A treatise on orthopedic surgery . f 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
A treatise on orthopedic surgery . f 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 supplemented by cuneiform osteotomy. A usefulmovable foot may be obtained by this operation, but it by nomeans assures the patient from recurrence of deformity. It isnever indicated as a primary operation, in childhood at varus should be thoroughly corrected as a preliminary pro-cedure, for until then the resistance that the astragalus offersto dorsal flexion cannot be accurately estimated (Fig. 561). Fig. 561. Fig. After forcible correction and astraga-lectomy. (See Fig. 560.) Partially corrected club-foot,showing secondary knock-knee. Cuneiform Osteotomy.—The removal of cuneiform sections ofbone from the outer border of the foot is sometimes indicatedwhen the deformity is of long standing, but the operation shouldbe secondary to other methods of correction. The aim should beto lengthen the contracted and shortened tissues on the innerborder of the foot to the extent required for reposition, not toremove bone to accommodate these shortened tissues. If thishas been shown to be impossible by ordinary means, then re-moval of bone may be indicated; but it is not often necessary in DEFORMITIES OF THE FOOT. 835 childhood or even in adolescence. If sufficient bone is cut awayfrom the adult foot to permit complete correction of the deform-ity, relapse is not usual; but in childhood, as has been stated,no operation will take the place of after-treatment. The treatment
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Keywords: ., bookauthorwhitmanr, bookcentury1900, bookdecade1910, bookyear1910
