A treatise on orthopedic surgery . r the forefoot may be simply twistedoutward and upward, while the astragalus and os calcis mayremain in an approximation to their original deformity. Theoperation is most satisfactory in those cases of resistant varusin which the equinus deformity has been overcome. Afterthorough overcorrection by the Phelps operation the danger ofrecurrence of deformity in the adult and adolescent type ofclub-foot is not great, and in many instances support other thanthat of the plaster bandage for several months after the opera-tion may be unnecessary; but in childho<3d
A treatise on orthopedic surgery . r the forefoot may be simply twistedoutward and upward, while the astragalus and os calcis mayremain in an approximation to their original deformity. Theoperation is most satisfactory in those cases of resistant varusin which the equinus deformity has been overcome. Afterthorough overcorrection by the Phelps operation the danger ofrecurrence of deformity in the adult and adolescent type ofclub-foot is not great, and in many instances support other thanthat of the plaster bandage for several months after the opera-tion may be unnecessary; but in childho<3d the ordinary pre-cautions in after-treatment to prevent relapse will be necessary. DEFORMITIES OF TEE FOOT. 833 Operations on the Bones.—Osteotomy of the neck of the as-tragalus, as a supplementary part of the operation of forciblecorrection, has been mentioned. In certain instances, particu-larly in the adolescent or adult type of deformity, the displacedastragalus may oifer such an obstacle to correction that its re- FiG. Resistant club-foot in later childtiood. (See Fig. 561.) moval is indicated—an operation first performed by Mr. Lund,of Manchester. Astragalectomy.—The astragalus, which in club-foot is dis-placed forward, may be removed easily by means of an incisionpassing over its most prominent part, in a direction forwardand downward from the tip of the external malleolus, betweenthe tendons of the peroneus brevis and tertius. The soft partsare drawn aside, the ankle and astragalonavicular joint areopened, and the attachments to the navicular, and, as far aspossible, those at the inner and outer border, are divided. Thefoot is then adducted so that the head of the bone may beseized with forceps and drawn upward, the interosseous liga-ment and the internal lateral ligament having been divided53 834 OBTEOFEDIC SUBGEBY. with curved scissors, the astragalus is removed. If after re-moval of the astragalus the deformity cannot be corrected, itshould be supplemente
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