In the military environment, the function of the foot is constrained by the daily wearing of combat boots, a veritable orthopedic brace. A significant segment of the military population reports shoe-related foot disorders and pain, but there is little research evaluating the effects of military footwear on the development of these disorders, both internationally and in the Algerian context. The main objective of this work was to evaluate the effects of regular wearing of Rangers type military footwear on the soldier's foot, by studying the incidence of musculoskeletal and skin disorders affecting the ankle-foot complex during a 12-month follow-up period, and by comparing foot health status before and after wearing military footwear.
SUBJECTS AND METHODS :
This is a prospective study of the longitudinal type on a population of young male adults following their training in a military school in the south-east of Algeria. These new recruits were observed for a period of twelve months with regular wearing of Rangers type military footwear. This follow-up period extends from T0 to T12 knowing that T0 corresponds to the date of incorporation, and T12 corresponds to twelve months after the start of military training. During this period, we recorded all the cases consulting for a problem of the foot or the ankle, on a register created especially for this purpose. Foot status was analyzed at T0 and at T12 using three evaluation methods : clinical, podoscopic and functional. The footprint taken by the electronic podoscope was analyzed by calculating the Chippaux Smirak Index (CSI) and measuring the Alpha angle (α) of hallux valgus and the Beta angle (ß) of quintus varus of the two feet. To assess the functional impact, we opted for the use of the scale "Lower Extremity Functional Scale" in its Arabic version (LEFS-Ar). Furthermore, a comparative analysis before after wearing the shoe was carried out for the different parameters studied.
426 soldiers are participating in this study, of which 384 have completed all stages of the protocol. In this young adult population (mean age = 19.5 ± 0.89 years), the cumulative incidence of all foot and ankle disorders was estimated at 80.5%. The incidence of musculoskeletal disorders is higher than that of dermatological disorders (64.6% versus 38.5%). The main risk factors retained are footwear mismatch, obesity, lower limb misalignments, lower limb previous injuries, and anatomical shape of the foot.
The comparison of foot statue before and after wearing combat boots (T0/T12) showed a significant upward trend in the prevalence of the majority of foot disorders. This difference concerns the musculoskeletal disorders such as hallux valgus, quintus varus, claw toes and overlapping toes, and the dermatological disorders such as corns, calluses, blisters, wounds, and onychodystrophies. Comparative analysis of the T0/T12 footprint indicates a significant increase in the CSI (p < 0.001), the Alpha angle (α) of hallux valgus on the left foot (p < 0.005), and the Beta angle (ß) quintus varus on both feet (p < 0.001). Regarding the evolution of the functional state from T0 to T12, we observe a very significant regression (p < 0.005) in the LEFS-Ar score.
DISCUSSION & CONCLUSION:
These results confirm that podiatric disorders remain fairly common among military personnel. Its frequency seems to worsen with the wearing of Rangers type military footwear. These epidemiological data, obtained in a completely original way, can help in the planning of future prevention interventions.
Military footwear, foot deformities, musculoskeletal disorders, footprint, Chippaux Smirak Index, Lower Extremity Functional Scale, Algeria