528 SURGICAL APPLIED ANATOMY, tchap. xxm. 



in contact with the tibia. The astragalus is displaced 

 downwards, and projects upon the dorsum. The foot 

 tends to become more and more bent at the medio- 

 tarsal joint, until at last the scaphoid may even touch 

 the os calcis. The ligaments of the sole are usually 

 inuch contracted. 



2. Talipes calcaneus. In this form of club-foot 

 the toes are drawn up, and the patient walks upon the 

 heel. The contracting muscles are the extensors on 

 the anterior aspect of the limb. The os calcis is 

 rendered more vertical, and the astragalus becomes so 

 obliquely placed that part of its upper articular surface 

 may project beyond the tibia in a backward direction. 



3. Talipes varus. This is the commonest form. 

 In a well-marked congenital case there is a four- 

 fold deformity : (1) The heel is drawn up by the 

 muscles attached to the tendo Achillis ; (2) the 

 foot is adducted ; and (3) its inner edge is drawn 

 upwards by the contraction of the tibialis anticus and 

 posticus ; (4) the sole is contracted by the flexor 

 longus digitorum muscle and the shrinking of the 

 plantar fascia and ligaments. In this variety of 

 talipes the os calcis is drawn into a more vertical 

 position. The astragalus is displaced forwards and 

 downwards, so that some part of its upper articular 

 surface becomes superficial on the dorsum. The 

 scaphoid is displaced upwards and backwards, until 

 its inner border often touches the internal malleolus. 

 The three cuneiform bones follow the scaphoid, and 

 the cuboid becomes the lowest bone in the tarsus. 



4. In talipes valgus the foot is abducted and its 

 outer border drawn upwards. The contracting muscles 

 are the two peronei. In a well-marked congenital 

 case the os calcis is found a little raised and the 

 astragalus is displaced forwards and downwards. The 

 scaphoid is so rotated that its inner pai-t is depressed 

 and its outer raised. The internal portion of the 



