484 SURGICAL APPLIED ANATOMY. [Chap. xxm. 



drawn up, and the patient walks upon the balls of the 

 toes. The contracting muscles are those of the calf 

 attached to the tendo Achillis. In a well-marked 

 case the os calcis is much raised, and may even be 

 brought in contact with the tibia. The astragalus is 

 displaced downwards, and projects upon the dorsum. 

 The foot tends to become more and more bent at the 

 medio-tarsal joint, until at last the scaphoid may even 

 touch the os calcis. The ligaments of the sole are 

 usually much contracted. 



2. Talipes cakaneus. In this form -of club-foot 

 the toes are drawn up, and the patient walks upon 

 the heel. The contracting muscles are the extensors 

 on the anterior aspect of the limb. The os calcis is 

 rendered more vertical, and the astragalus becomes so 

 obliquely placed that part of its upper articular 

 surface may project beyond the tibia in a backward 

 direction. 



3. Talipes varus. This is the commonest form. 

 In a well-marked congenital case there is a four- 

 fold deformity: (1) The heel is drawn up by the 

 muscles attached to the tendo Achillis ; (2) the 

 foot is adducted ; and (3) its inner edge is drawn up- 

 wards by the contraction of the tibialis anticus and 

 posticus ; (4) the sole is contracted by the flexor 

 longus digitorum muscle and the shrinking of the 

 plantar fascia and ligaments. In this variety of 

 talipes the os calcis is drawn into a more vertical 

 position. The astragalus is displaced forwards and 

 downwards, so that some part of its upper articular 

 surface becomes superficial on the dorsum. The 

 scaphoid is displaced upwards and backwards, until 

 its inner border often touches the internal malleolus. 

 The three cuneiform bones follow the scaphoid, and 

 the cuboid becomes the lowest bone in the tarsus. 



4. In talipes valgus the foot is abducted and its 

 ou ter border drawn upwards. The contracting muscles 



