A treatise on orthopedic surgery . tic calcaneus, showing secondary changes in contour. Operative Treatment.—In more extreme cases immediate re-duction of the deformity under anaesthesia may be contracted tissues, more particularly the plantar fascia,may be divided subcutaneously or by open incision; then byforcible manipulation or wrenching the sole may be somewhatlengthened and the heel pushed upward and backward to permitof slight plantar flexion. In this attitude the foot should be ^ Gibney, Transactions of the American Orthopedic Association, 1900,vol. xiii. DEFORMITIES OF T
A treatise on orthopedic surgery . tic calcaneus, showing secondary changes in contour. Operative Treatment.—In more extreme cases immediate re-duction of the deformity under anaesthesia may be contracted tissues, more particularly the plantar fascia,may be divided subcutaneously or by open incision; then byforcible manipulation or wrenching the sole may be somewhatlengthened and the heel pushed upward and backward to permitof slight plantar flexion. In this attitude the foot should be ^ Gibney, Transactions of the American Orthopedic Association, 1900,vol. xiii. DEFORMITIES OF THE FOOT. 861 fixed bj means of a plaster bandage. In the reduction of thedeformity one must not merely force the forefoot downward, asthis would simply increase the cavus, but whatever correction isaccomplished should be by means of elevation of the os calcisand elongation of the tissues of the sole of the foot. In cases ofextreme deformity the contracted tissues in the anterior aspectof the ankle must be divided also. Fig. Talipes calcaneus due to paralysis of the calf muscle (gastrocnemius andsoleus, illustrating the typical deformity of moderate degree. See Fig. .587. In some instances the improved position of the os calcis maybe assured by shortening the tendo Achillis, as first performedby Willett, of London.^ Willetts Operation for Calcaneus.—A Y-shaped incision abouttwo inches in length is made through the tissues down to thetendon. At the lower vertical part of the incision, which iscontinued down to the tuberosity of the os calcis, the tendon isdissected from the surrounding parts. It is then divided inan oblique direction from within outward and downward, andthe heel having been pushed upward as far as possible the ^St. Bartholomews Hospital Eeports, 1880, vol. xvi., p. 309. 862 ORTHOPEDIC SUBGEBY. divided ends are overlapped and sutured; tlie flap of skin isdrawn downv^ard at the same time, so that the Y-incision is Fig. 586.
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