A treatise on orthopedic surgery . e is abnormally concave, and looksbackward, inward, and downward. The foot often seems some-what smaller than normal, and the heel appears to be the outer dorsal surface the body of the displaced astrag-alus projects; the external malleolus is prominent, while theinternal malleolus lies deep beneath the redundant tissues of theinternal aspect of the foot. In many instances the turning inward of the foot is so ex-treme that it conceals the equinus element of the deformity(Fig. 526). Thus equinovarus is often classified as varus,especially by En
A treatise on orthopedic surgery . e is abnormally concave, and looksbackward, inward, and downward. The foot often seems some-what smaller than normal, and the heel appears to be the outer dorsal surface the body of the displaced astrag-alus projects; the external malleolus is prominent, while theinternal malleolus lies deep beneath the redundant tissues of theinternal aspect of the foot. In many instances the turning inward of the foot is so ex-treme that it conceals the equinus element of the deformity(Fig. 526). Thus equinovarus is often classified as varus,especially by English authors. 796 OETHOPEDIC SUBGEEY. The internal structure of the foot corresponds to the externalcontour; thus the relation of the bones to one another, and eventhe shape of the individual bones, are more or less altered as thedeformity is more or less of an exaggeration of the attitudes thatthe normal foot is capable of assuming. These changes are mostmarked in the astragalus and os calcis. The astragalus is thicker Fig. Typical congenital equinovarus (club-foot). at its external than at its internal border, or somewhat wedge-shaped from without inward; it is plantar flexed, so that a largepart of its body protrudes from between the malleoli. Its neckis often somewhat longer than normal, and it is, as a rule, de-pressed and deflected inward (rig. 527, B). The os calcis isalso in an attitude of plantar flexion; the internal tuberosity isdrawn upward to the vicinity of the internal malleolus, itsanterior extremity looks downward and inward, and it is oftenbent inward, corresponding to the deformity of the neck of theastragalus. Its external surface looks downward and forward,and it lies directly beneath the astragalus instead of to its outerside, as in the normal relation. The navicular is drawn inward and upward, and articulates DEFORMITIES OF THE FOOT. 797 with the inner part of the deflected head of the astragalus; itlies in close proximity to and is often in contac
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