Armored Medical Research Laboratory Fort Knox, Kentucky PROJECT No. T-13 " SURVEY OF FOOT MEASUREMENTS AND THE PROPER FIT OF ARMY SHOES Second Partial Report On Study of Sweating of the Feet of Marching Troops Project T-13 4- December 194-5 ARMORED MEDICAL RESEARCH LABORATORY Fort Knox, Kentucky AMRL Project No, T13 SCO Project No. 611 SPMiSA 727.3 4 December 1945 10 PROJECT AMRL No, T13. SCO Noa 611 - Survey of Foot Measurements and the Proper Fit of Army Shoes; Second Partial Report - Study of Sweating of the Feet of Marching Troops, a. Authority; First Indorsement SPMDO 421,3 - ASF-SGO, Washington, Do C0, dated 24 September 1945 b. Purpose: To obtain factual information pertaining to foot sweating with regard to: 1, The rate and volume of sweat secretion; 2, The relationship of sweating to foot symptoms; 3, The water retentive characteristics of service shoes and of various types of socks. 2. DISCUSSION; None, 3o CONCLUSIONS: In a temperate zone, summer environment: a0 Neither burning of the feet nor the development of blisters appears to result from the accumulation of excessive moisture within the sock0 b„ Service shoes, reversed upper, composition sole, whether dubbed or not, permit dissipation of only a relatively small amount of foot moisture to the exterior atmosphere. c. The sweat adsorbed by shoes is predominantly into the shoe- upper, despite the fact that the weight ox the leather in the sole is greater than that in the upper. Socks, wool, light, are not capable of retaining the amount of sweat excreted by some men during a warm summer day0 1 4. R ECOMMENDATIONS: None. Submitted by: Arthur Freedman, Captain, MC Charles M0 Kirkpatrick, Tec 3 ' \/l) ' > approved UvCdJrzy 3 3 L'W WILLIAMS. BEAN Major, Medical Corps Commanding Inc1.-Appendix 2 APPENDIX lo INTRODUCTION; The accumulation of sweat inside shoes has been blamed for many of the foot disabilities which marching troops suffer. In warm environments, in particular, blisters and the sensation of burning of the soles of the feet have been attributed to excessive sweating. Furthermore, the presence of moisture leads to tissue maceration and provides a favorable environment for interdigital fungus growth. It has been asserted also that the application of dubbing to shoes increases the retention of sweat, and this practice has therefore come to be regarded somewhat unfavorably by troops. In the course of other studies on the relationship of shoes to the development of foot casu- alties among marching troops, the opportunity was available to subject these beliefs to test. 2. CONDITIONS: Troops were marched over a 13®7 mile course, for which the actual marching time was 4 hours and 20 minutes, at a rate of 119 paces per minute. New service shoes, reversed uoper, composition sole were issued at intervals during the test and were worn continuously for an average of 6J hours daily. Two short breaks and a longer one for lunch were allowed. The observation procedures before and after each march occupied approximately 30 minutes each. The use of powder was not permitted. The marching course lay over rolling country, one-third on concrete road, one-third on improved dirt and gravel road, and one-third on unimproved dirt road. Water and salt were allowed ad libitum and were provided in abundant quantity. The troops began marching over the established course ten days before any observations on sweating were made, and observations were continued throughout 32 days of testing. The men, all of whom had been in the Army for a minimum of 8 months prior to their arrival at the Laboratory for study, were at least partially conditioned before data were collected. Typical Kentucky mid-summer environmental conditions were encountered during the test days. The weather data shown in the respective tables are for shade conditions and, therefore, are lower than temperatures in the sun. The test group used for these studies was chosen at random. 