Chap, xxiii.] THE ANKLE AND FOOT. 529 



bone forms one of the two projections obvious on the 

 inner side of the foot, the other prominence being 

 formed by the head of the astragalus. The cuboid 

 is found to be a little rotated outwards. The arch of 

 the foot is lost, and all those ligaments are stretched 

 that serve to support and maintain that arch. 



Of the mixed, or secondary, forms of talipes 

 nothing need be said. They are the results merely of 

 a combination of the primary varieties. 



As trouble is often caused in talipes by pressure 

 being brought to bear upon an unusual part of the 

 foot, it is well to note upon what portion of the 

 member the patient treads in the different varieties of 

 the deformity. In varus the " tread " is mainly upon 

 the outer side of the fifth metatarsal bone ; in valgus 

 upon the internal malleolus and scaphoid ; in equinus 

 upon the bases of all the toes ; in equino- varus upon 

 the base of the little toe ; in equino-valgus upon the 

 base of the great toe ; in all forms of calcaneus upon 

 the heel. In cases of extreme and obstinate club- 

 foot wedges of bone are sometimes removed by the 

 operation known as T'arsectomy. Thus in talipes 

 equino-varus the base of the wedge will be on the 

 outer side of the foot and will be mainly represented 

 by the cuboid ; the apex will be at the scaphoid. 



Flat-foot, or splay-foot, are the names given 

 to a deformity due probably to the yielding of certain 

 ligaments, whereby the arch of the foot is lost and 

 the sole becomes more or less perfectly flat. The 

 foot, at the same time, is abducted, and the outer 

 border is often a little raised, so that the patient 

 walks mainly upon the inner side of the foot. This 

 deformity is met with in those who stand a great 

 deal, and is the direct result of yielding of the tarsal 

 ligaments from long-continued pressure. When the 

 weight of the body is brought to bear on the foot 

 placed flat upon the ground, it will be transmitted in 

 ii 4 



