The operative treatment of resistant club-foot / by E.H. Bradford.

  • Edward Hickling Bradford
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of resistant club-foot / by E.H. Bradford. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ical means alone, provided the parents had sufficient persistency to continue the treatment for six months or a year or longer with daily or frequent visits; but where persistency and attention cannot be commanded, mechanical treatment becomes impossible, and these cases remain doomed to deformity unless some means can be devised which will enable the surgeon to cure in a short time. It is for this reason that operations on the bone, radical in character, are sometimes demanded which otherwise might have been avoided. The choice is between such methods as involve the least mutilation and give the best results in the speediest time. Of these methods three deserve careful consideration : (1) Forci- ble correction, preceded by thorough division of the ligaments and tendons; (2) removal of the astragalus, an operation frequently performed on the European continent, and advocated lately by Dr. Morton, of Philadelphia; ^ (3) osteotomy of the neck of the os calcis and of the astragalus, preceded by careful division of the soft parts of the inner side of the foot. It is not proposed to consider the claims of wedge-shaped resec- tion of the tarsus, although this method has given good results. But anyone who has had experience with it will know that an unnecessary amount of bone is sacrificed where this method is relied upon. Forcible correction, combined with division of the shortened soft tissues accessible to the knife, will be found to be a method which in a large majority, even of the most resistant cases, will prove entirely satisfactory. It has the advantage of avoiding any unnecessary sacrifice of bony tissue, and has given excellent results. The accompanying illustrations will serve to show the fact that in cases of the severest type the method is capable of giving satis- factory results without any sacrifice of bony tissue (Figs. 3, 4, 5, 6). This case has already been reported in the Revue d' Orthopedie, March 1, 1892. The foot-imprint represents the ultimate result three years after operation, and shows a sole of a foot entirely flat in walking, which three years before had been of the severest type of deformity, in a woman thirty-five years of age. A lever wrench was used in cor- 1 Transactions of American Surgical Association, 1890, vol. viii. p. 71.