Chap, xxn i.] THE ANKLE AND FOOT. 527 



caused by the eversion of the foot, while the tibial 

 malleolus and head of the astragalus form a projection 

 on the inner aspect of the limb. 



The medio-tarsal joint is composed of two 

 articulations, the astragalo-scaphoid and calcaneo- 

 cuboid. The ligaments supporting the former joint 

 are the external and inferior calcaneo-scaphoid and 

 the astragalo-scaphoid ; while the latter articulation 

 is maintained by the internal and dorsal calcaneo- 

 cuboid ligaments, and the long and short plantar. 

 Movement is somewhat freer in the astragaloid than 

 in the calcaneal segment of the joint. The movements 

 permitted in the articulation as a whole consist of 

 flexion and extension, with some rotation around an 

 antero-posterior axis whereby the sole can be turned 

 in or out. Flexion is associated with inward rotation 

 of the sole and adduction of the toes, extension with 

 outward rotation of the sole and abduction of the toes. 

 It should be noted that the movements of turning the 

 toes either in or out take place mainly at the hip- 

 joint ; while the turning of one edge of the foot either 

 up or down is a movement that mostly concerns the 

 medio-tarsal and calcaneo-astragaloid joints. The 

 chief deformities in club-foot take place about the 

 former articulation. 



Club-foot. It is usual to divide the various 

 forms of talipes, or club-foot, into four main divisions, 

 viz. (1) T. equinus; (2) T. calcaneus ; (3) T. varus; 

 and (4) T. valgus. Four secondary forms result from 

 combinations of these principal varieties, viz. T. 

 equino-varus, T. equino-valgus, T. calcaneo- varus, and 

 T. calcaneo-valgus. 



1. Talipes equinus. In this deformity the heel is 

 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 



