726 OPERATIONS ON THE FOOT. 



in avoiding injury to the coronary band, and to the podophyllous 

 tissue, which are essential elements of the organization of the 

 foot. It is also essential to avoid injury of the lateral Ugament 

 of the foot joint, which is close to the cartilage, and above all, of 

 the synovial capsule of the joiat, which is directly covered by the 

 cartilage. The partial or entire extii-pation of the cartilage can 

 be performed. In the first case, only a portion of the necrosed 

 fibro-cartUage is removed. Vatel, Sanstas, Eenault, Bell and La- 

 fosse have reported many cases of recovery by this mode of oper- 

 ation, but it is not Kkely to be thoroughly successful, unless in 

 circumstances as favorable as those accompanying the treatment 

 by liquid caustics. It is generally much better when the operation 

 is decided upon to perform it by excising the entire structure, and 

 removing all the carious elements. The partial removal is to-day 

 entirely abandoned, and entire extirpation accepted as the true 

 and only operative procedure. The best method of performing 

 it is that recommended by Renault and adopted in our colleges. 

 We shall make it the subject of description with all necessary 

 details, and with various modifications as performed by other 

 practitioners; we shall also offer some observations upon various 

 other modes of performing the operation in question. 



The operation includes two principal steps : first the removal 

 of the part, or the whole of the wall corresponding to the diseased 

 cartilage ; and second, the extirpation of the cartilage itself. The 

 opinions of surgeons vary as to the amount of hoof which should 

 be removed, and the extent of homy tissue to be taken off. In 

 respect to the length of the superior border of the portion requir- 

 ing removal, it is generally agreed that it must extend from the 

 anterior extremity of the cartilage backward, that is, the two pos- 

 terior thirds of the space reaching from the toe to the heels, or 

 one-third of the circumference at the coronary band. But opinion 

 continues divided as to the lower border (Fig. 527). Lafosse, Sr., 

 left it longer than the superior, and made the direction of the 

 division of the groove correspond to that of the fibres of the hoof. 

 Lafosse, Jr., accepting the idea of SoUeysel and of Dieterichs, did 

 not reach the sole with its groove, and removed only a portion of 

 hoof parallel to the coronary band. Eenault prefers crossing the 

 fibres of the hoof with the groove, and brings the lower end of it 

 to one-half the dimensions of the upper border, its groove running 

 backward. Rey considers this to be running too far back and 



