ABNORMAL CONDITIONS OF THE FOOT. 



349 



Fig. 164. 



which has been just described, the whole state 

 of the foot seems to be pretty nearly the exact 

 converse of every thing there mentioned. The 

 same bones are affected, and in the same rela- 

 tive degree ; and the same analogy which exists 

 between the one condition and the phenomena 

 of adduction, is found between the other and 

 those of abduction. The dorsura faces more 

 or less directly forwards, the plantar surface 

 backwards, the inner side of the foot rests upon 

 the ground, the outer is uppermost. The tibia 

 frequently here participates in the deformity so 

 far as to have a curve inwards, and the inner 

 ankle consequently approaches to the ground. 

 The double articulation between the first and 

 second row of bones in this case also suffers 

 the most. The astragalus sometimes projects 

 in front, and lower than in the varus. The 

 distortion is sometimes carried to such an ex- 

 tent that the foot is 



Fig. 165. 



turned nearly upwards 

 and at the side of the 

 fibula. The os calcis 

 is twisted outwards, 

 with the heel elevated, 

 its hollow inclining to- 

 wards the ground. The 

 scaphoid and cuboid 

 bones are, as we have 

 said, most displaced; 

 the first being nearest 

 the ground, the last 

 placed uppermost, and 

 near the outer malleo- 

 lus. The cuneiform 

 bones, and the other 

 bones of the foot, retain 

 their relation to the 

 bones to which they 

 are articulated, their 

 unnatural situation be- 

 ing the result of the 

 displacement of these. 

 3. The pes equinus, 

 (see^g.165,) so named 

 from the resemblance in 

 the position of the tar- 

 sus to that of the horse, 



differs from either of the others in its anato- 

 mical characters. When it has arrived at a con- 

 siderable pitch, the tibia is found partially dislo- 

 cated backwards upon the os calcis ; the sca- 

 phoid and cuboid are carried backwards, to- 

 wards the sole of the foot, leaving the upper 

 part of the head of the astragalus and cuboides 

 projecting; the cuneiform and metatarsal bones 

 are displaced sometimes in a similar manner. 

 Thus the whole foot is more arched than 

 natural, independently of its altered position ; 

 the sole is shortened and hollowed, the dorsum 

 is elongated and projecting. 



A very interesting history of yet another form 

 of this disease by M. Holz of Strasburg, is 

 given in the 13th vol. of the Lancet, in which 

 the foot was turned completely back, having 

 the dorsum resting on the ground, the plantar 

 surface being uppermost. The deformity was in 

 both feet. Walking was not painful ; the patient 

 rested his weight on the tarsus ; the metatarsus 

 and toes did not touch the ground. He wore 

 common half-boots, the toes of which pointed 

 backwards and the heels forwards. The man 

 died, and upon examination of his feet the fol- 

 lowing state of parts was found. The skin of 

 the dorsum upon which he trod was hard and 

 callous. The bones of the leg were well 

 formed ; the astragalus was dislocated forwards; 

 the calcaneum forwards and outwards, and the 

 cuboid downwards on the calcaneum. The 

 dorsal surface of the foot was very convex, ex- 

 cepting at the spot which touched the ground ; 

 the plantar surface very concave. The supe- 

 rior articular surface of the astragalus was 

 turned directly forward and a little downward ; 

 its posterior surface also looked forward, and 

 the tibia rested on the inferior, in a great de- 

 gree, and on the small process of the calca- 

 neum. The connexion of the scaphoid with 

 the astragalus was more natural ; the scaphoid 

 was, however, turned a little backward. The 

 cuboid rested by its posterior part on the inferior 

 surface of the os calcis. The articular surfaces 

 of the astragalus and os calcis gave attachment 

 to ligamentous fibres. The three cuneiform 

 bones, the metatarsal bones, and the toes had 

 not experienced any sensible change in their 

 position. 



The descriptions now given are of extreme 

 cases in each of the species of deformity. Of 

 course the degree of departure from the natural 

 form varies in every case. In the varus, every 

 intermediate shade between the extreme men- 

 tioned and the mere state of permanent adduc- 

 tion occurs. The state of fixed abduction may, 

 in the same way, be called the milder extreme 

 of the valgus, while the pes equinus shows its 

 simplest form in the mere fixed extension of 

 the foot. 



We also find in some instances a combina- 

 tion of more than one form of the deformity in 

 the same foot. The most frequent of these is the 

 state of permanent extension, of the pes equinus, 

 with the adduction of the metatarsal bones and 

 phalanges, constituting a variety of the varus. 

 (Fig. 166.) The same complication of the 

 pes equinus with the valgus is rare, but does 

 sometimes occur, A congenital deformity, so 



