Cases illustrative of the division of tendons / [William Rhind].

  • Rhind, William, active 1818-1867.
Date:
[1841]
Catalogue details

Licence: Public Domain Mark

Credit: Cases illustrative of the division of tendons / [William Rhind]. Source: Wellcome Collection.

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    treme curvature of the feet, the usual instruments of extension could not be applied. I had therefore prepared two long splints with hooks at their extremities, which were applied to the fibular sides of each leg, interposing an air cushion between each. In this way considerable extension was made and persevered in for a few days, until first a modification of the Scarpa shoe was applied, and at last the Scarpa shoes themselves. October 2d. Considerable progress has been made by using the Scarpa shoes during the day, and night shoes of a simpler construc¬ tion, with occasionally the use of the long splints and other appa¬ ratus. On examining the right foot more particularly, ] found that the undivided tibialis posticus is one cause of obstruction to its full ex¬ tension, divided it to-day about half an inch from its insertion in the os navicularis. 16th. Extension of right foot has greatly advanced. In the shoe it appears almost straight, and the sole and heel come down with ease. The patient can walk about tolerably well. The left foot is still considerably curved with great tendency of the whole leg from the knee to turn inwards. This has to be obviated by a splint, which reaches from the knee to the toes, resting upon the edge of the Scar¬ pa shoe, and which is bandaged tightly along the whole leg. Addi¬ tional compression is also applied to the left foot. The diligent use of fomentations and liniments, especially over the thickened inte¬ guments, is also enjoined. The old heels have now become soft, and are rapidly undergoing absorption. November 4th. A pair of common boots have been worn for some days. The right foot is almost perfectly straight with the slight re¬ straint of the boot. The left has still a tendency to turn inwards, but the heel and sole now come to the ground, and the motion of the ankle-joint is greatly more free. 9th. The patient now walks a little through the room ; the arti¬ ficial heels are fast disappearing, and thus the feet are assuming more of the natural symmetry. The fore part of the foot and toes can now be easily kept in a straight position by the simple restraint of a laced boot, but the opposing ligaments and muscles on the out¬ side of the foot and leg have not yet so contracted as to resume their power to retain the foot in its straight position without assistance. Indeed, in consequence of the great relaxation of the peronei mus¬ cles and tendons, as also of the overstretched ligaments of the outer edge of the tarsus, a considerable time must elapse before the proper action of the fore part of the foot is acquired. In the meantime, however, there is a firm footing of the heel, and a motion of the ankle-joint never before enjoyed. Fig. 8 and 9 exhibit the shape and position of the feet at this period. In this case I have already alluded to the inward twist of the leg from the knee downwards. There is an unusual looseness of the articulation of the upper end of the fibula with the tibia, as well as a corresponding looseness and deficiency in size at the inner ankle of the malleolus internus.