A treatise on orthopedic surgery . he table the leg is held upright. This allowsone to hook the fingers about the extremity of the os calcis, whilethe hand and arm, lying along the sole of the foot, may be usedas a lever to force it toward dorsal flexion as the os calcis isdrawn downward. In this manner forcible stretching is con-tinued until the dorsum of the foot can be brought almost intoapposition with the crest of the tibia. When the operation hasbeen completed the foot should be perfectly limp. It is usually52 818 OETHOPEDIC SrSGEEY. someTvhat congested from the pressure of the fingers,
A treatise on orthopedic surgery . he table the leg is held upright. This allowsone to hook the fingers about the extremity of the os calcis, whilethe hand and arm, lying along the sole of the foot, may be usedas a lever to force it toward dorsal flexion as the os calcis isdrawn downward. In this manner forcible stretching is con-tinued until the dorsum of the foot can be brought almost intoapposition with the crest of the tibia. When the operation hasbeen completed the foot should be perfectly limp. It is usually52 818 OETHOPEDIC SrSGEEY. someTvhat congested from the pressure of the fingers, but it iswarm and the circulation is unimpaired. One may assume that in the transformation of rigid deformityto yielding tissues that can be moulded into the desired shape,the component parts of the deformed foot must have been sub-jected to considerable violence; that ligaments and muscles musthave been stretched and, it may be, ruptured: that new surfacesare now apposed to one another in the articulations, and that the Fig. Untreated club-foot, showing the secondary knock-knee. (See Fig. 552.) bones have been forced into approximately normal method of treatment has a g-reat advantage over the ordi-nary operative treatment in that the entire foot participates inthe correction instead of a limited portion, as when, for example,bone is removed by cuneiform osteotomy. It has a second andalmost equally important advantage in that the immediate useof the corrected and yielding foot is possible in the place of thenecessary rest that must follow cutting operations. For thesereasons it should be the operation of choice, and preliminary,at least, to more severe procedures in the treatment of resistantclub-foot in childhood. The only disadvantage of the operation DEFOBMITIES OF TEE FOOT. 819 is the actual labor which it necessitates on the part of the sur-geon, usually twenty minutes or more of rather exhausting foot must now be fixed by a plaster bandage in
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