A treatise on orthopedic surgery . ance. The most important part of the actual deformity of calcaneusis the cavus, and in confirmed cases it is practically impossibleto reduce this directly, because the loss of resistance of the tendoAchillis takes away the point of fixation against which effectiveforce can be exerted. If the deformity is not marked the footmay be drawn as far as possible toward equinus and fixed in aplaster bandage, the sole part being strengihened by the inser- 860 ORTHOPEDIC SUBGEBY. tion of a tMii board. Upon this tlie patient may walk, theheel being bnilt up with cork wed
A treatise on orthopedic surgery . ance. The most important part of the actual deformity of calcaneusis the cavus, and in confirmed cases it is practically impossibleto reduce this directly, because the loss of resistance of the tendoAchillis takes away the point of fixation against which effectiveforce can be exerted. If the deformity is not marked the footmay be drawn as far as possible toward equinus and fixed in aplaster bandage, the sole part being strengihened by the inser- 860 ORTHOPEDIC SUBGEBY. tion of a tMii board. Upon this tlie patient may walk, theheel being bnilt up with cork wedges to make the sole the contraction of the anterior tissues has been overcomethe brace is applied and the usual treatment of manipulationand massage is continued (Fig. 591 j. The method of prolonged fixation in the attitude of equinusby means of the plaster bandage is often of value in early child-hood, if the paralysis is not complete, and cures of apparentlyhopeless cases by this means have been ^ Fig. Paralytic calcaneus, showing secondary changes in contour. Operative Treatment.—In more extreme cases immediate re-duction of the deformity under anaesthesia may be contracted tissues, more particularly the plantar fascia,may be divided subcutaneously or by open incision; then byforcible manipulation or wrenching the sole may be somewhatlengthened and the heel pushed upward and backward to permitof slight plantar flexion. In this attitude the foot should be ^ Gibney, Transactions of the American Orthopedic Association, 1900,vol. xiii. DEFORMITIES OF THE FOOT. 861 fixed bj means of a plaster bandage. In the reduction of thedeformity one must not merely force the forefoot downward, asthis would simply increase the cavus, but whatever correction isaccomplished should be by means of elevation of the os calcisand elongation of the tissues of the sole of the foot. In cases ofextreme deformity the contracted tissues in the anterior aspectof
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Keywords: ., bookauthorwhitmanr, bookcentury1900, bookdecade1910, bookyear1910
