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valgus of one foot and varus of the other, for instance, are more frequently met with than double valgus of the third degree.

There is rarely any real displacement of the tarsal bones in valgus, nor is there any deviation observed from the normal

Fig. 11.

forms of the bones.

The metatarsal bones are first affected by the retracted muscles, and later the cuneiform and the scaphoid bones undergo slight rotation. The scaphoid bone is drawn downwards and forwards, and comes prominently into view on the inner side of the foot, the astragalus and os calcis are tilted inwards, and the plantar arch is obliterated; a depression is formed beneath the outer malleolus by eversion of the foot and elevation of its outer border. The astragalus becomes slightly twisted in the articulation, and may even not be opposed to the inner malleolus; the fifth metatarsal bone, and the external surface of the os calcis present upwards, and the plantar surface of the foot outwards.

TALIPES CALCANEUS.-Talus, hook-foot, heel-foot, hakenfuss, pied-bot calcanien, stréphanopodie.

In congenital talipes calcaneus the foot is flexed upon the leg and the heel is depressed. Flexion may be so complete that the dorsum of the foot shall be brought into contact with the anterior surface of the leg; or, on the other hand, the foot may be only slightly flexed beyond a right angle. The muscles which occasion this distortion are extensor proprius pollicis, extensor longus digitorum, and tibialis anticus, and, in severe grades of distortion, M. peroneus tertius. (Fig. 12.)

Fig. 12.

:

Of the four principal varieties of talipes, this is the least important it is also removed with the least difficulty. There is neither malformation nor displacement of the bones in this distortion, but it is an abnormal degree of flexion of the foetal foot which is retained as a permanent position. It occasions, in its highest degree, considerable extension and debility of the muscles of the calf of the leg, which may continue for some time after the removal of the distortion. Power, however, is gained

by allowing the muscle to contract upon itself. From debility of the opponent muscles, and, doubtless, in some instances, from a continuance of irritation, this distortion (as indeed every form of congenital talipes) is liable to recur after the restoration of the foot to its normal position; but there is no form of talipes which is more easily removed, nor, after removal, in which the foot is more easily retained in its normal position, than calcaneus.

The posterior portions of the lateral ligaments of the tibio tarsal articulation are extended in this form of talipes.

TALIPES EQUINUS.-Pes equinus, talipes digitus, horsefoot, ox-foot, spitzfuss, pferdefuss, pied equin, pied-bot phalangien, stréphocatopodie.

This is an extremely rare form of distortion. It consists of permanent extension of the foot without abduction or adduction.

The only undoubted instance which I have seen of congenital talipes equinus has occurred since the publication of a series of papers in the Medical Times and Gazette,' in which congenital equinus is thus spoken of :

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"I should, with my colleague, Mr. Lonsdale, have said, that talipes equinus never occurs as a congenital affection (never having seen an instance of this variety of talipes which had existed at birth as a simple distortion, and without retraction of other muscles, whether adductors, abductors, or flexors of the foot), had not instances been recorded and figured by Ammon, Duval, Guérin, Dr. Little, and others: but, in consequence of their testimony, I will describe this as the rarest form of congenital talipes."1

In the case above referred to, and which I saw within a

Contributions to Orthopædic Surgery, Medical Times and Gazette,' p. 414, vol. ix, 1854.

week of the birth, the distortion was observed at the time of birth. Anxiety had occasioned premature labour; namely, at the eighth month. The child was born with talipes equinus of the left foot, without either adduction or abduction of the foot; the heel was raised half an inch; the tendo Achillis was tense; the convexity of the dorsum and the concavity of the sole of the foot were increased, and the toes were slightly flexed. The plantar fascia was not shortened.

There is also at the present time in the Orthopedic Hospital, under the care of my friend and colleague, Mr. Lonsdale, a child with spasmodic congenital equinus of one foot and equino-varus of the other. For the following particulars I am indebted to the Rev. William Charles Fox,

Fig. 13.

M.B., under whose auspices the child was placed in the hospital :

1

In adducing this as an example of congenital distortion, I must state, that Mr. Lonsdale expresses some doubt as to the congenital character of the affection.

"D. W., æt. 3, was admitted into the hospital, October, 1855: he is a fair child, plump, and pale.

"His mother asserts, as well as others who have known the child from birth, that he was born with the distortion as it now appears, and that distortion has neither increased nor diminished since birth. The child has never had a fit, nor does other known cause for distortion exist.

"The fore-arms are slightly extended by retraction of M. triceps; the hands are prone and extended on the fore-arms, and the fingers are flexed; the legs are extended on the thighs; the left foot is affected with equino-varus, and the right with equinus; the boy speaks very slowly, and stammers; the urine and fæces are passed involuntarily.

"The right foot offers an excellent example of congenital spasmodic equinus; the heel is drawn up, the arch of the foot is increased, the toes are flexed." (See fig. 13.)

as varus,

Talipes does not, however, always appear equinus, valgus, or calcaneus, but occasionally a compound distortion is produced, which partakes of two of the abovementioned varieties; as, for instance, equino-varus, in which the heel is more elevated than is usual in varus, and the foot is less inverted than in the third degree of varus ; and, again, equino-valgus, in which also the heel is unusually elevated both of these varieties are, however, uncommon congenital affections. Again, calcaneo-valgus, which is perhaps the most common compound form of congenital distortion, and also calcaneo-varus, which is the rarest, require to be named. It is scarcely necessary to enter into a special description of these compound varieties, as all that relates to them is comprised in the descriptions of the simple varieties, and their characters are marked by their distinctive appellations.

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