348 



ABNORMAL CONDITIONS OF THE FOOT. 



foot is by no means an uncommon occurrence, 

 and though in our English systematic works 

 on surgery this case has met with little notice, 

 yet, as a subject of great importance to the 

 comfort and well-being of a numerous class of 

 sufferers, it is by no means undeserving of a 

 place in a professed work on surgery. As, 

 however, the scope of the present is not strictly 

 surgical, we shall, in this article, content our- 

 selves with a pathological description of the 

 principal varieties of these deformities, and in 

 doins; this we shall freely avail ourselves of the 

 assistance of an able article on the " Pied-bot," 

 by Bouvier, in the Diet, de Medecine et de 

 Chirurgie Pratiques. 



The ankle-joint is not generally implicated 

 in congenital deformities of the foot ; displace- 

 ment of the bones may occur to an extreme 

 degree, and yet the natural form and functions 



of the ankle remain. But this rule is by no 

 means universal. The ankle-joint may be the 

 sole seat of the unnatural condition, or it may 

 share it in common with the bones of the foot; 

 but these cases are rare, they form only the ex- 

 ception to the general rule. There are three 

 principal forms of distortion to which the foot 

 is congenitally subject : 1. when the foot is 

 turned inwards, which has been termed vurus: 



2. when it is turned outwards, called vnlgus: 



3. when the foot is permanently extended, 

 and the patient can only put the toes to the 

 ground, termed pes equinus. Almost all the 

 varieties of club-foot may be referred to one of 

 these species. 



1 . When the foot is turned inwards, (varus,) 

 the following modifications in the form of the 

 parts present themselves. (See Jigs. 162, 163.) 

 The dorsum faces forwards, the sole is turned 



Fig. 162, 163. 



backwards, and very considerably curved upon 

 itself. The inner side of the foot is uppermost, 

 the outer side rests upon the ground, the heel 

 is more or less turned inwards and upwards. 

 The integuments of the outer side are thickened 

 by pressure, and there is a sort of provisional 

 cushion, of a somewhat elastic nature, formed 

 under it, while the thickness and hardness of 

 the integuments of the sole are not found to 

 the usual degree. The joints that suffer most 

 in this malformation are, as might be expected 

 from a review of their natural structure, the 

 double articulations between the first and second 

 row of tarsal bones. The scaphoid bone is 

 twisted inwards in such a manner, that the 

 dorsum of it presents forwards and its apex 

 backwards, and the navicular cavity is brought 

 to the inner edge of the astragalus. The cuboid 

 bone generally preserves its relation to the 

 scaphoid, being more or less displaced from 

 the os calcis, and turned under the foot. The 

 cuneiform bones, the metatarsus, and toes, are 

 little altered in their relation to those tarsal 

 bones to which they join, the peculiarity of 

 their position and direction being entirely the 

 result of the alterations in the scaphoid and 



cuboid, just mentioned. The os calcis is 

 turned, so that its outer sid is inclined to- 

 wards the ground, and further than natural 

 from the outer malleolus; the inner hollow side 

 is inclined upwards and inwards, and nearer to 

 the inner malleolus than natural, and the heel 

 itself is elevated. By this means the articula- 

 tions between this bone and the astragalus are 

 altered somewhat, particularly if the ankle-joint 

 itself remains natural, the astragalus not having 

 partaken of the general malposition ; this bone 

 is then thrown in some degree upon the outer 

 side of the os calcis. The astragalus, we have 

 said, rarely shares in the general deformity ; 

 when it does it is tilted outwards, so that its 

 upper surface inclines towards the external 

 malleolus, and the articular portion itself be- 

 comes altered in form, as is also the corre- 

 sponding portion of the tibia ; in one instance re- 

 lated by Bouvier, the astragalus, by the pressure 

 of the inner side of the tibia above and of the 

 calcis below, was reduced to a mere thin edge 

 on this side, the whole bone being something 

 in form of a wedge between them. 



2. In the va/gus, (see Jig. 164), where the 

 foot is turned in the opposite direction to that 



