Hints on the diagnosis and treatment of club-foot / by Buckminster Brown.

  • Brown, Buckminster, 1819-1891.
Date:
[1879]
Catalogue details

Licence: Public Domain Mark

Credit: Hints on the diagnosis and treatment of club-foot / by Buckminster Brown. 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.

    7/14 (page 5)
    birth is not infrequently the origin of more or less inward inclination of the foot. By the simple means which I have indicated, with modifications in accordance with the exigencies of the case, we can attain a delicacy of diagnosis often of essential service ; we can fix the deficiency upon a certain set of muscles, and often upon a single muscle. In addition to this, or rather previous to the examination, we may note the physiog- nomy, so to speak, of the foot. Whether the deformity is slight or severe, there usually may be observed a certain lack of firmness about the dor- sal aspect; not by any means, however, the relaxed or flaccid appear- ance of a paralyzed member. Ligaments, elongated or shortened, are simply passive elements in the condition of the foot, although often offering obstacles to its restoration. The character of those instances of varus which arise from traumatism or from other similar causes is for the most part easily ascertained. In a case some time since under treatment, an acute inflammation, almost localized in the os cuboides, caused a swelling of that bone and its investments, and produced as perfect a varus in general appearance as any originating in contracted tissue. Such an instance is extremely rare, and perhaps stands by itself in recorded cases. In talipes valgus, whether congenital or non-congenital, the rule in respect to partial or complete loss of power in a muscle or in a set of muscles may be reversed or much modified. There is generally a want of normal vigor. It may be simply a deficiency of nerve influence, which offers no appreciable impediment to the appropriate means of cui'e. In such instances, or even if limited paralysis is present, there is often complete restoration of normal subjection to volition. Two cases occur to my mind where there was partial dislocation of the foot outward, the internal malleolus being displaced inwardly, with extreme flexion, the foot lying against the leg; in neither of these cases was there paralysis. The deformity was removed in early infancy, the child in one instance walking at the age of ten months. Sometimes the cause of a slight eversion may be traced to a single muscle. The tib- ialis anticus alone may be in fault, and the imperfect gait and splay, parrot-toed foot may originate in debility or paralysis of that muscle. If the eversion is more marked the posticus may also be implicated, and if still further advanced the extensor longus pollieis may also have suffered, and still others may be involved. Valgus exists in every grade, from the simple debility or paralysis of a single muscle, with or without contraction of antagonizing muscles, and with a scarcely noticeable lameness, to that in which the internal mal- leolus touches the ground at every step. The peronei, if not originally contracted, in progress of time become shortened, and finally the ex- tensor longus digitorum and tendo-Achillis.