3® RESULTS r a, Amount and Effect of Sweating; (1) Moisture was trapped in the sock by inserting a thin boot of rubber dam between the sock and the shoe of one foot. By weighing the en- closed sock before and after a march, the total amount of accumulated sweat was readily determined. The results of one series of observations, shown in Table 1, indicate that the sweating rates for one foot for different men may vary at least from 2,0 to 8,5 grams per hour, at the temperatures encountered. (2) Each subject was interrogated concerning any difference in sen- sation between the foot wearing the rubber boot and the one without it, In only one instance did the foot wearing the rubber boot seem warmer than the other, and in no instance was the sensation of burning of the soles of the feet associated with the presence of the rubber boot. Blisters did not develop in connection with the increased accumulation of moisture0 Inclo (3) Some subjects who did report burning of the soles of the feet asserted that the burning was not associated with the wearing of the rubber boot, but was noted instead during rest periods rather than during actual marchingo This suggested that burning may be a manifestation not of sweat accumulation, but of the presence of an excess of intercullular fluid in the dermis or epidermis appearing as a circulatory phenomenon, in the lower ex- tremities of men resting after exercise. Since the volume of such fluid would be too little to detect by volume displacement, an attempt was made to test for its presence by injecting 0.1 cc of saline intradermally into the soles of subjects who noted burning and into the soles of others who did not, in the expectation that absorption of the fluid introduced might occur more rapidly in one group than in the other. Unfortunately, this proved unsuccess ful since it was not possible to produce blebs on the soles of the feet in a standard manner, and the thickness of the epidermis interfered with accurate assessment of their rate of disappearance. TABLE 1 AMOUNT AND RATS OF FOOT SWEATING OF TROOPS MARCHING IN A WARM ENVIRONMENT* DAY OF T3ST 24th 25th MEAN SHADE D.B. 83°F D0B0 84°F TEMPERATURES R0H0 55% R.HC 59% NAME SWEAT ACCUMULATION '(EA1B/64 Hrs.) SWEAT ACCUMULATION (GRAMS/61 Hrs.) MEAN SWEATING RATE FOR ONE FOOT (GRAMS/Hr) Woo 12e2 14 e 5 2.0 Fir 15 oO 25.0 3.1 Wea 209? 33.8 4.2 Voz 24 .5 29.5 4.2 Buf 29.0 32.6 4.7 Phi 35*5 41.8 5.9 Woh 36.9 43.2 6e2 Sin 37ol 29.5 5.1 Cru 54*5 55.0 8.5 Inclo * Sweat was measured as the increase in the sock weight when an impermeable boot of thin rubber dam was worn between the sock and shoe on one foot. The sweat which adhered to the rubber was fairly constant at 2.0 grams and is not included in the above figures. b0 Retention of Sweat by Footgear: (1) The transmission of sweat by shoes was estimated in a manner similar to that described above. Each subject wore the rubber boot between his sock and shoe on one foot and omitted it on the other. Both the sock and shoe were weighed before and after marching, the shoe being brushed vigorously before weighing to remove any dust picked up on the road. The results presented in Table 2 show that the shoe on the foot wearing the rubber boot consistently lost weight during the march, while the other shoe gained weight, the mean weight loss in the one case being 9<>6 grams, and the mean weight gain in the other being 9.1 grams. The loss of weight of the shoe containing the rubber boot may