect ourselves.
To do that, we need to name the things that make us different from them and then erect a protective barrier.
One historical example is the inability to pronounce “sh,” a failing used to an advantage by the men of Gilead, who after beating the Ephraimites in battle (Judges 12:5–6), took up posts along the banks of the River Jordan to keep their foes from crossing over on their way home. Simply by asking travelers to say shibboleth, which the Ephraimites pronounced sibboleth, the good folk of Gilead were able efficiently to identify and eliminate as many as 42,000 of their enemies.
There are, of course, other tests for Other-ness: skin color perhaps, curly (or straight) hair, the shape of the nose … or the height of the arch in the foot, a feature clearly visible and distinct in the left foot of Leonardo’s Vitruvian Man.
Creating the curve
Our feet differ from those of our primate cousins in two important details. The first is the position of the big toe, close to the four others so that our feet no longer function as hands. The second is the arch at midfoot.
Most vertebrates—think dogs, cats, lizards, elephants—have feet that sit flat on the ground. Primates from monkeys to apes and the prosimian aye-ayes, indris, lemurs, lorises, pottos, and tarsiers (whose elongated ankle bones allow the six-inch-long creatures to propel themselves into leaps as long as nine feet) have flat but flexible feet with those grasping opposable thumb-like big toes.
Our feet are neither completely flat nor completely flexible. Rather they are stabilized by arches built of bones wrapped in ligaments, tendons, and muscles strong enough to support our weight when we stand up. Our arches seem to have been with us since we stepped on to the path leading to human. In 2011, nearly forty years after our famous fossilized Australopithecus afarensis ancestor Lucy was uncovered in Ethiopia, an international team of archeologists returned to the scene and discovered a metatarsal bone that had somehow been missed the first time around. This small bone, which links a toe to the rest of the foot, proved that sometime between 3.9 and 2.9 million years ago, Lucy walked upright on arched feet.
Nobody knows exactly how many arches there were in Lucy’s feet. Ours have three: the medial longitudinal arch, the lateral longitudinal arch, and the transverse arch.
The medial longitudinal arch, which runs along the inside edge of your foot front to back from toe to heel, comprises the calcaneus (heel bone), talus (ankle bone), navicular (the bone that connects ankle and heel), cuneiform and three metatarsal bones. The bones are supported by the plantar calcaneonavicular and the deltoid ligaments, the tibialis posterior and anterior tendons, the peroneus longus muscle coming down from the tibia (leg bone), and the muscles on the bottom of the foot.
The lateral longitudinal arch runs along the outside of your foot, again front to back, toe to heel. If you did not even know you had this arch, that’s not surprising. It is hard to see except in people who have extremely high natural arches. This arch is very sturdy, with limited flexibility among its bones (the calcaneus, cuboid [tarsal], fourth and fifth metatarsals), tendons (the long plantar along the bottom of the foot to connect the cuboid and calcaneus bones and the extensor tendon that lifts the toes), and the muscles of the fifth toe.
As its name implies, the transverse arch crosses your foot from one side to the other, about halfway between your toes and your heel. This arch is supported by the interosseous tendons attached to the midfoot bones, the plantar and dorsal ligaments on the sole of the foot, the muscles of the first and fifth toes, and the peroneus longus, whose tendons crisscross all the arches.
Like every other part of the human body, the arched foot comes with its own standards of grace and beauty, duly immortalized by sculptors and painters such as Sandro Botticelli (c. 1445–1510) and Edgar Degas (1834–1917).
Standing in front of Botticelli’s The Birth of Venus, most of us focus quite naturally on the lush fl
esh tones (below, in shades of gray, alas) of the goddess rising from her scallop shell. To see the ideally arched foot, you have to ignore her and zero in on the right foot of the Hora (one of a coterie of mythical creatures who symbolize various seasons and times) holding the cloak in which she will wrap the naked Venus. Or you can look left to Zephyrus, the god of the west wind, and his wife, the nymph Chloris. The two are so intimately entangled that trying to figure which foot belongs to what figure can be as puzzling as deciding whether a staircase in Relativity, the dizzying anti-gravity lithograph by Dutch artist M.C. Escher (1898–1972), is going up or coming down. But Zephyrus’ (or Chloris’) foot is clearly arched. So are those of the ballerinas in the Degas painting, In the Dance Studio (facing).
In the ballet world, this high-arch extremity is known as a banana foot. When a ballerina lucky enough to have banana feet stands on her toes in ballet shoes, the curved feet in the similarly curved toe shoes produce classically graceful lines. Male dancers, for whom the ideal is strength and the ability to leap tall buildings in a single bound—or at least from the wings onto center stage like Albrecht in Giselle—can flex a foot into a curve for effect, but they dance more or less flat on their feet. Although this jars the foot and ankle, it may spare the men crooked toes, darkened nails, calluses, corns, and bunions, all common among the ballerinas. Unless the men are members of Les Ballets Trocadero de Monte Carlo, the fearless group of totally serious, but utterly funny dance parodists who first stood up in size 12 toe shoes in New York City’s Off-Off Broadway theaters and lofts in 1974. Since then, the “Trocs” have been en pointe on stage to nonstop applause all around the world; of course they are also at risk for crooked toes, darkened nails, calluses, corns, and bunions.
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