. The diseases of children : medical and surgical. f the footthe muscles and liga-ments of the sole andcalf contract, producingvarying degrees of de-formity and concavity ofthe sole of the foot,together with elevation of the heel (equinus). In some instances the pointingof the foot produces secondary retraction of the toes (hollow claw-foot) bythe strain of the extensors of the toes. The distortion resulting from theconflicting forces occurs mainly at the ankle joint, the medio-tarsal and themetatarso-phalangeal joints. All grades of deformity are met with, fromslight exaggeration of the arch
. The diseases of children : medical and surgical. f the footthe muscles and liga-ments of the sole andcalf contract, producingvarying degrees of de-formity and concavity ofthe sole of the foot,together with elevation of the heel (equinus). In some instances the pointingof the foot produces secondary retraction of the toes (hollow claw-foot) bythe strain of the extensors of the toes. The distortion resulting from theconflicting forces occurs mainly at the ankle joint, the medio-tarsal and themetatarso-phalangeal joints. All grades of deformity are met with, fromslight exaggeration of the arch of the foot to the most extreme more rarely the converse deformities are met with (fig. 178). In slight cases, manipulation or the use of artificial muscles without anyoperation will remedy the distortion, but in the severer forms of old-standingcavus and equinus, division of the tendo Achillis, or of more or fewer of theresisting structures in the sole, will be required. After operation an artificial 1 Brit. Med. Jour. June 1884. 3B. Fig. 177.—Acquired Talipes following measles, probablj dueto infantile paralysis 738 Club-foot, Deformities of Limbs, &c. muscle should be used, and kept on till all tendency to re-contract hasceased. In troublesome cases of cavus we attach the artificial muscle toa thin steel sole plate, which is modelled to fit over the balls of the toes,and so get over the difficulty of the tendency of the foot strap to slip intothe hollow of the foot. Some good figures of these cases are given in apaper by Mr. F. R. Fisher, Lancet, January 19, 1889. Patients, the subjects of club-foot, often suffer from complications of thiscondition. Bursae develop over the points upon which pressure is made, andthese may become inflamed and suppurate, giving rise to obstinate sores,which will not heal and acquire callous edges. In some cases rest andordinary treatment suffice, in others tarsectomy or even amputation may becalled for. PirogofFs or even Choparts
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