A treatise on orthopedic surgery . its centre and thus to remove theadverse leverage and to prevent dorsak flexion by direct contactof the tarsal bones with the anterior margin of the tibia. Thetendon transplantation is an additional safeguard against de-formity and of service in restoring function (Fig. 592). In about three weeks the long plaster is removed and a shortone is substituted, the foot being fixed in moderate equinus bya cork wedge beneath the heel. On this the patient is encour-aged to walk. The plaster support may be used with advantagefor six months or a light brace may be subst
A treatise on orthopedic surgery . its centre and thus to remove theadverse leverage and to prevent dorsak flexion by direct contactof the tarsal bones with the anterior margin of the tibia. Thetendon transplantation is an additional safeguard against de-formity and of service in restoring function (Fig. 592). In about three weeks the long plaster is removed and a shortone is substituted, the foot being fixed in moderate equinus bya cork wedge beneath the heel. On this the patient is encour-aged to walk. The plaster support may be used with advantagefor six months or a light brace may be substituted for the brace is discarded and a shoe with a cork inner55 866 OETHOPEDIC SUPiGEEY. sole holding the foot in plantar flexion is substituted. If all thedetails are properly carried ont, particularly the backward dis-placement and adjustment of the malleoli, the result is a sym-metrical foot, a movable ankle-joint, and yet a secure supportthat eventually enables the patient to dispense with the brace. Fig. . An X-ray picture after the authors operation demonstrating the mechanicalprevention of both lateral and anteroposterior deformity. See Fig. 58(5. ACQUIRED CALCANEOVALGUS AND CALCANEOVAEUS. In many cases, the foot deformed as a result of paralysis ofthe calf muscle is in addition turned in a lateral direction, sothat the weight of the body falls to the inner or outer side of itscentre (Fig. 593). Calcaneovalgus, in which the foot is turned outward andupward, so that the patient walks on the inner side of the heelor even on the inner ankle, is by far the most common. It isusually a result of more extensive paralysis than simple cal-caneus. For example, all the muscles about the foot may bedisabled except the peronei. or in cases of a milder type thetibialis anticus may be the only muscle of the front of the footthat is paralyzed. Treatment.—When the foot inclines toward calcaneovalgus itis diflicult to hold it in proper position by the ordinary braces
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