CLUBFOOT (talipes), the name given to deformities of the foot, some of which are congenital, others acquired—the latter being chiefly due to infantile paralysis. Talipes equinus is that form in which the heel does not touch the ground, the child resting on the toes. In talipes varus the foot is turned inwards and short ened, the inner edge of the foot is raised, and the child walks on the outer edge. These two conditions are often combined, the heel being drawn up and the foot twisted inward ; the name given to the twofold deformity is talipes equino-varus. It is the most usual congenital form. In talipes calcaneus the toes are pointed upwards and the foot rests on the heel. This is always an acquired (paralytic) deformity.
The treatment of congenital club-foot, which is almost in variably varus or equino-varus, should be begun as soon as the abnormal condition of the foot is recognized. The nurse should be shown how to twist and coax the foot into the improved position, and should so hold it in her hand many times a day. And thus by daily, or, one might almost say, hourly manipulations, much good may be accomplished without distress to the infant. If after weeks or months of these measures insufficient progress has been made, the subcutaneous division of a tendon or two, or of some tendons and ligaments, may be necessary, the foot being subse quently fixed up in the improved position in plaster of Paris. If these subcutaneous operations also prove disappointing, or if, after their apparently successful employment, the foot constantly relapses into the old position, a more radical procedure will be required. Of the many procedures which have been adopted there is, probably, none equal to that of free transverse incision intro duced by the late Dr. A. M. Phelps, of New York. By this "open method" the surgeon sees exactly what structures are at fault and in need of division—skin, fasciae, tendons, ligaments; everything, in short, which prevented the easy rectification of the deformity. After the operation, the foot is fixed, without any strain, in an over-corrected position, between plaster of Paris splints.
Talipes valgus is very rare as a congenital defect, but is com mon as a result of infantile paralysis, and is apt to be combined with the calcanean variety. "Flat-foot" is sometimes called spurious talipes valgus; it is due to the bony arches of the foot being called upon to support a weight beyond their power. The giving way of the arches may be due to weakness of the muscles, tendons or ligaments—probably of all three. It is often met with in feeble children, and in nurses, waiters, policemen and others whose duties demand much standing. Exercises on tip-toe, espe cially with a skipping rope, massage, rest, and tonic treatment will give relief, and shoes or boots may be supplied with the heel and sole thickened along the inner borders to throw the weight on the strong outer border of the foot. When the flat-footed indi vidual stands, it should be upon the outer borders of his feet, or better still, on tip-toe, as this posture strengthens those muscles of the leg which hold up the bony arches.
For paralytic club-foot, in which distressing corns have devel oped over the unnatural prominences upon which the sufferer has been accustomed to walk, conservative measures are usually dis appointing, and relief may be obtainable only after a Syme's amputation through the ankle-joint.