be attributed to the fact that no moisture was picked up from the foot, while some of the intrinsic moisture within the shoe evaporated and some of the composition sole wore away. ( The total moisture content of a shoe is approx- imately 26 grams. This was determined by drying a new shoe in an oven at 75°C for 12 hours to nearly constant weight)„ TABLE 2 DISPOSAL OF SWEAT BY FOOTGEAR Comparison Between Changes in Sock and Shoe Weights When Sweat is Trapped in Sock and When it is not Trapped (Data are in grams) CHANGE IN CHANGE IN MEAN SHADE SOCK WEIGHT SHOE WEIGHT TEMPERATURES DAY OF D0Bo°F. RUBBER BOOT RUBBER BOOT TEST R.H.jS SUBJECT WORN OMITTED WORN OMITTED 10 B5 60 Woh 4 28,2 4 12 08 - 8.5 4 5.7 Bel 4 30,6 4 6,8 - 12,7 4 5.9 11 86 67 Woh 4 31.7 4 13.3 - 7.6 + 19.3 Bel + 26.3 + 6,9 - 10.9 + 5.9 12 88 64 Woo 4 16,7 4 18,7 - 9,6 - 1,6 Voz 4 46.9 4 20.7 - 12,1 + 14.7 13 86 62 Woo 4 12 c7 4 13o8 - 7.2 + 4.5 Voz 4 50,9 + 21o7 - 8,5 4 17.5 MEAN 4 30o5 4 14 o3 - 9.6 4 9.1 Inclo (2) It is possible to derive from these data the percentage of moisture retained by the shoe. To do this one must assume that the foot sweats at the same rate on two successive days and that the presence of the rubber dam does not alter the sweating rate. Table 1 does suggest that the sweating volume is reasonably constant on successive days but it was not possible to verify the latter assump- tionc Table 3> which is derived from Table 2, compares the sock weight increase when the rubber boot is worn with the combined sock and shoe weight when the rubber boot is not worn, both for the same foot on successive days and for the opposite foot on the same day0 TABLE 3 RETdNTION OF SWEAT BY SHOE AND SOCK SUBJECT AMOUNT OF FOOT SWEATING* (Grams) INCREASE IN TOTAL SHOE AND SOCk WEIGHT** (Grams) PROPORTION OF ranma BY SHOE AND SOCK Woh 28 o 2 18.5 65.6* Bel 30.6 12o7 41.5* Woh 31o7 33*1 104.5* Bel 26 o 3 12,8 48.5* Woo 16.7 17.1 102.5* Voz 46.9 35.4 75.5* Woo 12o? 18,3 144.0* Voz 50.9 39 o 5 77.5* MEAN 30 o 5 23.4 RATIO OF THE MEANS - Determined when rubber boot worn as the increase in sock weight0 ‘Determined when rubber boot not wornc Inclo 4 (3) The data, which are only approximations, indicate that a large part of the moisture from sweating of the foot actually remains in the shoe and the sock and does not get to the outside. In those instances in which the shoe and sock actually weighed more than the amount of sweat measured when the rubber boot was worn, it is likely that the sweating rates of the feet differed during the two tests and that some of the road dirt picked up by the shoes was not brushed off0 (4) Dubbed shoes are compared with undubbed shoes both with regard to their own capacity to adsorb moisture and with regard to their influence on the accumulation of moisture within the sock0 The dabbing was applied generously and worked in well. It is apparent from Table 4 that there is not a great differ- ence between the weight increase of the sock or the shoe whether or not dubbing is used. Dubbing, therefore, does not appear to affect significantly either the permeability of the shoes or their capacity to adsorb moisture from the foot surface. TABLE 4 EFFECT OF DUBBING ON THE RETENTION OF SWEAT BY FOOTGEAR Comparison of Increase in Sock and Shoe Weight Due to Sweat Accumulation when Dubbed and New Undubbed Shoes are Worn0 (Mean of 4 Subjects)* DAY OF TEST MEAN SHADE INCREASE IN A SIGHT TEMPERATURES SOCK SHOE D.B,°F RoH9$ (GRAMS) (GRAMS) 28 71 77 Dubbed io0o 9.8 29 77 56 it 7.7 6.2 30 77 46 n 7.8 6o0 31 S3 53 Undubbed 9.0** 9.8 32 86 47 « 8.8 9.2 *Troops marched 13 <>7 miles and wore their shoes 6g hours 0 **Mean of 3 subjects only. Inclo (5) The relative increase in weight