. Modern surgery, general and operative. , or the removal of the cuboid or othertarsal bones, may be indicated. Buchanan employs subcutaneous divisionof all resistant structures. Occasionally, in relapsed and inveterate cases,astragalectomy is performed. It is seldom practised upon young children(see page 795). In some cases of talipes calcaneus shortening of the tendoAchillis is advised; but such an operation is only of temporary value, as stretch-ing occurs after two years or more. In talipes due to infantile paralysis theoperative treatment is the same, but we should not immobilize in plast
. Modern surgery, general and operative. , or the removal of the cuboid or othertarsal bones, may be indicated. Buchanan employs subcutaneous divisionof all resistant structures. Occasionally, in relapsed and inveterate cases,astragalectomy is performed. It is seldom practised upon young children(see page 795). In some cases of talipes calcaneus shortening of the tendoAchillis is advised; but such an operation is only of temporary value, as stretch-ing occurs after two years or more. In talipes due to infantile paralysis theoperative treatment is the same, but we should not immobilize in plaster,but rather in some apparatus which can easily be removed to permit the useof massage and electricity. In paralytic cases tendon-transplantation isoccasionally employed. This consists in transferring the tendon of an activemuscle so that it will take the place of the tendon of a paralyzed muscle. Thetransferred tendon should alw3,ys be attached to the periosteum (Tubby andJones on the Surgery of Paralysis). Treatment of Pes Planus ^35. Pes planus (flat=foot) is a condition in which there is loss of the arch ofthe foot due to muscuhir paralysis or ligamentous weakness, to prolongedstanding, or to trauma. Flat-foot is especially apt to occur in rickets. Spu-rious flat-foot, or injiainmatory flat-foot, occurs in Potts fracture and in inflam-mation of the ankle-joint or of the tendon of the peroneus longus flat-foot is seen after infantile paralysis. Static flat-foot is due to dis-proportion between the body weight and the support of that weight. Allchildren are born with pronated feet; the arch usually begins to form soonafter birth, but in some individuals it never forms. Flat-foot, according tode Vlaccos, is thus produced: If we suppose a straight line prolonged downwardfrom the center of the leg, most of the astragalus and os calcis will beexternal to it; hence the body weight presses on the inner side of the foot,and tends to flatten the arch and cause outwa
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