A treatise on orthopedic surgery . rmity and become of some functional service,even if slight. (See Talipes Calcaneus.) Paralysis of the tibialis posticus muscle may be treated bydividing the peroneus brevis at or near its insertion, passing itbeneath the tendo Achillis and attachins; it to the tendon of the OF THE FOOT. 875 former. It may be mentioned, also, that sections of the tendoAchillis have been used to strengthen either the posterior ad-ductors and abdnctors. As has been stated, one must plan theoperation according to the function that is lost and the powerthat remains an
A treatise on orthopedic surgery . rmity and become of some functional service,even if slight. (See Talipes Calcaneus.) Paralysis of the tibialis posticus muscle may be treated bydividing the peroneus brevis at or near its insertion, passing itbeneath the tendo Achillis and attachins; it to the tendon of the OF THE FOOT. 875 former. It may be mentioned, also, that sections of the tendoAchillis have been used to strengthen either the posterior ad-ductors and abdnctors. As has been stated, one must plan theoperation according to the function that is lost and the powerthat remains and combine this procedure if possible with othersto assure the desired result. As a rule, the most successfuloperations are those in which a muscle of similar function tothat of the paralyzed one is transplanted. It is apparent, also,that it will be of little use to transpose a muscle unless its originis such that it can work to advantage at its new point of attach-ment. For example, an anterior adductor may be changed to Fig. Paralytic equinovarus cured by operation, showing power of dorsal flexion(one-half of the tendon of the tibialis anticus attached to the periosteum of theouter border of the foot). Operation July 19, 1898. The direct union of tendonsto periosteum at the most advantageous point has been urged especially by Lange(Ueber Periostale Schnenverplanzung bei Liihgmung, Miinch. med. Woch., 1900,No. 15). an abductor, and the function of a posterior adductor or abduc-tor can be similarly transferred, but a posterior plantar flexor cannever be efficient as a dorsal flexor; nor can one muscle act asan extensor and as a flexor at the same time, as would appear tobe the belief of many who have contributed to the literature ofthe subject. The variety of combinations of this character thathave been advocated is very large, but it is hardly necessary todescribe them. As has been mentioned, one mar alwavs sacri- 876 OETHOPEDIC SURGEEY. fice a less important to a more im
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