chap, xxiii.] THE ANKLE AND FOOT. 483 



In the outward luxation the foot is abducted, its 

 outer border is raised, and the deformity produced 

 is not unlike that of talipes valgus. The outer 

 malleolus is lost in the hollow caused by the eversion 

 of the foot, while the tibial malleolus and head of the 

 astragalus form a projection on the inner aspect of 

 the limb. 



The medio-tarsal joint is composed of two 

 articulations, the astragalo - scaphoid and calcaneo- 

 cuboid. The ligaments supporting the former joint 

 are the external and inferior calcaneo-scaphoid and 

 the astragalo-scaphoid ; while the latter articulation 

 is maintained by the internal and dorsal calcaneo- 

 cuboid ligaments, and the long and short plantar. 

 Movement is somewhat freer in the astragaloid than 

 in the calcaneal segment of the joint. The move- 

 ments permitted in the articulation as a whole consist 

 of flexion and extension, with some rotation around an 

 aiitero-posterior axis whereby the sole can be turned 

 in or out. Flexion is associated with inward rotation 

 of the sole and adduction of the toes, extension with 

 outward rotation of the sole and abduction of the 

 toes. It should be noted that the movements of 

 turning the toes either in or out take place mainly at 

 the hip-joint ; while the turning of one edge of the 

 foot either up or down is a movement that mostly 

 concerns the medio-tarsal and calcaneo-astragaloid 

 joints. The chief deformities in club-foot take place 

 about the former articulation. 



Club-foot* It is usual to divide the various 

 forms of talipes, or club-foot, into four main divisions, 

 viz., (1) T. equinus ; (2) T. calcaneus; (3) T. varus; 

 and (4) T. valgus. Four secondary forms result from 

 combinations of these principal varieties, viz., T. 

 equino-varus, T. equino-valgus, T. calcaneo-varus, and 

 T. calcaneo-valgus. 



1. Talipes equinus. In this deformity the heel is 



