. A practical manual of the treatment of club-foot. he plaster will thus preventit from slipping. Care must be taken not to havethe plaster completely encircle the foot, and a fewnicks cut in the edge nearest the ankle may benecessary to prevent strangulation of the circu-lation. Although this plan is frequently successful, casesdo occur in which the muscular rigidity is too greatto yield to manipulation, unless continued for alonger time than can be generally given. A con-stant tractile force then becomes necessary, and theplan suggested by Mr. Richard Barwell, of London,is by far the best. 4
. A practical manual of the treatment of club-foot. he plaster will thus preventit from slipping. Care must be taken not to havethe plaster completely encircle the foot, and a fewnicks cut in the edge nearest the ankle may benecessary to prevent strangulation of the circu-lation. Although this plan is frequently successful, casesdo occur in which the muscular rigidity is too greatto yield to manipulation, unless continued for alonger time than can be generally given. A con-stant tractile force then becomes necessary, and theplan suggested by Mr. Richard Barwell, of London,is by far the best. 48 BAEWELLS PLAN. This consists in cutting from stout adhesiveplaster, spread on Canton flannel (the best I haveseen is that styled mole-skin plaster,v ihade by , 11 Aldersgate Street, London), a fan-shapedpiece. In this, cut several slits, converging towardthe apex of the piece, for its better adaptation to thepart. {See Fig. 11.) The apex of the triangle is passedthrough a wire loop with a ring in the top (Figs. 10 Figs. 10. 11. 12. 13. yi and 11), brought back on itself, and secured by sew-ing. The plaster is firmly secured to the foot insuch a manner that the wire eye shall be at a pointwhere we wish to imitate the insertion of the mus-cle, and that it shall draw evenly on all parts of BARWELLS PLAN. * the foot when the traction is applied. Secure thisby other adhesive straps, and a smoothly-adjustedroller. The artificial origin of the muscle is made asfollows: Cut a strip of tin or zinc plate, in lengthabout two-thirds that of the tibia, and in widthone-quarter the .circumference of the limb (Fig. 14),This is shaped to fit the limb, as well as can con-veniently be done. About an inch from the up-per e,nd, fasten an eye of wire. Care should betaken not to have this too large, as it would notconfine the rubber to a fixed point. The tin issecured upon the limb in the following manner:From the stout plaster above mentioned cut twostrips long enough to encircle th
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