RADICAL NAIL PRICK OPERATION 



463 



one. The operation itself, almost universally, leaves the 

 patient more or less permanently lame, no matter whether 

 the condition for which it was performed was trivial or 

 serious, because in sacrificing the navicular bursa, adhesions 

 which form between the plantar aponeurosis and navicular 

 bone, retain a persistent hyperassthetic state for many months 

 and finally end in deforming the foot and constraining the 

 pedal articulations, for all time thereafter. In view of the fact, 

 therefore, that the trivial cases and those of moderate se- 

 verity, terminate quite as well, or even better without this 

 intervention, it is evident that its usefulness is limited to the 

 serious cases only. In fact it can be prudently recommended 

 only where the life of the patient is in danger from pain, septic 

 infection, advancement of the inflammation into the artic- 



Fig. 240 — Dressing Applied. 



ulation or adjacent zones and exhaustion. In these events it 

 is an emergent intervention of unquestioned value, as in every 

 instance the threatening symptoms immediately subside. 

 The fever drops, the accelerated respirations diminish, the ap- 

 petite returns and the patient for the first time takes a good 

 sound rest in peaceful decumb'ency. The claudication, how- 

 ever, does not immediately disappear. On the contrary, it 

 may even accentuate. The patient, which before the oper- 

 ation may have supported some weight on the toe, supports 

 no weight whatever for at least three weeks afterward, and 

 then goes slowly onward to incomplete recovery. 



TECHNIQUE.— The patient is placed in the recumbent 

 position, the plantar nerves on both sides of the affected leg 

 are cocainized, and a tourniquet is wrapped upon the cannon. 

 If secured upon the table the affected foot should be under- 

 most because the sole can then be made to face upward by 



