Suturing the tendo Achillis in the correction of deformities of the feet / by H. Augustus Wilson.

  • Wilson, H. Augustus (Harry Augustus), 1853-1919.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Suturing the tendo Achillis in the correction of deformities of the feet / by H. Augustus Wilson. 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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    Reprinted from THE INTERNATIONAL MEDICAL MAGAZINE, August, 1893. compliments OF H. AugustusW ilson , M. D. 1611 SPRUCE ST. PHILADELPHIA. SUTURING THE TENDO ACHILLIS IN THE COR- RECTION OF DEFORMITIES OF THE FEET.1 BY H. AUGUSTUS WILSON, M.D., Professor of General and Orthopcedic Surgery in the Philadelphia Polyclinic; Clinical Professor of Orthopaedic Surgery in the Jefferson Medical College and the Woman’s Medical College. Experience has shown that in most of the deformities of the feet that require operative procedures for their correction the tendo Achillis demands section, and not infrequently the lengthening or shortening of that structure only is required. It is clearly apparent that all remedial measures, to be ultimately and progressively efficient, must have for their object not alone removing the appearance of the deformity, by lengthening or shortening of tendons, but it is equally essential that the resulting strength of the tendon must be equal to the demands to be placed upon it. The tendo Achillis communicates to the heel the power required to enable the arch of the foot to maintain the weight of about three times as many pounds as it exerts pounds of force. The leverage of the foot in walking is that of the second order of levers,—that is, where the weight is placed between the power and fulcrum, the power being applied to the pos- terior end of the os calcis, the fulcrum being the distal extremities of the metatarsal bones, while the weight is imposed upon the astragalus. Careful measurements of over a hundred approximately normal feet have resulted in showing that the average comparative distance from the end of the os calcis to the centre of the internal malleolus, and from that point to the end of the distal extremity of the metatarsal bone of the big toe, was as 1 to 3. This adverse position of the weight in its relation to the power and fulcrum necessitates the use of a greater power moving through a small dis- tance to lift weight equal to one-third of the power through a proportionally greater distance. The powerful action of the gastrocnemius and soleus muscles would be less confusing if it could be disassociated from its attachment to the weight it is to lift. Let it therefore be assumed that the upper end or insertion of this muscle is made fast to some immovable body, and then its action in lifting the whole body will be apparent. A force of one unit applied to the