The other types of congenital club foot rarely call for operative pro cedures, and yield usually to manipulations, massage and the use of splints when treatment is commenced during the first week of infantile life. Ogston condemns promiscuous tenotomies in ordinary cases of all types and trusts to a plaster of Paris bandage applied after straightening out the deformity under chloroform, but he divides the tendo Achillis after the virus position has been treated for six weeks by the plaster splint, which is then to be applied from the toes to the middle of the thigh.
Acquired club foot or paralytic talipes is nearly always, as its second name implies, the result of infantile or spastic paralysis.
Preventive treatment is of primary importance; since the deformity results from the permanent contracture of the muscles from loss of power in their opponents, much can be done by massage of the weakened muscles and passive movements which will exercise the unopposed muscles and prevent their contracture. But, above all, faulty positions of the foot resulting from the paralysis must be corrected whilst the limb is in the flaccid stage, otherwise permanent shortening not only of the muscles but of the ligaments and fasciae with changes in the bones is certain to occur.
Thus it will be obvious that the early treatment of acquired talipes will be that of the infantile paralysis which causes it. In addition to massage, douching, and passive movements mechanical appliances are required to keep the foot in its normal position when at rest and a boot with irons worn when walking can be attempted. The use of electricity is doubtful. In unskilled hands it may be positively dangerous either by causing over action in paretic muscles, or by acting on sound muscles overstretching the paretic ones.
When the loss of power in the paralysed muscles has become permanent the secondary shortening and deformity must be met by operative measures as tenotomy, division of the plantar fascia, excision of bones, arthrodcsis of the ankle, tarsal and metatarsal joints and transplantation of tendons. By employing the above operative suitable to the indications in each case the deformities of acquired equino-varus, talipes equinus, calcaneus and the other compound types of acquired club foot and pes cavus or claw-foot may be remedied.