Club foot : its causes, pathology and treatment.

  • Adams, William
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: Club foot : its causes, pathology and treatment. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    cases in his work on club-foot. When a tourniquet had been applied to the femoral artery, a longitudinal incision four inches in length was made over the centre of the tendo Achillis, the integument dissected off, and the fascia divided on a director to the same extent. The tendon was then cut across, and force employed to bend the foot. As this failed, the incision was extended to the os calcis, the cicatrices were divided, and the tendon isolated. Even with this, however, the joint did not yield, and we are told by Sartorius that he employed his whole strength, when the joint, giving way, such a noise and cracking ensued as though the whole of the bones had been broken. The operator was very anxious about the possible consequences, although no fracture was discovered at the time. Symptomatic fever and suppuration followed, but the latter not to any great extent. After nine weeks the wound cicatrized, complete anchylosis of the ankle having resulted. The patient, however, was able to walk easily without a stick. Such was the manner in which talipes equinus was treated sixty-six years ago. The result was more fortunate than might have been looked for, or would generally follow such a procedure. In 1809 Michaelis, of Marburg, in Germany, treated several cases of talipes equinus by partially dividing the tendo Achillis; but it.must be presumed he either ruptured the undi- vided portion, or made complete sections, from his !_having brought the feet at once, as he is reported to have done, into a natural position. In the year 1816 Delpech,* of Montpellier, next suggested an important modification in this operation, viz., the avoiding of direct exposure of the tendon by open-wound. He did not expose the tendon by dissection, but transfixed the limb be- tween the tendo Achillis and the deep muscles with a common scalpel, the wound in the integuments on either side being an inch in length; after introducing a convex-edged bistoury, he divided the tendon from before backwards, taking care to leave the bridge of the skin over the space between the divided ends * Cliirurgie clinique de Montpellier, par le Professor Delpech, Tome i., page 192, Paris et Montpellier, 1823.
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