504 Deformities of Foot 



Talipes valgus is not the same as flat-foot ; it is that condition 

 in which the outer border of the foot is drawn up by contracted 

 peroneal tendons. The condition is rare ; and rarer still is that in 

 which the peroneal tendons need division. Obviously it is wrong 

 to divide the tendon of the peroneus longus in mere flat-foot, for, as 

 remarked above, that tendon does much in supporting the arches of 

 the foot. 



Students often experience a difficulty in remembering which is 

 talipes varus and which is valgus. They should think of the well- 

 known condition of knock-knee, or genu valgum, for genu valgum 

 is constantly associated with the flat-foot, the inner arch of the 

 instep having sunk ; flat-foot is also called spurious talipes valgus. 

 Talipes varus is tJic opposite condition, in which the inner border of 

 tJie foot is drawn up and the patient walks on its outer side. Often 

 in talipes varus corns form over the external malleolus, the cuboid, 

 and the base of the fifth metatarsal bone ; in those places also bursae 

 may be developed and become inflamed. 



Every new-born child has a little * varus,' for this was the position 

 of the foot in utero. 



Talipes calcaneus is the reverse of talipes equinus. In the 

 former condition the tibialis anticus and its associates may require 

 division ; in simple equinus Achilles-tenotomy may suffice. The 

 latter operation is common enough, the former is rarely needed. 



In paralysis of the calf-muscles the heel may drop from stretching 

 of the tendon of Achilles, the patient becoming the subject of paralytic 

 calcaneus. In this condition an oblique segment may be removed 

 from the tendon, the cut surfaces being then spliced. 



In equinus the first phalanx of the great toe, and the first phalanges 

 of the other toes, to a certain extent, are drawn up towards the dorsum 

 of the foot and even partially dislocated backwards. The reason of 

 this is that when the heel is elevated the toes are pointed down, and, 

 the distance between the origin and insertion of the long extensors 

 of the toes being increased, whilst the muscles themselves are not 

 lengthened, the toes are drawn into the position of extreme extension. 

 The long flexor still holds down the ungual phalanx. 



If the foot be forcibly flexed the position of the toes is at once 

 improved, if not corrected. 



Pes cavus is a rare congenital deformity, in which the heel is 

 drawn up by a contracted tendo Achillis, whilst the plantar fascia 

 shortens the foot and exaggerates the arch of the instep. 



In pes cavus the tendon of Achilles and the plantar fascia may 

 require division. 



Hammer-toe is a congenital deformity in which the first phalanx 

 of (generally) the second toe is drawn back, whilst the middle and 

 ungual phalanges are flexed. Thus the angle of the first inter- 

 phalangeal joint forms a prominent ' knee' which is constantly'pressed 



