Treatment of Congenital Club-Foot. ANSEL G. COOK, M.D., HARTFORD, CONN. Henry Ling Taylor in his book on Orthopedic Surgery has concisely expressed the consensus of opinion on Congenital equino-varus, the commonest form of club-foot, and one of the most common congenital deformities. There is, in the form under discussion, no primary defect in the embryo and no paralysis; the foot has simply been shaped or molded to the posture forced upon it by its constricting envelope. The deformity is of all grades from very mild to very severe; when fully developed it presents the following elements: (1) Adduction of the forefoot (varus); (2) inversion of the foot; (3) inward rotation at the ankle; (4) dropping of the forefoot (cavus); (5) dropping of the foot at the ankle. (equinus). The symptoms consist in the deformity and consequent stiffness, lameness and disability. The natural tendency of the affection if uncorrected is to get progressively worse. Treatment consists in first correcting the deformity and second holding the foot in the corrected position till the over-stretched tissues have contracted and the normal muscle balance is restored. This is accomplished by manipulation to abduct and evert the foot and by continuous mechanical pressure against the deformity, made by metalic or plaster of Paris splints. The foot is to be gradually unfolded or remolded by overcoming first the varus element, later the equinus. The foot may be allowed to drop and leverage applied by a splint on the inner side of the foot and leg. The Judson splint, made of a strip of brass with a half band at each end properly padded, and a free band applied to the outer ankle, may be securely strapped to the inner side of the foot and leg by adhesive plaster, and gradually straightened as the foot yields. This may also be done by a plaster of Paris |