392 Anatomy Applied to Medicine and Surge? y. 



matisms to which their situation and functions predispose 

 them, and, since the synovial membranes in connection with 

 these bones are six in number, injuries would, therefore, 

 have a greater chance of inducing tubercular synovitis, 

 which, when started, could readily spread from one bone 

 to another through continuity of the synovial tissue, 

 and, lastly, the distance of this part of the limb from the 

 heart, along with its dependent position, would tend to 

 favor alteration in the circulation through the bones and 

 thus cause them to be less resistant to the action of the 

 bacilli. 



Club Foot. Of the five chief forms of this deform- 

 ity, talipes equinus is nearly always acquired and is gen- 

 erally due to infantile paralysis of the extensor muscles. 

 The heel is drawn up by the tendo Achilles, while the por- 

 tion of the foot in front of the mid-tarsal joint is bent 

 downwards and backwards so that the patient walks on 

 the balls of the toes. Talipes varus is generally congeni- 

 tal and is most commonly seen in the condition described 

 as equino- varus. In the latter form, i.e., equino- varus, 

 the heel is drawn up by the tendo Achilles and the portion 

 of the foot, in front of the mid-tarsal joint, is drawn in- 

 wards and upwards by the tibialis anticus and the tibialis 

 posticus, so that, the scaphoid is situated internal to, rather 

 than in front of, the astragalus, with the result, that the 

 anterior part of the foot is adducted and inverted, the inner 

 border being turned upwards, and the outer border down- 

 wards, so that the sole looks backward and the dorsum 

 forward the patient walking, therefore, on the front 

 part of the outer, side of the sole. In talipes calcaneus 

 the patient walks on the os calcis, and in the congenital 

 form, the anterior part of the foot is drawn up by the ex- 

 tensor muscles. In talipes valgus, or flat foot, the two 

 arches of the foot are more or less flattened, the anterior 



