. Modern surgery, general and operative. the foot resting on its innerside. The incision, which cuts the tendo Achillis and reaches the bone at once,is begun at the upper border of the os calcis and the inner margin of the tendoAchillis, and is taken outward and horizontally forward to a point in front ofthe calcaneocuboid articulation (see Fig. 494, f). A vertical incision is begunnear the forward termination of the initial incision, is carried across the outeredge and plantar surface of the foot, and terminates at the external marginof the inner surface of the os calcis. Some surgeons carry
. Modern surgery, general and operative. the foot resting on its innerside. The incision, which cuts the tendo Achillis and reaches the bone at once,is begun at the upper border of the os calcis and the inner margin of the tendoAchillis, and is taken outward and horizontally forward to a point in front ofthe calcaneocuboid articulation (see Fig. 494, f). A vertical incision is begunnear the forward termination of the initial incision, is carried across the outeredge and plantar surface of the foot, and terminates at the external marginof the inner surface of the os calcis. Some surgeons carry the vertical incisiona little upward, toward the dorsum. The periosteum is entirely stripped byan elevator, the os calcis is removed, the cavity is packed with iodoform gauze,the wound is stitched, a drain is inserted posteriorly, the foot is dressed anti-septically, is placed at a right angle to the leg, and plaster of Paris is applied,trap-doors being cut for drainage. Later the drain is removed and the packingof gauze changed Fig. 501.—Volkmanns dorsal splint for excision of the ankle. Astragalectomy, or excision of the astragalus, is seldom performed. As-tragalectomy is employed occasionally for relapsed and inveterate cases of club-foot. The indications are pointed out by Willard (International Clinics,vol. iii, 12th series): (i) Adults with great bony deformity; (2) neglectedchildren of five to fifteen years, who have markedly distorted their tarsi bylocomotion; (3) relapsed cases which have resisted the milder forms of opera-tion, or which have been neglected by parents after previous operation; (4)only occasionally, young children in whom from infancy the bones of the foothave been exceedingly rigid and unyielding, and where there is practically butlittle motion either at the ankle-joint or in the tarsus. Operation by the Subperiosteal Plan.—Barker advises an incision going atonce to the bone, from the tip of the external malleolus forward and a Uttleinward,
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