of the sole and upper of the shoe, due to moisture accumulation, was estimated by weighing a shoe before and after a march, then severing the upper from the sole, weighing again to obtain the com- ponent values and finally weighing the shoe halves twelve hours later to determine the weight loss of each half as a consequence of equilibration with the atmosphere. Table 5 shows the results of such weighings on two different shoes„ TABLE 5 DISTRIBUTION BETWEEN SOLE AND UPPER OF MOISTURE ADSORBED BY SHOES DURING MARCHING (Data are in Grams) SHOE N0.1 SHOE NO.2 Weight gain of shoe during march 18oG 16,0 Weight loss of upper after 12 hours at room temperature 8,9 6.9 Weight loss of sols after 12 hours at room temperature 5.5 4.8 Total weight loss due to evaporation of accumulated shoe moisture 14.4 llo7 Weight gain not accounted for 3.6 4.3 (6) These figures are interesting inasmuch as the weight of the leather upper of the shoe is only 23% of the total weight of the shoe while the weight of the leather components of the sole is aoproximately 36%, as shown in Table 6, It would appear, therefore, that the upper leather adsorbs a proportionately greater part of the sweat of the foot than the sole. To what extent this relates to the proportionate sweat production of the various foot surfaces cannot be stated pre- cisely. Under certain influences the plantar surface of the foot sweats more abundantly than the dorsal but under other influences the reverse is true (1), (1) Kuno,Y, - The Physiology of Human Perspiration, J&A Churchill, LTD, London,19340 Inclo TABLE 6 WEIGHT OF COMPONENT PARTS OF SHOE (Grams) NON-LEATHER PORTION OF SOLE; Composition outsole 188,5 Composition heel 124.5 Metal s hank 1205 325.5 41$ PREDOMINANTLY LEATHER PORTION OF SOLE: Midsole and filler 131.5 Insole,welt, filler and canvas 147.5 279o0 36$ LEATHER UPPER: 187.1 23$ Total Weight Exclusive of Nails 791.6 100$ (7) The moisture retentive capacities of various standard types of socks were also determined as a matter of record. Table 7 shows the results when 6 types of socks were dried in an oven to determine the amount of moisture adsorbed from the atmosphere. Inclo TABLE 7 JIOISTURE CONTENT OF SOCKS AT EQUILIBRIUM WITH ATMOSPHERE (D0B« 76°F, R.H. 50% Approx.) WEIGHT AFTER DRYING IN OVEN MDISTURE CONTENT TYPE OF SOCK WEIGHT BEFORE DRYING FOR 24 HOURS AT 50°C PSBCSWT OF INITIAL WEIGHT Wool, light, woven, 0*Do 33 08 Goiso . 31.1 Gins o 7.9? Wool, light, knit, 0eDo 42=8 » 38*0 n 11.2? Cushion sole, 73-531824 42 c 7 " 38.9 n 8.8? Cushion sole, 73-531828 43.3 " 37.7 10.8? Wool, heavy, white, 73-532238 58,4 ” 53 o 2 »i 9.7? Wool, ski, 73-534403 77.3 " 70,2 w 9.1? (8). The mates to these socks were then soaked in water to determine their maximum adsorptive capacity. After soaking, the socks were allowed to hang for 3 hours at room temperature to permit all surface water to drip off* Some evaporation undoubtedly occurred during this period since the room conditions were approximately 76°F, D.B0, 50% R.H0 The amount of water uptake after soaking is shown in Table 80 It is of interest that neither of the socks, wool, light, would be capable of retaining the amount of sweat accumulated within the rubber boot in only hours in the case of CRU ( Table 1). Inclo TABLE 8 WAT SR UPTAKE OF SOCKS AFTER THOROUGH SOAKING WATER CONTENT WEIGHT WEIGHT PERCENT OF TYPE OF SOCK BEFORE DRYING AFTER WETTING INITIAL WEIGHT Wool, light, woven, 0oDo 31.5 Gms. 71o5 Gms. 126.9? Wool, light, knit, 0oD, 41.9 " 86.0 " 105.2? Cushion sole - 73-531624 37.8 " 97 o7 " 158.4? Cushion sole - 73-531828 41o9 " 110o6 " 163.9? Wool, heavy, white - 73- 532236 60.6 M 139o9 " 130.8? Wool, ski, 73-534403 75.3 " 170„5 " 126.4? Inclo