350 



ABNORMAL CONDITIONS OF THE FOOT. 



not 



far as we know 

 mentioned, has once 

 fallen under our no- 

 tice, namely, a dislo- 

 cation of the tibia back- 

 wards upon the upper 

 and posterior part of 

 the os calcis, so that the 

 prominence of the heel 

 was entirely lost, and 

 the foot flexed to such 

 a degree, as that the 

 dorsum lay in contact 

 with the anterior part 

 of the leg. 



The alterations from 

 the normal state of the 

 ligaments, bones, mus- 

 cles, and articular sur- 

 faces, in these cases of 

 deformity, are easily 

 comprehended. The 

 ligaments are of course 

 elongated on the one 

 side of the dislocated 

 joint, and shortened on 



the other side ; the bones are altered in shape, 

 occasionally, where pressure is produced by a 

 neighbouring bone, and sometimes a portion of 

 the bone is twisted, and drawn towards the unna- 

 tural situation of that one with which it articulates. 

 The muscles are elongated or shortened, accord- 

 ing as their points of attachment are, by the 

 deformity, approximated or further separated. 

 The articular surfaces undergo great alterations : 

 they are altered in shape and situation by the 

 friction of the parts in contact producing a new 

 synovial surface upon its new situation, while a 

 part, or the whole of the natural joint loses its 

 polished surface, and becomes adherent to the 

 integuments, while, in many instances, the 

 altered position of a bone brings it into contact 

 with another, with which naturally it had no 

 such relation, and here again a preternatural 

 synovial articulation will form, in accordance 

 with the same law of the animal economy, by 

 which long-continued pressure will produce a 

 synovial bursa. As a general observation, we 

 may state, that the whole limb is smaller, 

 shorter, and feebler than the sound one, and 

 that this defect increases by comparison with 

 the sound one, as the child grows. M. Cru- 

 veilhier has also found that individual bones 

 are sometimes singly defective in their growth, 

 while occasionally only the portion of a bone 

 which is subjected to pressure is checked in 

 its developement. 



The deformities described above are gene- 

 rally congenital, but they are also occasionally 

 produced after birth by accidental causes; 

 though/in this case there is no difference in the 

 nature of the distortion or in the anatomical 

 condition of the parts, yet they are less fre- 

 quently cured, because the same carelessness 

 or bad management which has too often occa- 

 sioned the accidental form of the disease to 

 creep on unheeded, makes the parents indiffe- 

 rent as to the cure, while the deformity, which 

 has not mismanagement for its cause, is imme- 



diately remarked on the birth of the child, 

 excites alarm in the mind of the parent, and 

 means are early adopted for its removal. 



This part of our subject leads us to notice a 

 deformity, of not uncommon occurrence, but 

 one which has met with little notice from 

 writers, although the inconvenience and suffer- 

 ing occasioned by it, great in degree, and, as 

 far as we have known, permanent in duration, 

 will entitle it to the consideration of the sur- 

 geon. We allude to that state of the foot 

 wherein the arch is lost, and the foot rests flat 

 upon the ground. It is met with generally, 

 but not always, in those children of the lower 

 classes who are obliged, in their early youth, 

 to engage in laborious occupations, and parti- 

 cularly in lifting heavy weights, before the 

 powers of the system are developed, though 

 we have known it to occur where none of these 

 causes could be traced. It happens generally, 

 not in the very weak, nor in the firm and robust 

 children, but in those who have the promise of 

 developement on a large scale, and are rapidly 

 growing. It comes on insidiously, and is 

 rarely detected until too far gone to admit of a 

 complete cure. The marks of this disease are 

 an evident alteration in the shape of the foot. 

 The dorsum has comparatively lost its con- 

 vexity, the concavity of the sole is entirely 

 gone ; the scaphoid bone projecting below un- 

 naturally, and the inner malleolus falling con- 

 siderably inwards. The relative position of all 

 the rest of the foot appears natural. The pa- 

 tient complains of pain and tightness at the 

 upper part of the instep passing through to the 

 sole upon attempting to elevate the heel while 

 standing. Indeed, in aggravated cases, he 

 cannot lift himself at all upon the metatarsus, 

 while every step upon an uneven surface is 

 accompanied with pain. The anatomical cha- 

 racters of this distressing disease consist, as far 

 as a close examination of the living parts can 

 detect, for we have had no opportunity of dis- 

 secting them, in a relaxation of that ligament 

 which passes between the os calcis and navicu- 

 lar bone, and on which the fore part of the 

 astragalus rests and moves. It will be quite 

 evident, from an examination of these parts 

 and their connexions, that this supposition is 

 sufficient, to account for the symptoms that are 

 apparent, and the idea is borne out by the fact 

 of the point of the scaphoid being further sepa- 

 rated than natural from the tubercle of the os 

 calcis, which may be readily ascertained by the 

 touch. We conceive the remote cause to be a 

 certain degree of inflammatory action in the 

 elastic ligament just mentioned, produced by 

 over-exertion, before the part had acquired its 

 full developement and strength. The morbid 

 action being continued by the continuance of 

 the irritation, the elasticity of the ligament is 

 impaired, and it can no more support the 

 weight laid upon it; it consequently yields, 

 and is stretched. This view receives some 

 support from the fact of the tenderness upon 

 pressure constantly found in this precise spot, 

 and from the relief afforded to the more dis- 

 tressing symptoms by the application of leeches 

 and counter-irritations. 



